Proprioception is defined as the body’s ability to sense stimuli with regard to position, motion and equilibrium. It is the sense of the orientation of one’s limbs in space; the ability to know where a body part is without looking at it. Therefore, the body is able to sense the position of its parts, analyze it, and react with proper movement. Without proprioception, we would have to constantly watch our feet while we were walking.
Balance and proprioception are not the same things. The sense of balance originates from the fluids in the inner ear. Proprioception is provided by proprioceptors, which are sensory receptors. These nerves are located inside the body and transmit information from the muscles, joints, tendons and skin to the central nervous system.
Proprioceptors control balance, coordination and agility, and by training proprioception, we can improve balance, coordination and agility. Balance is a basic skill needed in practically every activity. The key to efficiency is changing your center of gravity to match your moves. Agility is what allows us to move gracefully without wasting motion. It allows our joints to move through the full range of motion smoothly and confidently. Proprioception also reduces the risk of injury. For example, ankle sprains are a fairly commonly injury for athletes. These are often caused by a lack of balance or proprioception. Even if a runner has strong lower limbs and good endurance and flexibility, slight deviations in the terrain during running require adjustments in balance. If the athlete has not trained the neuromuscular system to react appropriately when running on uneven ground or when they have a misstep, they may be injured.
Just like any other motor activity, proprioceptive ability can be trained. Any new motor skill that involves precise movement of our arms and legs– from baseball to painting to skiing – involves training our proprioceptive sense. And just like any new skill or exercise, it requires a progression during training. Start with simple exercises and make them more complex as the individual improves.
Proprioception can be tested by standing on one leg for 30 seconds with both eyes open and then standing on one leg with both eyes closed. Beginners should start with static balance activities and advance to agility and coordination activities. Balance exercises should start on the floor and progress to unstable surfaces, such as stability trainers or wobble boards. On the stability trainer, you can perform lunges, mini-squats, etc and progress to using a resistance band and then further progress to one leg. Wobble boards are good for static balance training and can be made more difficult by using a weighted ball. Be sure to exercise caution when using unstable surfaces.
After mastering balance, you can move on to more advanced proprioception for agility and coordination. Activities used to improve agility and coordination including pivoting, twisting, jumping and cutting. Progress jumping from two legs to one leg.
It is important to use correct technique when performing proprioceptive exercises. Reduce the intensity or level of activity if you cannot perform the exercise with proper technique. In order to reduce the risk of injury, perform these exercises before you are too fatigued. It is important to consider age and body weight when engaging in proprioceptive exercises. Performed correctly, this type of core stabilization or stability training is an invaluable tool to enhance overall fitness.
For many years, fitness professionals have used the sit-up as the exercise of choice for the core. It is important to train core muscles, which include the muscles around your trunk and pelvis, for both balance, stability, and strength. Additionally, a tight core makes you look thinner, since generally you will have tight abs and a slimmer waistline! While most experts agree that a strong core is crucial to any exercise routine, there is some discrepancy on the best way to achieve this goal. Those educated in the field contend that the sit-up is outdated and shouldn’t be used to exercise because it presents too great a risk of back injury.
According to Dr. Stuart McGill, a professor of spine biomechanics, sit-ups can place hundreds of pounds of compressive force on the spine. McGill has published many studies and written over 200 scientific papers and found that repeatedly performing sit-ups and flexing can squeeze the discs in the spine. This may potentially lead to herniated discs, which press on the nerve and cause pain.
Old school sit-ups can be damaging to your lower back because the sit-up recruits and overuses the hip flexor muscles. When you perform a sit-up, you push your spine into the floor and use your hip flexor muscles to lift you up. Hip flexors that are too strong or too tight can pull on the lower back and create discomfort by compressing the lumbar discs and creating back spasms and lower back pain. For example, the psoas, one of the hip flexor muscles, runs from the upper thigh to the lower back, and when it is contracted, it causes the pelvis to shift into an anterior position, forward and down. This position may cause discomfort plus it may increases pressure on the disks. When the feet are anchored down, this exacerbates the problem. Additionally, many people contract the neck when performing sit-ups, causing neck strain.
