Why Practice Yoga?

Life is a journey and Yoga practice is one of the best friends to have with you on that journey! It doesn’t matter where you are, it doesn’t matter who you are. Yoga can be your companion.

We have all heard that the journey of a thousand miles begins with a single step. Yet many of us resist taking steps, making choices and working to change. Yoga can be designed to help you understand the steps to achieving an enriched life. That journey can start today! What better a time than at the end of a year, with the concept that the new and better is just around the corner.

Because it does not matter how big that step is, it does not matter if you fall over with that first or any other step, it just matters that you took it. Always remember that life can be more exciting and joyful when it is approached as an exciting discovery rather than a chore and a problem to solve.

The difference between these approaches is simple; it’s a choice. Even though many of our actions happen unconsciously, we still have a strong capacity to choose our actions.

And, we must never lose sight of the fact that it is our actions that determine who we are, not our thoughts or even our words.

So, that’s my approach to Yoga. I believe it can be used to give you the tools to understand how to change, to understand what to change, to understand why to change, and finally the practice will support you taking action.

First, we need to explore and accept that our mind state WILL influence our actions. So, we before we take action we need examine some of our mind processes. This introspection can take a healthy approach filled with curiosity, mindfulness and determination. It doesn’t have to be heavy! Buddha has some fine ideas, here’s one.

All that we are is the result of what we have thought. The mind is everything. What we think we become. Buddha

It might be difficult to separate and look at our thoughts, and, it can also be difficult to look at our actions in life. But don’t worry, we just start any way we can! A good place to start is to become introspective and curious about our human life. Being entertained by your way of being is much more useful than becoming obsessed with your perceived flaws!

This process of YOGA then is all about discovering!! One a deeper level it’s not about being flexible, or strong, or putting your foot on your head! It’s not really about making shapes – though we have a physical form to look after and develop. It’s about discovery and awareness.

Starting with the physical body is really useful though. Asana is a great and practical tool to use. Why? We all walk/move around living in a physical body but most of us spend little time truly examining our physicality. Real contentment, real health can only be accessed when we can manage and understand our body and this can only happen when we develop awareness not of just our physical state but our thinking body as well. So step one is really a two part process, deliberate, mindful physical practice to quiet the body and mental practices to develop insight.

Asana is the tool, meditation is the task.

There are many ways to approach mindful awareness. We can start with what we observe (but often we can’t observe, we just get carried along with our thoughts like a leaf in a river) or we can try to repeat a deliberate mantra and notice the associated thoughts that arise.

Repeating the same mantra for a long, long time (like months or years!) can be a great means to developing deeper insight into how we think. Here are two to get you started, but making up your own is awesome. Just find some statement that you can sit with, something that holds your attention. I am a scientist so I like the cell one. But it doesn’t matter!

  1. I am a universe of cells; I am a cell in a universe.
  2. My thoughts influence my words, my words influence my actions and my actions influence my experience. My experience is my reality.

Asana can be really helpful to use as the position you use while you contemplate. It is like mixing Zen meditation into Yoga asana.                                                                                                            

You could try Child’s Pose. Here is a mindful approach you might like to try. 

  • Start with head down, eyes closed – it sets the scene for introspection, leaving the world of interaction with others, and lets you venture into sensing your own physical and mental body.
  • Yoga practice is an individual practice – we practice in a group for support NOT comparison, child’s pose allows you to become internally focused and begin the concentration required to learn about yourself.
  • Close the eyes – the dominant human sense is our vision – it connects us with the outside world. Our open eyes are ALWAYS checking for danger and sending a non-stop flow of stimulus to our brain. With closed eyes we can free up brain space and use it to explore and examine our physical body.
  • Having our bodies dropped on the mat symbolises dropping our attitudes and expectations. We can also drop our tension and muscle contractions and feel the body without using muscular effort.
  • Hence pose of the child becomes a restorative pose and can be used at any stage in a yoga class to relax, restore and recover.
  • This is a great position to focus on the breath and observe it travel in and out of the body. The movement of the ribcage can be easily noted along with a beginning understanding of how the abdominal muscles assist in active out breathing. The quality of the breath – its length, depth, speed and smoothness can be felt and the beginning of breath control explored.
  • Once you have breath awareness and are in your body, start repeating your mantra until you see it! Until you develop a bigger picture of that statement. Find out where it leads you. Let it simmer and develop.

