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Back pain goodbye!

Back pain goodbye - Your gait is that important!

In this article I want to show you how important a holistic view is for the symptomatology of back pain. The trigger for pain is rarely the cause. What is often crucial is how efficient and fluid your movement looks.

"That's how important your gait is to you..."

The Basics

First of all, it is important to understand that the body is three-dimensional and therefore all three dimensions must be considered during training. The three planes are the sagittal, frontal and transverse planes. Using the example of stepping forward with your left leg, this would mean the following: You are creating - flexion in the sagittal plane, which bends your pelvis forward, - adduction in the frontal plane, which shifts the pelvis to the left and the knee inward, and - internal rotation at the left hip joint in the transverse plane, which is caused by the left rotation of the shoulder axis.

The highest goal in functional training is to act in all three planes simultaneously. In addition to considering the three axes of movement, it is also important that you do not ignore gravity. Gravity is an omnipresent law of nature and affects you from top to bottom. Its goal is to make your body "collapse". Your muscles and the structure of your body work against it completely subconsciously even when you are standing. Now let's look again at the step through which you evoke a ground reaction. At the moment of first contact with the ground, various muscle loops in your body switch on, while your entire body is slowed down in its movement. Your upper body falls forward and downward. Gravity and your own movement, in conjunction with the upbeat movement on the floor, force you to flex your hips. This flexion is not caused by an active impulse of your hip flexing muscles, but solely due to physical laws of nature.

In conclusion, this means that gravity should be used as the most important training tool! Especially the control of the hip is a great difficulty for many people. The hip provides the connection between the upper and lower part of your body as well as their connection to each other and is therefore the most important limb. It is outshone by the largest muscle in the body, the gluteus maximus muscle, which means that it can handle high resistance as well as high mobility. As the link between the upper and lower half of the body, it is responsible for building strength as well as power output from the trunk, shoulders, arms and legs. Since most people spend their working day mainly sitting in an office chair and movement is often neglected here, the question arises as to why many gyms bring their clients back into precisely this seated position by means of appropriate training equipment. Rather, the client should learn to control his hip again and use the simplest means for this - such as gravity.

Strapping product image | PAT.fit
Dynamic jump with PATband Strapping

The hip - synergistic movement patterns

In the following, let's take a closer look at the hip in the so-called antagonist model: 

Here it quickly becomes clear that the classic view of muscle functions in our functional world has long been obsolete. The antagonist model, as it is still taught in many training courses, teaches that the leg flexor always acts in opposition to the leg extensor. I see the problem with this approach in the lack of transfer from a sitting or lying position to an upright standing position. For example, if the thigh is trained in a seated position, there are the options of knee extension or knee flexion. In this case, the bilateral muscles actually act in opposite directions. However, the consideration is only in the sagittal plane, that is, with one-third of the possible range of motion. However, I do not consider it very useful or purposeful to train the hip in a lying or sitting position, although there are of course sport-specific exceptions here. 

Let's look at the gait again, which is probably the most important functional exercise: The leg flexor is activated when you step with the heel and prevents you from "collapsing" towards the ground after the step. In addition, it brakes the tilting of the pelvis in the sagittal plane, which you yourself have triggered by this one step forward. Since there are also attachments of this muscle group below the knee, a muscle tension is created. This increased muscle tension in turn pulls your knee backwards, i.e. into extension. The leg flexor (ischiocrural muscle group) thus supports knee extension during gait. From a functional point of view, it is therefore not an antagonist of the leg extensor, but a synergist. 

PATrigger Faszienrolle Trainingsrolle Knieheben 1 | PAT.fit
Gait pattern in functional exercise with PATrigger

For your training or rehab, it is important to integrate these synergistic movement patterns as soon as possible. Since, as mentioned earlier, no exercise is more functional than walking, your training plan should be based primarily on this function. The main criterion for choosing the right exercise is your joint movements. Often exercises such as crunches or supine chest workouts, isolated shoulder exercises or miniband abductions are recommended, but these are more muscle-oriented and thus, in my opinion, classic examples of misunderstood movement ideas for your muscle functions.

Four basic movements in functional training of the hip

Since functional exercises can often be more complex, I always go from simple to difficult. However, simple here in no way means that the exercise can't be strenuous. It just means that the number of loading variables is reduced, and therefore the room for error and the possible number of compensatory movements is smaller. As a coach, this makes it easier to spot imbalances. And it is correspondingly easier to counteract. To help you understand this principle, here are four hip exercises and their respective compensation patterns. 

For these exercises I use the PATrigger I developed. You can find it pictured on the exercise images. However, you can also use similar fascia rollers with a maximum diameter of 10 cm and a width of 35 cm. Before I had the PATrigger at my disposal, I used round cardboard packaging as a training roller. At that time, I shortened them to the appropriate width and used them "for other purposes".