The Canadian Armed Forces has recognized the negative repercussion of the sit-up and recently banned it from its fitness test. Many military experts in the US are trying to cut it from the Navy and Armed Forces as well. In fact, a commander at the navy was quote as saying that sit-ups don’t prepare us for daily life activities. Core strength is needed to pull, push, carry and lift, and the sit-up is not an effective way to stabilize the abs to perform these daily motions.
Instead of a traditional sit-up, McGill recommends a modified curl-up that he created where the hands palm down are positioned under the low back to lessen the pressure on the spine. The back should not be flattened on the ground, and the shoulders barely leave the floor. The crunch up should be slight in order to work the abdominal muscles; you do not have to crunch up very much. Additionally, it is possible to do a modified sit-up or crunch on a stability ball, but this not recommended for everyone, and a personal trainer should evaluate you to determine your individual level and physical limitations.
Another good core exercise is the plank because it recruits more muscles on the front, sides and back of the body instead of just a few target muscles like the sit-up does. Most of our activities of daily living, in addition to sports and recreational activities, require muscles to work together instead of in isolation like the sit-up. Using patterns of movement that are dynamic will help strengthen the entire set of core muscles used everyday.
Other research also supports the fact that the sit-up is not the best exercise for abdominal strength. According to a study published in the Journal of Orthopaedic and Sports, researchers found that exercises on a swiss medicine ball were more effective than the traditional bent knee sit-ups/crunches.
The sit-up has continued to remain popular because the general population believes they cannot have tight, toned abs without them in their routine. However, powerlifters and weightlifters develop amazing abdominal muscles without the sit-up and use only total-body lifts, such as squats, power cleans and deadlifts. Dr. Stuart McGill further states that toned abdominals are not about crunches; it is about lower body fat. So even if you do not have any back or neck pain from sit-up, why take the risk of damaging your spine and potentially causing back pain in the future? Great abs are possible without the sit-up, so cut them out of your routine!
As we get older, we are finding it harder to adhere to a healthy, active lifestyle. This is especially true for those in Corporate America . Anyone, from the receptionist answering phones to the CEO closing 7 figure deals, can have terrible eating habits, less time to exercise, and more stress than they are meant to endure. These environmental stresses speed up the aging process and contribute to the deterioration of the body. Throw in a crazy travel schedule and bad sleeping habits, and you have your average American. It is because of these stressors that 1 in 3 Americans is considered obese and struggles with weight issues.
Our lack of activity is actually killing us, and the older we get the more important exercise becomes. So, why do people refuse to exercise? There are too many reasons to list, but often I hear, “I don’t know where to start.” In a sea of misinformation and in an unregulated fitness industry, it is almost impossible to know where to begin. The gym can be a dangerous place if you do not know how to use the equipment or where to begin. As an expert witness, I have seen improper form and misuse of equipment that leaves me speechless. My advice to those confused about what to do is to start by finding a reputable professional, who has an accredited certification and who can list doctors as references.
Recovering from injury can take longer as we get older. For this reason, err on the side of caution when starting a program. Regardless of age the most common injuries occur in the lower back and shoulders. Very often, these injuries are simply a result of poor exercise form or performing the wrong exercise. Starting out at a high intensity and doing complex exercises may seem like the best avenue for fast results, but more often than not, it results in injury. It is crucial to take a person’s daily activities and orthopedic issues into account before prescribing exercise. For example, if you sit all day and have lower back pain or discomfort, sit-ups and leg raises may actually make your condition worse. Planks, chops and deadbugs are safer and more effective exercises for the core. In addition, some machines are not designed properly and can contribute to injury. For instance, some seated leg presses can stress the lower back and cause pain and/or injury. For the lower body, it is safer to start with a ball squat or step-up instead of using a machine, so as not to disrupt natural movement patterns.
