Introduction

Additional Considerations

Side Plank Research Review

Comparison to Other Core Exercises

Research Summary

Motor Behavior and Recommendations

Addition of Abduction and Adduction

Additional Modifications

Stable vs Unstable Surfaces

Outcomes

Comparison to other Exercises

Plank as an Assessment

Plank Exercise and Side Plank Exercise Progressions

NASM

ACSM

AFAA

CanFitPro

PTAGlobal

ISSA

REPSI

PACE

WITS

AUSREPS

CIMSPA

AUSPHYSIO

TPTA

NYPT

AOTA

Plank and Side Plank Progressions

This course discusses the variations, <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>, and <a id="exercise-regression" data-tip="1178" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regressions</a> of the plank exercise and side plank exercise. This includes tips and cues for learning the starting position and/or improving the standard plank (a.k.a. basic plank, forearm plank. or elbow plank); more complex <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> like high planks on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball with the right foot elevated and left foot planted; or <a id="exercise-regression" data-tip="1178" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regressions</a> of the starting position, like an elbow plank on knees. Discussion of core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> anatomy, plank variations, and programming will highlight why planks have become incredibly popular exercises for core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> group strengthening and conditioning.
This course also considers routine and program design with the plank and side plank exercises. This includes performing planks during core training to &#x201C;set-up&#x201D; more advanced upper extremity and lower extremity exercises that start in plank <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a>, including push-ups, mountain climbers, renegade rows, inch worms, burpees, etc. Further, performing planks and side planks with the addition of the <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver may aid in integrating core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> synergies including the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> Oblique Subsystem. Or, may contribute to corrective exercise programs designed to address <a id="movement-impairment" data-tip="1576" target="_blank" href="/glossary-term/movement-impairment" class="glossary">movement impairments</a> like an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> pelvic tilt or knee valgus. Further, the plank exercise may be included in physical rehabilitation programs to address the core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> inhibition correlated with low back pain, hip pain, knee pain, and/or sacroiliac dysfunction.
Movement and sports medicine professionals (personal trainers, fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding plank position exercises to their repertoire with the intent of improving patient/client outcomes from their <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> performance exercise programs and therapeutic (rehabilitation) interventions.
<h4>Planks:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/plank">Plank</a></li>
 <li><a href="https://brookbushinstitute.com/videos/plank-progressions-with-elbows-on-ball">Plank Progressions</a></li>
</ul>
<h4>Side Plank</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/side-plank">Side Plank and Progressions</a></li>
</ul>
<h4>Reactive Progressions</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/modified-mountain-climbers-for-core-reactive-stabilization">Mountain Climbers</a></li>
</ul>
<h4>Subsystem Integration:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/static-standing-chop-pattern">Anterior Oblique Subsystem</a></li>
</ul>
<img title="Dr. Brent Brookbush demonstrating a plank on a stability ball" src="https://www.datocms-assets.com/25800/1649306769-ball-plank-2-1.png" alt="Stability ball plank">

