In Part I of this series I talked about the necessity of working core stability to protect the lumbar spine from excessive mobility. I also discussed the initial progressions in supine and quadruped to avoid excessive loading of the spine and to decrease the resistance of gravity.(1)
Standing -- squat stance to split/lunge stance (we will get to these in Part IV)
In the tall kneeling position, the hips are in a symmetrical position, similar to when on the feet performing a squat or dead lift movement. Start with tall kneeling to take the ankles and knees out of the equation to force more stability through the core.
The athlete first extends the arm away from the resistance then presses down with the other arm to finish the move. Work in the opposite fashion to return to the starting position.
When initially teaching the exercise, it is a good idea to place your hand on the athlete's head throughout the set. It's a great tactile cue to keep them "tall". If their head or trunk drops, they know instantly. Maintaining the "tall"posture increases recruitment in addition to staying in a neutral position. (2)
The beauty of this exercise is that the athlete must resist motion in all three planes. Flexion is resisted by staying tall especially during the press down. Rotation and lateral flexion are also resisted due to the PNF diagonal nature of the movement.
Everything remains the same in regards to posture. The first move is extension of the away upper extremity followed by a lift/punch up the closer upper extremity. Again the goal is to resist motion in all three planes but there is more resistance to extension versus flexion with the lift.
The athlete must continue to maintain the "tall" posture. The rear glute is contracted to place the hip flexor group on stretch and take them out of a position to stabilize (especially the rectus femoris). Note that the knee closest to the source of resistance is up to stay out of the way of the bar or band. This hip should be at 90 degrees.
In this case, the athlete's knee away from the resistance is up. Increasing core stability requirements with ½ kneeling chops and lifts is achieved by narrowing the base of support.
One thing to watch with chops and lifts: how is the athlete/patient breathing? It should be diaphragmatic all the way. They should be relaxed through the neck and upper traps. It they are unable or breathing becomes apical, then resistance should be reduced or they should be taken back a step. Proper breathing is critical to core function, specifically the inner core (diaphragm, pelvic floor, TA, and multifidi). When other larger muscles begin to take over then the body is using compensatory strategies to stabilize the spine.
A quick note here on changing positions. The idea of differing patterns of core recruitment with different positions, i.e tall kneeling, ½ kneeling, squat stance, lunge stance, was proposed by Vladamir Janda in his discussions of "sensorimotor training". The idea being that increasing afferent input can facilitate reflexive stabilization of the muscles of the hip and core. Sensorimotor training has been proven to improve proprioception, strength, and postural stability in ankle instability (3), knee instability (4), and after ACL reconstruction (5).
In Part IV, I will discuss standing chops and lifts using varying foot positions as well as a few other exercises that can be adapted to sports specific or work specific activities.
Bibliography
1. Callaghan JP, Gunning JL, and McGill SM. Relationship between lumbar spine load and muscle activity during extensor exercises. Physical Therapy, 78 (1): 8-18. 1998.
2. Cook, Gray. Introduction to the chop and lift. Balanced Body Series. 2006.
3. Freeman MA, Dean MR, Hanham IW. 1965. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 47(4):678-85.
4. Ihara H, Nakayama A. 1986. Dynamic joint control training for knee ligament injuries. Am J Sports Med. 14:309.
5. Pavlu D, Novosadova K. 2001. Contribution to the objectivization of the method of sensorimotor training stimulation according to Janda and Vavrova with regard to evidence-based-practice. Rehabil Phys Med. 8(4):178-181.
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