As we age, we lose muscle mass and flexibility and our overall balance degrades. Posture is a major problem, especially for those in Corporate America, because they sit for so many hours, often without taking a break. It is important to create a solid foundation for an active lifestyle and focus on exercises that attain personal goals. Performing balance exercises, stretching and correcting postural distortions are critical to participation in daily activities. Without these exercises, the likelihood of daily pain and injury is markedly increased. Stretching and core strengthening will eliminate most of common everyday aches and pains.
Balance, mobility, postural training, and circuit training with weights at a 50-60% intensity are a great start for the older, sedentary population. It might sound easy but if you haven’t been exercising for a long time, it will be very challenging. It is important to remember that we are all individuals with different strength and weaknesses, so what may be easy for one person may be impossible for another person. Do not just copy exercises that surround you in the gym! Remember that you are a unique individual and your workout needs to be tailored to your specific needs. A majority of older clients who were not athletes or workout buffs in their youth have no interest in looking like a fitness model or a bulging Adonis on the beach. They just want to feel better and live longer. More than half the battle is the training consistency, not the training intensity. If a client does a low to moderate level workout and follows a fairly healthy diet, he/she will feel better and have health benefits, even if he/she is only exercising a couple of days per week. The bottom line is that some exercise is better than no exercise.
I have worked with many older clients. In fact, my oldest client was 90 years old. In my experience, I found that many exercise programs do not include enough flexibility training and intensity is often too high. Many professionals believe that you must train at a high intensity to get any substantial results. There is plenty of reputable research that shows higher levels of intensity can be a better use of time compared to low to moderate levels of exercise. The majority of these professionals will insist that regardless of your age, you need to build your workouts up to intensities beyond 80-90%. While there is truth to the science behind this theory, the experts fail to explain that working out at lower levels is still extremely beneficial. They don’t take into account that at higher intensities, not only is injury risk is increased but a majority of older individuals are not interested in exercising at that level. As a result, they will never stick to that sort of program. Others cannot train at that level because of orthopedic injuries or some other health limitations. If a client’s goal is to eliminate back pain, to increase balance and to be able to play with their grandchildren, plyometrics and intense sprinting is probably unnecessary. They will get more benefit from full body circuit training with active rests and with sets that include therapeutic exercises and stretching. When we look long-term, consistency is king because the most consistent person regardless of intensity will reap the most rewards of exercise.
The fact is low to moderate intensity workouts will produce significant results and keep your client healthy and pain free. If a person is capable of more and wants to work up to a high intensity program, I am not against it and agree that it works for some people. I believe the average person does not have an athletic history and is frequently deconditioned. In my personal experience, it seems that the people who need low intensity exercise the most often believe it is a waste of time to work out if they aren’t “dying” during a workout, and therefore they won’t engage in lower intensity training. The truth is that most Americans just need to move and do low-level exercises to remove stress and to keep them healthy. For some people, exercise is a stress outlet, it helps them stay healthy, and it keeps their eating habits on track. Lower intensity exercise is also important for those who need to recover from their active lifestyle. For example, clients playing 2 hrs. per day 4-5 times per week or those who are avid runners training 25 miles per week should focus their training on flexibility, recovery and exercising when they are in the gym. The goal should be to increase efficiency and to increase the longevity of participation in that activity.
My advice it to focus on the fundamentals and to get the client moving better and feeling good. Once you achieve this, then you and the client can decide what is next. Individualize the workouts and encourage them to meet their individual goals. Start with a solid foundation, and if high intensity is their goal, gradually build up to those type of workouts at a pace that works for the client physically and mentally.
Emphasis – The concentric action is hip and knee extension. The primary muscles used during hip extension are the gluteus maximus and hamstrings (semimembranosus, semitendinosus, and biceps femoris). During knee extension is quadriceps (vastus lateralis, vastus intermedius, vastus medialis and rectus femoris).
