Neuromuscular exercise for Patellofemoral Stress Syndrome- Bosch Overhead Reach Drill

The boys like to watch the pelvis wiggle, but the knees don't like it very much.  Upon foot contact in running/jumping, the pelvis goes too deep into the frontal plane, presenting in contralateral rotation.  Ideally, the ilia should be at least level, or optimally the fee pelvis a bit higher.  When the ipsilateral ilium is higher, it contributes to excessive knee abduction/internal rotation at ground contact.

This is one of the exercises I use to enhance pelvic stiffness in athletes presenting with patellofemoral stress syndrome.  I do it a bit different than Frans does. BTW, Frans does not use this as a rehabilitation exercise, he uses it as a neuromuscular drill to enhance sprint mechanics.  I'll have the athlete take a big step forward onto the affected leg, punch the non weight bearing ilium and hand to the ceiling, then step backwards with that same leg and return to the starting position for 3 sets of 10 reps.  I begin with the athlete holding a crutch overhead, then build up to a weighted bar.

I know horizontal training ("clam shell" exercise etc) is popular for developing pelvic & core stability, but as I've articulated many times on this blog, it has little carryover to upright function.

Sahrmann vs. Lederman

I listened to a recent webcast from Dr. Shirley Sahrmann in which she says a if you can't recruit a specific muscle under a controlled condition, there is little chance it will be beneficial in an integrated manner.  If you read her "movement impairment syndromes" book, a lot of open chain strengthening done on-table with alot of grooving movement patterns to get that muscle working in the real world sort of speak.
Dr. Eyal Lederman, on page 10 of his "Neuromuscular Rehabilitation in Manual & Physical Therapies" he says, "There are several misconceptions about motor control which are likely to make rehabilitation unnecessarily long and complex.  They all originate from the principle of "isolate in order to integrate".  The muscle is NEVER the goal of the movement.  Focusing on tensing, clenching, bracing, or holding specific muscles during movement turns them into the goal of the movement.  Muscles work in complex synergies- they never work alone.  All muscles are equally important, even muscles that are silent.  Muscles which are slow or at low EMG activity are part of the whole control pattern."

Sahrmann's approach is very much, "isolate to integrate".

In her excellent text, "Diagnosis & Treatment of Movement Impairment Syndromes", for the most part she uses very isolated corrective muscle work. On page 32 she says, "the desired muscle action should be practiced under the specific conditions in which it is to be used."

Comments?

3 weeks out, from 1 to 5

Not a single ROM exercise.  I focused in where the PCA led me.  Its interesting how symptoms resolve before the the SICK scapula totally corrects.

PFSS Rehab





Hip hikes, stagger squats with double arm reaches at ankle height, and lateral mini band walks.  Here I'm unloading the quads a bit to minimize patellofemoral compression.  Focusing on the pelvic engine. 

Fire Puxatony Phil

              Ahhhh, springtime in New Jersey.



On ground function carryover to upright

Don't be afraid to go to the ground if you think you can get something out of it that can facilitate upright function.  This athlete is using a traditional bridge with a L/R bilateral upper extremity, in sync (arms moving in the same direction) rotational reach.  Real important to keep the elbows locked straight and hands together.  He's using it as a remedial exercise to improve his ability to rack the olympic bar to his shoulders (ie front squat position).  His glenohumeral flexibility is actually not bad, its his thoracic spine and rib cage that have the motion restrictions.  Restrictions of the costovertebral/costosternal joints are commonly created when heavy bench press exercise is overused.  These restrictions are often overlooked as a culprit in shoulder dysfunction.

It has nothing to do with lactic acid

"Unraveling the neurophysiology of muscle fatigue", Enoka et al; JEK 3-11.

The authors don't have all the answers, but basically fatigue is the brain's way of protecting the body from injury.