Course Description: Plank and Side Plank

<h3>Target Muscles:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">Rectus abdominis</a></li>
 <li><a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">External obliques</a></li>
 <li><a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">Internal obliques</a></li>
 <li><a href="https://brookbushinstitute.com/courses/transverse-abdominis" target="_blank" rel="noopener">Transverse abdominis</a></li>
</ul>
<h3>Target Subsystem:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem</a></li>
 <li><a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem</a></li>
</ul>
<h3>Signs of Under-activity (Anterior Trunk Muscles):</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/sign-clusters-compensation-patterns-overhead-squat-assessment" target="_blank" rel="noopener">Overhead Squat Assessment:</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-9-anterior-pelvic-tilt-excessive-lordosis" target="_blank" rel="noopener">Excessive Lordosis/Anterior Pelvic Tilt</a> (Long/Under-active)</li>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-17-sign-clusters-posterior-pelvic-tilt-butt-wink-and-inadequate-forward-lean-breakdown" target="_blank" rel="noopener">Inadequate Forward Lean</a></li>
 </ul>
 </li>
</ul>
<h3>Acute Variables:</h3>
<ul>
 <li>Sets: 1- 3</li>
 <li>Repetitions: Hold the position for as long as <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> can be maintained.</li>
 <li>Frequency:
 <ul>
 <li>Strength: 2 - 3 days/week</li>
 <li>Corrective/Therapeutic: Up to 1-2 submaximal sets performed daily</li>
 </ul>
 </li>
</ul>
<h3>Sample Program (Anterior Pelvic Tilt)</h3>
Mobility
<ul>
 <li><a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/tensor-fascia-latae-tfl-self-administered-release" target="_blank" rel="noopener">Tensor fascia latae (TFL) release</a></li>
 <li><a href="https://brookbushinstitute.com/video/rectus-femoris-sa-static-release" target="_blank" rel="noopener">Rectus femoris release</a></li>
 <li><a href="https://brookbushinstitute.com/video/adductor-sa-static-release" target="_blank" rel="noopener">Adductor release</a></li>
 </ul>
 </li>
 <li>Mobilization
 <ul>
 <li><a href="https://brookbushinstitute.com/video/hip-mobilization" target="_blank" rel="noopener">Self-administered hip mobilization</a></li>
 </ul>
 </li>
 <li>Lengthen
 <ul>
 <li><a href="https://brookbushinstitute.com/video/kneeling-hip-flexor-static-stretch" target="_blank" rel="noopener">Kneeling hip flexor static stretch</a></li>
 <li><a href="https://brookbushinstitute.com/video/standing-adductor-stretch" target="_blank" rel="noopener">Adductor static stretch</a></li>
 </ul>
 </li>
</ul>
Activity
<ul>
 <li>Isolated Activation
 <ul>
 <li><a href="https://brookbushinstitute.com/video/quick-glute-activation-circuit" target="_blank" rel="noopener">Glute activation circuit</a></li>
 <li><a href="https://brookbushinstitute.com/video/transverse-abdominis-tva-isolated-activation-quadruped" target="_blank" rel="noopener">Transverse abdominis activation</a></li>
 </ul>
 </li>
 <li>Core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">Integration</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/plank-progressions-with-elbows-on-ball" target="_blank" rel="noopener">Plank with elbows on a ball</a></li>
 <li><a href="https://brookbushinstitute.com/video/ultimate-glute-bridge" target="_blank" rel="noopener">Ultimate Glute Bridge</a></li>
 </ul>
 </li>
 <li>Subsystem <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">Integration</a>
 <ul>
 <li><a href="https://brookbushinstitute.com/video/squat-to-row-posterior-oblique-subsystem-integration" target="_blank" rel="noopener">Squat to Row</a></li>
 </ul>
 </li>
</ul>

Behavior:<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> The <a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" style="letter-spacing: 0px;" rel="noopener">Anterior Oblique Subsystem (AOS)</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> (including the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" style="letter-spacing: 0px;" rel="noopener">rectus abdominis</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" style="letter-spacing: 0px;" rel="noopener">external obliques</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">) are <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to a complex set of altered behaviors that likely imply <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> (long/over-active) in those exhibiting dysfunction.
Recommendation<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">: The Brookbush Institute recommends that <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> issues are addressed prior to active techniques and that <a href="https://brookbushinstitute.com/courses/gluteus-maximus-activation" target="_blank" style="letter-spacing: 0px;" rel="noopener">isolated activation</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> <span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">techniques (e.g.<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> <a href="https://brookbushinstitute.com/courses/transverse-abdominis-activation-quadrupeds-progressions" target="_blank" style="letter-spacing: 0px;" rel="noopener">Transverse Abdominis Activation</a><span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">) should precede core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques, such as the plank. However, research demonstrates that plank and plank <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> have excellent efficacy for increasing activity, hypertrophy, and strength of core musculature.
Adding Abduction and Adduction:<span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;"> Planks may be progressed by adding isometric resisted hip abduction, <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> hip abduction, and increasing hip abduction angle. The addition of hip adduction should be avoided due to concerns regarding the reinforcement of knee valgus and future knee pain and injury.
Additional Progressions: <span style="background-color: transparent; font-family: inherit; font-size: inherit; font-style: inherit; font-variant-ligatures: inherit; font-variant-caps: inherit; font-weight: inherit; letter-spacing: 0px;">The abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) (or hollowing), cueing a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, increasing shoulder flexion angle, altering foot position, and adding resistance band held in the hands and wrapped around the feet are all <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> that have demonstrated an increase in core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a plank.
<ul>
 <li>Regression: Modified planks (plank on elbows and knees) result in significantly less trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity than a conventional floor plank.
 <ul>
 <li>Additional Considerations: Altered head and scapular position may result in undesired increases in activity of muscles that were not the intent of the exercise.</li>
 </ul>
 </li>
 <li>Stable versus Unstable: Research suggests the following <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> will increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity:
 <ul>
 <li>Lower Extremity Support: Modified (knees), to <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> (both feet), to <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> (one foot)</li>
 <li>Unstable Environment: Floor plank, to inflatable disks or <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> pads, to <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball or suspension trainer</li>
 <li>Placement of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">Unstable</a> Environment: Under the feet, to under the forearms, to under the feet and forearms.</li>
 </ul>
 