Your mind is a garden and your thoughts are seeds

Are you growing flowers or are you planting weeds.

So the mantra idea is designed to plant seeds of understanding and knowledge. Try it out, give it a go. It’s been used for centuries across multiple continents and cultures. Something that old MUST be worth a go. Then come and train with me! I have lots to offer as a Yoga teacher trainer 🙂

Touch or not – Assisting in Yoga

Recently, I gently eased someones head into neutral in my yoga class and they responded by saying ‘be careful my neck is broken!!’ So, once again I was reminded of why I do so little touching these days. The dilemma of seeing students with poor technique often makes me4294-1TPsim SzTonedI want to immediately rush over and correct them, yet I have often pondered if that is the best path to take.

Lately I have been debating once again whether I should touch students in large Yoga classes. I wonder whether I should stay on the stage and demonstrate or wander the room.

I do not know my students individually and always vacillate between whether touch is ‘implied’ or not. I always ask my class to be responsible for their injuries and seek knowledge of self management. I always say that a general yoga class is not an injury management system and that I am not there to look after injuries. Yet, still many students wait till after class to say that they have injuries etc. and yet still allow assists.  know-thyself-layout-for-slicing_03

As well, the only injuries I have ever had in my own yoga practice have happened when being assisted. Both times an instructor moved my body in such a way that I immediately had pain. Both these were experienced instructors and I am sure their intentions were good. Both times the instructor was attempting to move me just a little more into what they thought was a better pose.

I often contemplate if there is a BEST way to learn yoga, and is it through self experience or guided? In a classroom, do we get our students too reliant upon the instructor manually supporting and teaching them? Do we take them ‘out’ of their body when we approach? How many times does a student fall when you walk by? Could it be better to let them explore the process with minimal interference? How can we best  teach the discipline of self practice?4323-4_Fotor_Collage 5_YOGA DISCIPLINE Why do we assist then? I am not going to discuss all the points below but they all are worthy of much reflection.

  1. Correct alignment
  2. Offer modifications
  3. Regress the pose
  4. Deepen the pose
  5. Support the student
  6. Encourage the breath

If our goal is to correct alignment we  must  be diligent in our learning of anatomy. Yet because Yoga teacher training encompasses such a broad amount of knowledge, and as a teacher we seek to become experts in so many areas, our working knowledge of anatomy appears to become a copy of others.

Many of the cues I hear in classes are the same, as if as instructors we have learnt a script and just repeat it. Furthermore, many of these common cues are not really anatomically safe. And then, we add a touch cue, actually moving the joints and bodies of our students! We then unfortunately end up over emphasising poor technique.

One common cue that I hear in nearly every class I attend that does not make anatomical sense is keep the shoulders back and down, pull them into the spine in dog pose, or in poses when the arms are above head in moves such as chair pose. Let the shoulder blades move up  the sides of the ribcage when in shoulder flexion,SupraspinatusBack- socketRotation do not keep the shoulders back and down or you will risk impingidownloadng the shoulder. I know we have to cue but adding a touch to the words is imprinting the movement even more into their brain. So, when we walk around and draw peoples shoulder blades down their back we are teaching their brain the wrong movement pattern. The scapula has to move up to allow room for the top of the humerus.

I appreciate that learning anatomy is a difficult and long journey. However, in reality the prime tool that we work in asana practice is the skeleton. The journey into understanding how joints move and what is normal range of movement is therefore essential.