Starting Position – Begin the upward movement by stepping up with one leg. Keep trailing foot at start position and shift weight to the leg on the box. As the hip and knee extend on the box stand tall while simultaneously bring the opposite foot next to the starting foot. The downward movement starts with shifting the body weight to the same start leg and stepping off the box with the opposite leg. Shift the body to the the opposite leg and the start leg will follow to starting position.
- Keep torso erect and parallel to the tibia
- Initial contact of lead foot with top of the box must be made by the entire foot
- During upward extension push through the heels and squeeze the glutes
- Maintain hip flexion, knee flexion, and dorsiflexion of ankle at top of movement
Warning Tips: Do not allow the heel to hang off the edge of the box
Many people who have personal trainers feel that theirs is the very best. I have never met anyone who doesn’t rave about his or her trainer, especially if he/she has been working with them for a substantial period of time. Part of the training experience is the camaraderie and trust formed between the trainer and his client, and the majority of people are very loyal.
However, putting friendship and personality aside, only a handful of personal trainers are truly competent and knowledgeable. As a result, many people get injured and sometimes the client doesn’t even realize that their trainer is responsible. Many injuries are repetitive injuries, which are injuries that occur gradually over time due to frequent, repeated, unsafe movements.
The client may not even know that they are being injured! For example, one morning a person can wake up with his knee bothering him and he is unable to walk without pain. He may not remember doing anything the day before to cause the injury; in fact, this injury may have been happening gradually over a period of time. Therefore, a client may be ignorant to what is causing his ailment. Injuries may be caused by improper form, unsafe exercises, or lack of knowledge about anatomy and how the body works. Clients need to be able to evaluation their trainers objectively; you cannot assume that all gyms are hiring qualified, competent trainers.
Intensive training &/or education is not currently required to become a personal trainer. All that is required is a certification that is accredited that the National Commission of Certifying Agencies (NCAA); for example, the National Academy of Sports Medicine (NASM), NFPT (National Federation of Personal Trainers and the Aerobics and Fitness Association of America (AFAA). Most gyms require that their trainers are certified, but NOT all do! Make sure that your trainer is certified and that he attends seminars and takes continuing education courses to stay current.
The body is a complex machine and it is important that a trainer understands proper mechanics to avoid injury, especially if the client has pre-existing conditions. A trainer should perform an initial evaluation and obtain a health history so to target weak areas and avoid aggravating an injury or condition that is already present. The evaluation should include testing flexibility, balance, core strength, muscle strength and endurance, as well as proprioception. Your trainer should be able to explain why he is choosing certain exercises and how they benefit you. He or she should also be knowledgeable in functional training, which is training for daily activities or a specific goal. Additionally, your trainer should be able to use the initial assessment to design a tailor-made workout program for each individual. There is no one-size-fits-all in personal training.
There are many benefits to using a personal trainer rather than working out on your own. Choose wisely, because not all trainers are created equal. Do your due diligence and do your research to ensure you get the results that you want.
There are many different opinions on which exercises are best to do. “What type of training should I be doing?” is a big question along with “Do I perform slow or fast reps?”, “Do I use a bench or a physio-ball?”, or “Do I do one body part at a time?” The answer is that everyone should be training according to their own personal goals. There isn’t one specific routine that will work for every person. Performing a typical gym program of random exercises, three sets of ten, with one-minute rest between each has benefits but will not be the most efficient way to attain your goals or address your specific needs. Training primarily with machines without the use of free weights is inefficient because you are moving resistance along a fixed axis, and not freely in space as the body normally would. Machines have value while integrated properly but are often misused. They have limited functional strength transfer to real life situations in most cases and can actually create poor motor patterns in some people.