 </li>
 <li>Posterior Chain Muscles: Although studies demonstrate that some <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> increase <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity, the addition of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments to planks are likely not ideal for improving <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> chain <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strength/endurance.</li>
 <li>Outcomes
 <ul>
 <li>Training: Progressive training with planks is effective for increasing <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strength, endurance, and hypertrophy. Further, incorporating the plank with additional exercise may result in additional increases in hypertrophy and performance.</li>
 <li>Transference: Incorporating planks into a strength training program may result in an increase in strength and endurance during other strength training activities.</li>
 <li>Symptomatic Patients: Planks may be beneficial for improving core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> hypertrophy in individuals with pelvic asymmetry, and may be more effective for reducing symptoms of low back pain than general stretching and strengthening routines; however, planks may not be recommended for the treatment of diastasis recti.</li>
 </ul>
 </li>
 <li>Comparison: Planks may be one of the most effective exercises for increasing <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and recruitment.
 <ul>
 <li>Squats: Planks resulted in more <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity than 3-RM front squats or back squats.</li>
 <li>Gluteus Medius and Glutes Maximus Activation: Single-leg planks with hip extension resulted in high levels of activity of the gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>.</li>
 <li>Kegels: Planks are as effective as Kegals for recruiting the transverse abdominis.</li>
 <li>Leg Raises: Leg raises may increase <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity more than planks; however, the Brookbush Institute does not recommend their use due to the potential risk of increasing hip flexor over-activity and lumbar spine stress.</li>
 </ul>
 </li>
 <li>Plank as an Assessment
 <ul>
 <li>Quality of Assessment: The plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> is a <a id="validity" data-tip="1514" target="_blank" href="/glossary-term/validity" class="glossary">valid</a> and <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">Assessment</a>, some <a id="normative-data" data-tip="1508" target="_blank" href="/glossary-term/normative-data" class="glossary">normative data</a> has been established, and the <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> differs significantly from the v-sit endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>.</li>
 <li>Correlations: Plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> performance is correlated with anaerobic endurance and not a high-velocity activity, and obesity is moderately correlated with faster times to fatigue.</li>
 </ul>
 </li>
 <li>Additional Considerations:
 <ul>
 <li>Attentional focus: Attentional foci are unlikely to have any effect on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment during planks.</li>
 <li>Caffeine: Caffeine is unlikely to have any effect on plank <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> or time to fatigue.</li>
 <li>Weight loss: Planks may be an effective intervention for aiding in the achievement of weight loss and waistline circumference goals.</li>
 <li>Social Media: Social media challenges may be an effective means of spreading education and motivation for participation in fitness activities, including planks.</li>
 </ul>
 </li>
</ul>
<h3>Side Planks</h3>
<ul>
 <li>Stable versus Unstable: The addition of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments during a side plank may increase <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity; however, there is likely an upper limit to the increase in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity that can be expected from the addition of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments alone. Further research is needed to determine the factors that may contribute to additional benefits from <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> (e.g. coordination, <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, athletic performance, etc.).</li>
 <li>Comparisons:
 <ul>
 <li>Muscle Recruitment: Side-planks are more effective than many common core exercises for increasing <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> and gluteus medius recruitment, are effective for increasing recruitment of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>, but are less effective than planks for recruiting <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk musculature.</li>
 <li>Lumbar Erector Activity: Side-planks should not be considered an exercise that primarily recruits the lumbar erectors; however, lumbar erector activity is higher during side-planks than planks. This may have implications for the treatment of low back pain.</li>
 <li>Time to Fatigue and Hypertrophy: Despite shorter times to fatigue when compared to lumbar flexion or extension endurance, side planks may result in hypertrophy of trunk musculature on the engaged side (bottom side), which may be beneficial for addressing lumbopelvic asymmetries.</li>
 </ul>
 </li>
</ul>