When I first started yoga I did not know that it is not normal to put your hands on the floor in a forward bhamstringsend. Now I know that fingertips yes but hands no. I now know that also, it is probably better to not focus on hamstring stretching in standing forward bends. In this position there is the added stress on the discs of the back.

This makes the touch cue of placing your hand on the sacrum and sweeping the spine down to the floor as risky and possibly causing more harm than good.

When we offer modifications to our poses it is usually because of a perceived limited range of movement. However, to do many common Yoga poses you actually need excessively long muscles. And, when muscles are long we need extra strength. It has been a long journey learning what is normal and knowing when I should resist from moving someone further into a position and possibly weakening them.

If our understanding of anatomy is still in its early days (or even if we have plenty of knowledge) it maybe better if as instructors we didn’t walk around correcting our students as much but rather demonstrated good alignment and become a visual role model for our students. When we walk around the room we also teach the beginner students eyes to wander to see what they have to do (as they must).

When the student is forced to look around we are actually encouraging them to observe others in the class which will immediately bring in an element of comparison. The student will notice all the more flexible students and often see them as being the normal ones. If the teacher is the role model we can encourage the student to have only two focus points, their own body and one person’s demonstrations.

When I resist walking around the room I am better able to teach them a meditative, reflective and introspective practice. From there they can teach themselves the art of yoga.

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Yoga – 10 Safety Tips

Adding yoga to your routine is such a good idea – but you need to be really aware of your body, its limitations, strengths and weaknesses. All exercise creates stress on the body and yoga is no different. Injuries occur.

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Yoga Diversity

In Yoga we put our bodies into really unusual positions, challenging the joints and muscles in a different way to typical Western forms of exercise.

The ‘stretching’ component of Yoga needs great a awareness of the skeleton, joints, ligaments and normal range of movement. It doesn’t help that many yoga poses require excessive flexibility and that as instructors we often forget that what feels normal to us is possibly extreme for many participants.

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Protect your back – extreme movement is NOT a good idea if health alone is your goal.

One of the most frequent  comments that I have received over the years is, ‘I am not flexible enough to do yoga”!

The standing yoga poses are compound, complex and loaded full body movement. Hence risk of injury is high. Furthermore, common alignment techniques may not work for your posture patterns.

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Extended Side Angle

Group classes are challenging and require you to know quite a bit before you enter them. Most classes are mixed level with practitioners with between 1 day and more than 10 years practice. The instructor is really challenged when attempting to deal with such a broad range of experience levels and body types.

My Top 10 Tips:

  1. Take responsibility for your body – the instructor is a guide, you have the capacity to know your body the best.
  2. Go to a specialist and get expert advice if you carry injuries, the general yoga class is NOT the place to try to deal with injuries.

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    The shoulder is one of the most commonly injured joints

  3. Book in for a one on one yoga session, lean the asanas slowly and with attention to detail before you enter either a fast or a heated class
  4. Google the skeleton and REALLY get to know how your joints move.
  5. Leave your ego at the door, try not to compete with yourself or anyone else in the room.
  6. Work from the foundation of each pose.
  7. Maintain control and internal focus.
  8. Breathing should not be laboured, stressful or held.
  9. Learn and USE the modifications.
  10. The goal is healthy movement – DO NOT OVERSTRETCH.

My top tips to being a better Personal Trainer

I have been a PT since about 1991 and boy have I learned a lot. It is kind of amazing that i have had several clients for well over 20 years! Even when I have made many dumb decisions and used exercises and program ideas that were well, a waste of time. When I started out as a PT I felt that I knew very little (and i was right). This made me look to others for ideas, support and methods. The problem of course is that the other trainers didn’t know what the were doing either, they just were able to exude confidence and convince me – so I copied many a bad idea! So this is a little of what I have learnt along the way.Image