Functional training is defined as movements or exercises that improve a person’s ability to complete their daily activities or to achieve a specific goal. It is not a series of exercises deemed functional by some manual. Doing movements in the gym that strengthen the muscles involved in the movements you wish to improve outside the gym is a good start. This does not mean you can simply add weight to the exact movement you wish to enhance. There is research that has proven doing this can actually be detrimental to some athletic movements. When a baseball player adds weight to his bat, that actually can slow his bat speed down because the added resistance changes the forces on the joint and disrupts mechanics. All exercises have some functional value when applied correctly however, this value is determined by the benefit outside of the gym. Every exercise has a functional limitation and it is up to the trainer to understand what that limitation is. A good program will focus on weak areas as well as the specific goals of the client. It is important to understand how to progress someone from simple smaller targeted movements to more complex multi joint movements. Training someone functionally can range from having a tennis player lunge to a chop or a bodybuilder do a slow curl for bigger biceps; its all about the goal. Keep in mind that doing complex movements before a client is ready will do more harm than good.
In order to build appropriate muscle strength, joint integrity, balance and flexibility in all planes of motion, it is essential that the body is exercised in a functional manner. It is crucial to include multi-joint and multi-planar exercises, as this recruits the body’s stabilizers to synergistically facilitate movement. Doing this ensures that the nervous system is working properly and that all parts of the body are used in the appropriate manner, with the correct muscles firing at the right time. This is not to say you shouldn’t include some so called non functional exercises, including a machine or old school exercise can be beneficial, safe and fun when applied correctly. To create a functional program, a trainer must set realistic goals and understand the client’s weaknesses, daily activities and limitations.
A trainer must be able to identify postural distortions and include exercises that correct them. More importantly, they have to educate the client on what movements or activities to avoid or modify during their day. It’s not what you do; it’s how you do it. The ability to identify a postural distortion is dependent on the trainer’s understanding of anatomy, motor patterns and muscle function. A trainer must also be able to identify when muscles are over active and firing out of sequence, or not firing at all. Synergistic dominance is common in most postural dysfunctions. In general, if the agonist is tight then the antagonist is weak, thus creating increased stress on the joint. This can result in patterns of repetitive stress, ultimately leading to accelerated joint degeneration .
Core stability, flexibility and balance are key factors when designing a functional exercise routine. It is important to maintain posture while being able to move all joints in a full range of motion. Training with free weights, and challenging the surrounding environment promotes balance and stability, which is necessary if you expect to see benefits outside of the gym. Keep in mind, it is more important to be able to control your own body weight and concentrate on form, balance and core endurance, than to move heavy weights.
A functional core routine consists of dynamic movements, isometric exercises and challenges the center of gravity. To completely train the core, you must also include dynamic stabilization, isometric and proprioceptive movements, not just for the mid section, but for the entire trunk. Medicine balls, balance boards, foam rollers and physio-balls are great tools for core training, and should be integrated into every program. It is a fact that training on the physioball (challenged environment) is superior to traditional floor exercises. As a person ages, balance and stability become compromised. If balance and stability are not addressed, they will consistently degrade. A weak core contributes to poor stability, and inhibits proper limb movements, causing muscle imbalances in the kinetic chain. This is why falls are common in the geriatric population. Many back and hip injuries are related to weak core muscles. There are many small muscles in the core that the general population knows little about or addresses during exercise. In most spinal injuries, MRI images show atrophy in these small muscles. In order to maintain a healthy spine, these little muscles need to be trained. Without stability, even the strongest person can not effectively propel a force into the environment.
Flexibility is a very important facet of any exercise program, but is often overlooked. Lack of flexibility in the right places appears to be the root of many problems. The body’s movements are hampered when flexibility and posture are distorted. Active, dynamic, static and PNF stretching are key factors and should all be included in any training program. When a muscle is tight, it limits the muscle’s ability to contract properly, causing inefficient movements and risk of injury. Without flexibility, the body’s movement becomes limited, and good results are difficult to achieve.