Plank Research Review

As described in the Brookbush Institute&apos;s predictive <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> of <a href="https://brookbushinstitute.com/courses/lumbo-pelvic-hip-complex-dysfunction-lphcd" target="_blank" rel="noopener">Lumbo Pelvic Hip Complex Dysfunction (LPHCD)</a> and demonstrated in a growing body of research, the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> (included in the <a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">Anterior Oblique Subsystem (AOS)</a>) are <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> to a complex set of altered behaviors that likely imply <a id="synergistic-dominance" data-tip="1643" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistic dominance</a> (long/over-active) in those exhibiting dysfunction (1-9). This includes research demonstrating that low back pain and fatigue may result in an increase in <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity, relative to a decrease in <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> and transverse abdominis activity (1-4). Swayback <a id="posture" data-tip="1661" target="_blank" href="/glossary-term/posture" class="glossary">postures</a> may result in a decrease in the activity of the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> during static standing (5-6), and low back pain results in a decrease in <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity during un-resisted lumbar rotation (2, 9). Studies also show that pain may result in an increase in activity (bilaterally) to stabilize the spine (bracing) during functional tasks, like bending forward and lifting (3, 6, 8-9). Additionally, chronic low back pain patients typically cannot differentiate between transverse abdominis and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activation when asked to perform the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) (4). The <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> exhibiting less activity during static <a id="posture" data-tip="1661" target="_blank" href="/glossary-term/posture" class="glossary">postures</a> and more activity during resisted motions have led to various hypotheses; however, based on the Brookbush Institute&apos;s review of additional muscles and the development of predictive <a id="model" data-tip="1471" target="_blank" href="/glossary-term/model" class="glossary">models</a> of dysfunction, these behavior seems to fit a category of altered behavior referred to as &quot;synergistic dominance&quot; or &quot;long/over-active&quot;.
The <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> (and <a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">AOS</a>) are hypothesized to be <a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistically dominant</a> for an inhibited <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem (ISS)</a>. The <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> includes the transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, multifidus, quadratus lumborum, and psoas. When recruitment and function are <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a>, the <a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">AOS</a> and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> subsystems should work synergistically. Several studies have demonstrated the synergy between these subsystems. This includes studies demonstrating that any <a href="https://brookbushinstitute.com/glossary/lateral/" target="_blank" rel="noopener">lateral</a>, <a href="https://brookbushinstitute.com/glossary/posterior/" target="_blank" rel="noopener">posterior</a>, or rotational force on the trunk will result in increased <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in all layers of the abdominal fascial network (10-12); and further, increased activity of the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, and transverse abdominis (recruitment of the <a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">AOS</a> and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a>) (13-15). As described below, planks and plank <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> are effective exercises for increasing activity, recruitment, and hypertrophy of all muscles of the <a href="https://brookbushinstitute.com/courses/anterior-oblique-subsystem-aos" target="_blank" rel="noopener">AOS</a> and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a>. The Brookbush Institute recommends that <a id="mobility" data-tip="1455" target="_blank" href="/glossary-term/mobility" class="glossary">mobility</a> issues are addressed prior to active techniques and that <a href="https://brookbushinstitute.com/courses/gluteus-maximus-activation" target="_blank" rel="noopener">isolated activation</a> techniques (e.g. transverse abdominis activation) should precede core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques, such as the plank. However, as the research discussed below demonstrates, the plank and plank <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> have demonstrated excellent efficacy for increasing activity, hypertrophy, and strength of core musculature.
<img src="https://www.datocms-assets.com/25800/1648090001-1642005302-internal-oblique.jpeg" width="196" height="240" title="The internal oblique muscles, notice the direction of the fibers and attachment" alt="The obliques (internal oblique muscle shown)">