1.   Supervise the warm up – Don’t get your clients to warm up themselves for four reasons.1. Most clients don’t know how to warm up properly, at least initially, l think we should educate our clients on WHAT they are doing and HOW they should be feeling. 2. I want to watch them move as they warm up, this is where I assess posture, mobility and control. 3.  During this time I also get to ask all the important questions about what exercise they have done and how they are feeling. 4. Finally, (sometimes) I can shift their mood state and get them excited about the exercise to follow. 
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2.   Plan your session but be ready for a TOTAL change. I used to follow my program and was often caught short when clients were a little under the weather, tired or had suddenly had a strong workout that day!. Now it is during the warm up that I formalise my session and outline it to the client. Know how to regress EVERY exercise you use and when you regress or modify do it in a way that doesn’t give a feeling of failure to the client (this is hard).

3.   Use a tool to check perceived rate of exertion. But teach it – really explain what efImagefort feels like until the scale you are using has meaning.Look at the client as well and recognize the under rater ( says 8 but could sing a song) and the over rater (that says 8 but is struggling with technique). Remember you are the professional so take control of the intensity. Use a rating scale for technique as well, especially when performing rehab or for clients that only assess their workout by how hard it is.

4.   Congratulate technique more than intensity. If we always praise ‘intensity’ the client will feel inadequate on the days you give technique specifics or even new exercises. Avoid saying perfect and awesome because it gives you nowhere to go when you need to improve technique.
5.   Sell the exercises you are doing – and to do that you gotta know both your exercises and your anatomy inside out. This is what makes the PT professional and not just a motivator. This is what keeps you clients coming back.
6.   Demonstrations MUST be awesome. Watch yourself, video yourself, find peers that you respect to give you honest feedback about how you look when you move.You got to walk the walk, its part of the job.

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7.   Know what are dangerous exercises – DO NOT follow the crowd. Learn something about how technique is related to injury everyday and NOT from GOOGLE!!! Simple things are important, no small arm circles at a horizontal level, no wide star jumps to warm up, knees inline with toes on step ups etc etc etc (more coming on this one). Use safe technique not athletes techniques, remember their goal is to win a medal – our goal is health.

8.   Watch your clients closely, eventually your eyes will become SO quick you will see the technique flaw before it happens.Image
Spot with respect, DO NOT touch the abdominals to see if they are engaged unless you are doing rehab and the ALWAYS ask permission. Humans are the only mammal that exposes the vulnerable belly repeatedly when we communicate. The abdominal area is a place of fear and anxiety in many. Get your clients to touch YOUR abdominals to show what TVA activity and bracing is.
9.   Don’t do flexion exercises at the end of session, and, that includes, crunches, sit ups, bicycles etc etc. You will leave the nervous system with a memory of round shoulders, thoracic flexion and a forward carrying head. Leave your clients with an open chest, lengthened spine and retracted shoulder blades so they feel energised and good.Image

10.   Identify and constantly assess your clients posture so that the stretches you give at the end are specific, corrective and designed to improve how they move after they leave.

11.   Learn from your mistakes – we all make them.Image 

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Preparation – It just makes sense.

Preparation - It just makes sense.

Spectacular achievement is always preceded by unspectacular preparation.
Robert H. Schuller
It takes time to get the results you want. Body work is no different. Many people give up just before they get to feel and see their success. Don’t sell yourself short, keep going. Each day of work will add up. The future is coming anyway, so we may as well be prepared for it. Inch by inch, step by step get to know yourself; your thoughts, your body, your way of moving. Without introspection and analysis life just passes us by and the changes we experience in our body as we age will not lead us to physical health. We all want to have ‘it’ ‘now’ and it sounds good but life doesn’t work that way. Develop the ability to wait, with effort, with focus and with a step by step to do list. It might not sound fun now but what other choice do you have?

A skeptics approach to Pilates

clairenorgate

When I first was asked to teach Pilates I was  definitely not interested in it. To me lying on the ground performing body weight, isolated exercises appeared boring and I couldn’t really see the benefit. I thought that all the core training I needed would happen in my other exercise programs.