Traditional weight lifting is a thing of the past, and has been proven to produce limited results compared to a functional program. The only way to enhance movement is to mimic the movement in the gym until it becomes autonomous in every day life. Before initiating any exercise program, one should always consult a physician, as well as a qualified fitness professional. This insures that they are addressing their specific needs and goals.
Q) Should I do slow repetitions or fast?
A) You base the speed of the repetition on the speed of the required activity. The body needs to be trained at the same or a higher velocity during exercise to benefit a particular activity. A sprinter doesn’t jog to increase their speed. In my opinion slow training is good for form training, rehabilitation and hypertrophy.
Q) My friend works out at the local gym and mostly uses machines. He has been doing the same routine forever and has gotten good results. Is this program good for me?
A) NO! Any exercise program will produce results whether it is done right or wrong if you stick to it. Unfortunately when exercise is done incorrectly the harmful affects may not be noticed until the damage is done. By exercising functionally you will systematically attain your goals and insure that your time in the gym is spent safely and efficiently. Just because someone looks good does not mean they are an expert.
Q) Can functional training benefit anyone?
A) Yes. Functional workouts are beneficial for any athletic level or age group. By training functionally your time in the gym is spent more efficiently. When you train in this fashion you will see drastic improvement in overall health and performance not just appearance.
Q) Shouldn’t I do cardio and lose weight before I start a functional program?
A) NO! You should have a functional training program that concentrates on raising and lowering your heart rate. The program should first use body weight exercises then advance to free weights. This promotes lean muscle mass, skeletal integrity and healthy cardiac function. Muscle mass accelerates fat loss.
Q) My friend tells me to do 3-5 sets 10-12 reps to failure with 1 minute rest intervals.
A) This is what everyone who thinks of the gym envisions. Unless you are a body builder this is not a good program. If you train in a functional fashion you burn more calories and get more benefit from your sessions outside of the gym.
Q) Aren’t aerobic classes and the treadmill enough?
A) NO! A weight training program that includes balance, core stability strength and cardiac conditioning builds lean muscle mass. When you build muscle you burn more calories at rest and during daily activities. Which would mean, by adding resistance to your program you actually will burn more calories doing the same aerobic class or distance on the treadmill?
Q) Should I stretch before or after exercise or an event?
A) Evidence demonstrates that static stretching before an activity is not beneficial to prevent injury. If you want to avoid injury you need to be flexible by stretching regularly and not just before activity. Active and dynamic stretches with a short warm up mimicking activity before, P.N.F and static stretching at the end help remove waste from the muscles.
Q) Why have none of my doctors told me to stretch and exercise to alleviate pain?
A) Unfortunately we live in a society of doctors that prescribe meds for everything imaginable. Everyone wants immediate gratification (pill) not a long term solution (exercise). The fact is most people would ignore the doctors’ request to stretch and exercise then seek a new doctor for a simpler solution. Most minor health problems can be eliminated by moderate exercising but people choose to take meds because they are lazy.
Q) I injured my knee and my doctor told me to rest it for a while. Do I?
A) This is the worst thing you can do. Pampering an injury for extended periods causes muscle atrophy and decreased blood flow. All injuries should be functionally rehabilitated under careful supervision.
Q) Should I cut carbs out of my diet?
A) NO! Cut high glycemic carbs out only. Carbohydrates are essential for cellular function. Eating carbs that do not spike insulin levels is healthy and effective for weight loss.
Q) My doctor told me to walk to get some exercise for my aches. Is walking enough?
A) NO WAY. If walking were enough basically everyone would be healthy we all walk. If you have pain chances are there is a biomechanical issue. My first suggestion would be to stretch. More walking will only aggravate the issue. You need to correct the imbalance first not just walk more.
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4: Kiyoshi Yoshihara, MD; Yasumasa Shirai, MD; Yoshihito Nakayama, MD; Shinji Uesaka, MD. Histochemical Changes in the Multifidus Muscle in Patients With Lumbar Intervertebral Disc Herniation. Spine 2001;26:622-626
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