Movement 1

This movement is the first step towards hip dynamics. Its main purpose is to increase the control of the hip in a double-leg parallel stance. The upward movement should be initiated mainly from the hip muscles. The focus is on the sagittal plane: position your training roller at hip level against the wall and lean backwards against it. Stand with your feet hip-width and a little more than a foot's length away from it. Draw your belly button inward toward your spine and open your chest forward and upward. Now lower your hips down as far as possible, close to the wall. Keep your whole foot in contact with the floor. Your gaze remains neutral and directed forward. Exhale as you stand up.

image | PAT.fit
image 1 | PAT.fit

Common compensation patterns:

1. during the standing up movement the knees push inwards - therefore pay attention to the complete foot contact especially with the outer edges. 

2. the gaze is tilted downwards or often the shoulders are pulled forward and upwards. This is where your training roll offers a clue: the more pronounced this compensation, the more often the roll needs to be repositioned. The training roll therefore serves as feedback for a cleanly controlled movement. It also prevents the speed of execution from being too high. The basic rule applies: control comes before speed! The hip joint is moved primarily in the sagittal plane. We prevent frontal or transversal movement in order to minimize compensation possibilities and to be able to devote ourselves completely to the control of a stand-up movement. The joint works mobile in one axis and stable in two axes. We speak here of the so-called "mostability". In this case, movement only takes place in one axis, while the other two remain stable. Mobility and stability are therefore not separable constructs, but must be considered in their constant interaction.

Movement 2

In everyday life, double-legged standing movements with an even weight distribution (as in movement 1) are much rarer than single-legged movements. Therefore, it is important to train the single-legged control of the hip as quickly as possible in training. Again, we use a suitable roller, which you again position at hip level. We now also add an arm movement to increase the control of the torso.
image 2 | PAT.fit
image 3 | PAT.fit

Common compensation patterns:

The knee of the supporting leg is pushed forward too much and the heel loses contact with the ground. Control the exercise even more with the hips to perform the movement more downward and backward.

2. the rear leg shows a lack of mobility either in the toe joints, in the ankle joint or in the knee joint. This exercise is generally a good test of these joints and is therefore always suitable as a re-test after appropriate mobility interventions. Increase the distance to the wall and thus simplify the overall movement by providing more room to move. This is a squat pattern, but in a lunge position. So the requirement here increases in terms of complexity. The main focus is still on flexion and extension. By maximally flexing the back knee, there is a stretch in the back thigh. The movement is controlled by the anterior hip.

Movement 3

In addition to the one-legged hip control, the embedding of the transversal plane takes place here through a counter-rotation of the upper body. The roller is used here as a standardizer. It helps coordinate the arm movement, which can always cause confusion for newcomers to functional training. In a lunge position with the back heel against the wall and the fascia roller between both palms, touch the wall first with the back of the hand, on the side of the back leg. The hip of the front standing leg is in extension. Keep your gaze neutral and your chest open. As you move down, rotate your torso over your front leg until the back of your other hand touches the wall. The knee of the back leg touches the floor.
image 4 | PAT.fit
image 6 | PAT.fit

Common compensation patterns:

Due to the additional upper body rotation, it can lead to a stronger evasion of the knee with somewhat movement-restricted clients in the area of the hip and/or spinal column. Here, the degree of rotation can be minimized with a clearer focus on working with foot contact. The lifting of the front heel can also be observed. This is where a slower controlled downward movement (no "dropping") often helps. This is the last exercise we do before a true lunge to control the hip. The focus is on the impact that an upper body movement can have on the pelvis. There should be a clearly identifiable and delayed rotation of the upper body to the pelvis. That is, the upper body rotates with the shoulder axis toward the wall before a rotation of the pelvic axis becomes apparent. If the knee rotates equally with the pelvis, this is an indication of a lack of internal rotation of the hip.

Movement 4

In the last and most complex exercise, a shift of weight occurs through a step. From a low position, with the back heel touching the wall, a step forward is taken. During this rising movement, the fascia roll moves from one side of the hip to the other. It rests on the hip side of the standing leg in the standing position, with the chest open upwards and the front hip extended.

image 7 | PAT.fit
image 6 | PAT.fit

Common compensation patterns:

1. the standing-up movement is not carried out until the standing leg is fully extended in the knee and hip. This hip extension is trained and automated with continuous practice of the movement pattern through consciously controlled tensioning of the buttocks. Attention should also be paid to stretching and opening the chest. The use of targeted tension on the trunk area is indispensable. 

When stepping backwards from the standing position towards the wall (lowering movement), the focus is on the ability to decelerate the movement downwards. Deceleration is through the hip of the stance leg and not through leaning the back leg into the wall or even bracing against the floor. These patterns can be observed with a lack of hip control. It helps to vary downward with decreased distance from the wall or even non-maximal flexion.

Conclusion

These four movements serve as a way to automate complex patterns of hip activation progressively, i.e. with increasing number of degrees of freedom. The more fluidly and simply these movements are performed, the better the activation of the muscles surrounding the hips. I also like to use these movements in a leg workout before moving on to more dynamic patterns with multiple steps and jumps or even movements with higher external weight. In a rehab or also as a preventive measure for a fine coordination and improved control of the hip, these movements have already proven themselves. I am happy if these exercises find a place in your training from now on. Feel free to send me feedback with your experiences.

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Patrick

Functional Therapist, Head of PAT.fit

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