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As a fitness instructor I saw the high intensity classes as being results oriented and thought those people lying on the floor were, well, wasting their time! I like a workout that is challenging and intense and i didn’t see that Pilates was that. How wrong was I, the challenge is there, it just lies in a different focus – body awareness.

Can you squeeze your biceps? Tighten just one gluteal muscle? Draw in your TVA? Isolate your pelvic floor? And, how sure are you of your BEST posture to use in daily life and when exercising? Pilates is…

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A skeptics approach to Pilates

When I first was asked to teach Pilates I was  definitely not interested in it. To me lying on the ground performing body weight, isolated exercises appeared boring and I couldn’t really see the benefit. I thought that all the core training I needed would happen in my other exercise programs.

4468-TPAd.viv

As a fitness instructor I saw the high intensity classes as being results oriented and thought those people lying on the floor were, well, wasting their time! I like a workout that is challenging and intense and i didn’t see that Pilates was that. How wrong was I, the challenge is there, it just lies in a different focus – body awareness.

Can you squeeze your biceps? Tighten just one gluteal muscle? Draw in your TVA? Isolate your pelvic floor? And, how sure are you of your BEST posture to use in daily life and when exercising? Pilates is so much more than a core workout, and, isolation in exercise so much more important than I had initially been trained to consider.

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Today of course ‘core’ training and stability work is more fashionable and as instructors we now acknowledge the importance of technique when training, but, I still see most trainers not really ‘getting’ how to correct the subtle movement problems their clients exhibit.

I am glad I persisted in trying to understand Pilates though as it has been the SINGLE best training I have done that improved my skill as a PT. It helped me learn to look at posture in a different way. It has also given me a wider range of tools to use when correcting my clients posture.

But even in the Pilates world not all programs have the same emphasis. I have attended several training’s and I have to admit that not all were that helpful.

However, the PRINCIPLES of movement are really interesting and useful. I discovered that applying the principles requires major focus and gives amazing long term results.

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I credit my Pilates (and yoga) practice with holding my skeleton together and allowing me a deeper insight into HOW my body works. And you can only manage what you know.

Pilates is NOT a fat burning workout that some people believe.

Pilates is NOT a substitute for strength training.

Pilates is NOT a flexibility program and is NOT a calorie burning class.

BUT it has a place that can not be underestimated. Pilates provides postural correction as a method of injury prevention.

I encourage you not to dismiss this method and try it. I have several youtube videos htps://www.youtube.com/user/YogaAerobicsPilates designed to teach some of the Pilates principles and more will be coming. Give it a go for your self. Contact me for Pilates training, you wont be sorry.

Specialise or generalise which works best for you?

What’s your story? All through my career I have been told to specialize, find a niche market, clarify the point of difference etc, etc. However, I couldn’t do it, you see I just kind of like variety!

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I could never find the ONE thing I wanted to specialize in, so I tried many. And, that has proven to be an awesome choice. Now my mind is full of so many different ways of viewing movement, health and exercise that I have multiple answers to the same question.

I truly believe that each person is unique and to attempt to find the single solution will limit them long term.

It seems to me that finding a point of difference is a ‘MARKETING” not a health strategy. Everyone is trying to sell their product and in doing so subtly suggests that other products are inferior.

Research doesn’t always help, the researcher (people with their own opinions) perform studies looking for pre determined answers to their problems. Remember, if you only have a hammer all problems resemble a nail.

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The Strength coaches will be tempted to see every problem as needing strength, the Yogi see the problem as needing introspection, the Pilates instructor sees physical problems from a musculoskeletal basis etc. There is no ONE best way in the field of health. If you meet someone who says ‘I know the BEST/ONLY way to do’, well – anything, keep a healthy dose of both skepticism and respect. Respect for the knowledge they have that may be incredibly useful, but skepticism that they could possibly know it all.

 

 

The BEST three exercises for ALL lower back pain.

Did you know that between 7 and 8 out of 10 people experience back pain at some stage in their life! That makes it the most common form of musculoskeletal pain. And, approximately 10% of those will be significantly disabled as a result. Non – specific cause is the most likely diagnosis for lower back pain (roughly 80%) and a further 10-15% are associated with disc pain. Non-specific usually is related to poor posture and there’s heaps of useful things that you can do. Check my youtube clairenorgate.com for short videos or my website for further training.

Read on for some simple and useful things you can do, and, some simple exercises that can make a big impact.

First of all – GET OFF YOUR BUTT! As much as you can stand up. Research just keeps revealing the poor health associated with sitting down.  Try getting a stand up desk. Be an office trend setter, you wont regret it.

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Since most of our pain comes from poor use, sitting down all day can only make your posture worse. Keeping good posture is important, takes practice and requires a combination of coordination, stability, and mobility.

These three exercises I am giving you today are designed to retrain the brain so that it knows where good posture is. These exercises are designed to change the way the bones are held and help your muscles work correctly as a team. It’s interesting to know pain in our lower back comes not just FROM the lower back but from the whole body! Head placement, shoulder position and even knee shape all influence how we use our lower back.

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These first three exercises can be done by anyone – Stay away from crunches and traditional ‘gym’ based abdominal exercises – they may just aggravate your problem. Stay away from exercises that instruct you to push your lower back into the ground. These old school techniques are going to cause more harm than good.

These three exercises are good because the

  1. The lower back part of the spine is kept still as the exercises are performed.  
  2. These exercises are performed in a neutral lower back shape.

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These are called stability exercises and it doesn’t matter what caused your problem. When performed in NEUTRAL the lower back is being held in a safe position.

So, before you begin the exercises you need to know WHAT neutral spine is. Neutral spine is a position where the joints of the spine are in the optimal alignment. (Neutral is a small lower back curve as demonstrated in the picture above). That way the forces of movement can be directed through the center of a joint and keep it protected. Also, the muscles around the joints will work in harmony – none too much and none too little.

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Exercise 1 – Supine Lying – Leg lifting

SET UP

  • Lie on back
  • Knees bent, feet parallel and flat
  • Have neutral pelvis, rib cage and neck
  • Relax shoulders and across chest
  • Gently pull abdominal muscles in as if putting on tight jeans (don’t suck in the belly though)

Level 1 EXERCISE 1 (Is the set up – just lying there)

  • Maintain neutral spine
  • Aim to breathe in and out without moving the belly – keep it still and contracted
  • Work on increasing breath length without moving belly
  • Aim for 3 seconds on inhalation and 3 seconds on exhalation

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  • This is a static exercise – the holding of the leg in neutral as you breathe  is the exercise

 Level 2 Exercise 1

  • Breathe in to prepare
  • Breathe out, maintaining neutral; lift one leg into table top position, without losing neutral or abdominal muscles bulging or doming
  • Keep abdominals activated as lifting, holding and lowering 
  • Hold knee and hip flexed to 900
  • Hold for 3 – 5 breaths (beginner – increase to 8 -10 breaths over time)
  • Breathe out as you lower leg

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Level 3 Exercise 1

  • Breathe in to prepare
  • Breathe out, lift one leg into table top position
  • Hold knee and hip flexed to 900
  • Breathe in to prepare
  • Without changing body position breathe out and lift other leg into table top position (maintain neutral pelvis and rib cage)
  • Legs can be hip width apart or knees and feet together
  • Hold for 3 – 5 breaths
  • Breathe out as you lower one leg
  • Breathe out as you lower other leg
  • Repeat lifting opposite side first 

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EXERCISE 2 – Four Point Kneeling

 Level 1 is the Set up – learn to hold and breathe.

  • Position in four point kneeling
  • Place hands under shoulders
  • Place knees under hips, feet directly in line with knees
  • Maintain neutral head, rib cage, lumbar spine and pelvis
  • Unlock elbows
  • Engage core by gently drawing navel to spine
  • Maintain lateral thoracic breathing

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Level 2 – Either lift the leg or keep on ground as you extend it

  • Breathe in to prepare and engage core
  • Breathe out to lengthen and extend leg at the hip
  • Only lift as high as neutral can be maintained
  • Maintain soft elbows and head/neck alignment
  • Perform 8-10 repetitions on each leg then attempt 8 – 10 alternating legs without moving torso
  • Avoid shifting hips from side to side when alternating leg lifting
  • Keep weight evenly placed over palm and hands

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Exercise 3 – Prone Upper back Extension

Level 1 is set up – Learn to hold and breathe

  • Lie on front, pelvis, rib cage, shoulders and neck in neutral
  • Legs extended, feet and buttocks relaxed
  • Gently pull abdominals into body
  • Maintaining breathing without relaxing abdominals
  • Breathe in to prepare, maintaining alignment

Head can be lifted from the floor – set up is a working position

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Level 2 Exercise – Head and upper body lifting (this is a small movement – there should be NO pain in the lower back)

  • Breathe out, gently lengthen thoracic spine and neck to lift upper back from the floor (minimal movement)
  • Keep arms resting on floor, do not push through them to gain height
  • Maintain neck/head alignment as lifting
  • Extend only as high as strength and mobility allow with no pressure on abdomen and no shortening of lumbar spine (no hyperextension)
  • Breathe in to return to the floor – avoid pressing into the floor 

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These exercises are safe and effective.

Stop if in any pain and always eek medical help if pain persists or you feel any nerve/radiating pain through legs and buttocks.

Do be confident though that you CAN learn to manage you body and keep it feeling surprisingly good.

Let me know how you progress and read Part 2 on flexibility to assist your back pain.

Scapula Stabilisation

Scapular Stabilizing Muscles: Rehabilitation Protocol Considerations
• Why is the scapula important? Normal shoulder motion involves a coordinated rhythm between movement of the shoulder blade on the chest wall and movement of the ball in the shoulder socket. This is called the “scapulohumeral rhythm.” Because the shoulder socket is part of the scapula, many conditions involving the shoulder joint cause secondary problems related to scapular motion and position. These secondary problems can, in turn, worsen the primary condition.
• What is scapular dyskinesia?: This term refers to abnormalities in the rhythm of movement between the shoulder blade and ball and socket joint. It often goes unrecognized in the treatment of shoulder conditions such as impingement syndrome, rotator cuff tendinosis and shoulder instability. It may result from fatigue of the shoulder girdle muscles, pain-mediated muscle inhibition or stiffness about the shoulder joint.
• Why is scapular dyskinesia important?: The scapula functions to provide a stable foundation through which energy can be transferred from the legs and trunk to the arm and hand. This linkage is called the kinetic chain. Scapular dyskinesia may result in ineffective energy transfer, placing added stress on the tissues around the shoulder which must compensate for a weak link in the chain. This added stress may result in further muscle fatigue and tissue injury about the shoulder. Restoring a stable scapular base is essential to rehabilitating the shoulder and returning to functional activities.

The position and movement of the scapula on the chest also controls the orientation of the shoulder socket relative to the ball and the orientation of the acromion bone relative to the rotator cuff tendons. Any abnormality of the scapular position therefore results in secondary effects on the function of the shoulder joint. For instance, if the scapula tilts anteriorly and laterally, the space available for the rotator cuff may be narrowed, resulting in tendon abrasion and injury.

• What is scapular stabilization?: Scapular stabilization refers to a set of exercises that strengthen the shoulder girdle muscles to restore normal scapular motion and correct dyskinesia. These exercises also aim to facilitate energy transfer through the kinetic chain. An essential part of rehabilitating the kinetic chain therefore involves exercises that transfer energy from the trunk to the arm.

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• Which muscles are involved in scapular stabilization?: The two most important muscles are the trapeziusImage

and serratus anterior

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because these have the most influence on the position and movement of the
scapula. Other important muscles include the rhomboid major, rhomboid minor, levator scapulae and
latissimus dorsi. Exercises which strengthen these muscles should be combined with exercises to strengthen the rotator cuff as cuff fatigue may lead to secondary scapular dyskinesia.

General Guidelines
• Early rehabilitation should aim to improve the endurance and strength of the scapular stabilizing muscles. Low weight, high repetition exercises promote muscle hypertrophy and improve fatigue
resistance. Once more normal scapular mechanics have been restored, higher weights with lower repetitions may be used to promote power.
• Rotator cuff strengthening can begin once a stable scapular base has been restored

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• Once endurance and strength have improved, exercises that promote effective energy transfer through
the kinetic chain should be added
• If you are working with a physical therapist, they may institute a special set of exercises called
Proprioceptive Neuromuscular Facilitation that help promote normal scapulohumeral rhythm and improve the body’s ability to position the scapula for stable energy transfer during functional activities.
Phase 1: Muscle Strengthening and Conditioning (0-3 weeks)
Principles
• Avoid exercises that cause pain
• Use ice following exercise to alleviate inflammation and swelling
Range of Motion stretches should be done 3-5 times per day. Each stretch should be held for 10-15 secImage

seconds and repeated 3 times
• Cross body adduction: below neck level, at neck level, above neck level
• Sleeper stretch
• Roll-over sleeper stretch
• External rotation in abduction doorway stretch
• Towel roll and corner stretch for pectoralis minor

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• Core body flexibility

Scapular Stabilizer Strengthening with rubber tubing or light resistance with dumbbells or machines
• Isometric scapular retraction and depression

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• Prone rowing or bench rows
• Seated rows with scapular pinch

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• Low row
• Push-ups with a plus: wall, table-top, floor
• Bench with a plus
• Chair press-ups
• Lat pull downs
Scapular Positioning

• Closed chain scapular clocks with hand stabilized on wall at 90° abduction
• Protraction/retraction
• Elevation/depression
• Closed chain axial load ball rolls in varying degrees of abduction
• Start low and work to horizontal
• Scapular punches with light weights
Phase 2: (3-8 weeks)
• Continue posterior capsule and anterior chest wall stretching
• Continue maintenance shoulder girdle strengthening with progressive increase in weights as endurance improves
• Begin upper body ergometers beginning at low resistance and height below 90° and slowly progress to
height at 140° flexion
Rotator Cuff Strengthening with rubber tubing or lightweight dumbbell, perform 20-30 repetitions and do 2-3 sets of each
• Sidelying internal and external rotation
• Internal and external rotation at 0° and at 90° abduction
• Abduction to 90°
• Scapular plane elevation: empty can and full can
• Prone horizontal abduction in neutral rotation and external rotation
• Prone horizontal scapular plane elevation in neutral and external rotation
• Prone external rotation
• D2 flexion and extension
Scapular Stabilization
• Closed chain scapular clocks
• Closed chain axial load ball roll
• Start at low angles such as table top and progress to horizontal abduction on wall
• Include humeral head depressions
• Wall wash with axial load at varying degrees of abduction
• Start with vertical and progress to diagonal
• Scapular punches
• Shoulder diagonal punches and dumps combined with scapular retraction
• Start with vertical and progress to diagonal
• Plyoball chest pass and overhand toss
• PNF exercises

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Phase 3: Return to Functional Activities
• Maintenance strengthening with increased weights
• Maintenance flexibility
• Continue UBE with increasing resistance
• Especially reverse direction to work scapular girdle muscles
• Sport or work specific rehabilitation