<h4>Variations</h4>
Research has investigated a variety of modifications and <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> for the plank. Most of these studies include analysis of electromyographic (EMG) activity or changes in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness using ultrasound. This allows for a comparison of these modifications based on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and recruitment. The volume of studies has allowed for a relatively detailed description of the benefits of a plank and modifications.
<h4>Addition of Abduction and Adduction</h4>
Several studies have investigated <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a plank modified with additional <a href="https://brookbushinstitute.com/article/hip-joint" target="_blank" rel="noopener">hip</a> adduction or hip abduction. Park et al. demonstrated that <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> resistance of adduction during a plank significantly increased transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity (16). Similarly, Kim et al. demonstrated that <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a>, and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity increased when <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> isometric hip adduction was added to a conventional plank, and activity increased further when isometric hip adduction was resisted unilaterally (17). Ko et al. compared core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness following a progressive 4-week routine (5 days per week, 5 sets per day) of planks, planks with adduction, and bridges, demonstrating that planks with adduction resulted in the largest increase in thickness of the transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and multifidus (18). These studies demonstrate that the addition of adduction to a plank may increase activity and thickness of core muscles; however, the Brookbush Institute has concerns about this modification which are discussed below.
Additional studies have investigated the plank with the addition of hip abduction. Bak et al. compared a conventional plank to knees supported by slings, ankles supported by slings, and ankles supported by slings with the addition of hip abduction, demonstrating that ankles supported by slings (with and without abduction) significantly increased <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and multifidus activity (19). Cho et al. demonstrated that progressing from <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> lower extremity <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> to <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> lower extremity <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a>, and progressing hip abduction from 0&#xB0; to 15&#xB0; to 30&#xB0;, significantly increased activity of the <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> (20). Mok et al. compared core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during various suspension exercises, demonstrating that the plank with hip abduction resulted in the highest EMG activity for the transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>&#xA0;multifidus <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> hamstring curls resulted in the highest EMG activity for the multifidus, and 45&#xB0; suspension push-ups and 45&#xB0; suspension rows resulted in the least core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity (21). These studies demonstrate that planks with the addition of abduction, and further increasing the amount of <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> abduction up to 30&#xB0;, may significantly increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and thickness.
Recommendations for the addition of <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hip</a> abduction or adduction to a plank should likely consider the effect on hip <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and lower extremity alignment. Oddly, the studies investigating the addition of hip adduction and abduction do not include an investigation of hip <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity; so, indirect evidence must be considered. The Brookbush Institute does not recommend the addition of hip adduction due to the potential of increased <a href="https://brookbushinstitute.com/courses/adductors" target="_blank" rel="noopener">adductor</a> activity, decreased gluteus medius activity, and reinforcement of knee valgus. Excessive knee valgus during functional activities has been correlated with an increased risk of future pain and injury (23-25). And, increased abduction strength has been correlated with a decreased risk of knee pain and injury (25-27). Further, a study by Kang et al. compared planks with the addition of abduction or adduction, demonstrating no significant difference in <a href="https://brookbushinstitute.com/article/internal-obliques" target="_blank" rel="noopener">internal oblique</a> or <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity (22). This may imply that the addition of adduction could be detrimental to knee health, the addition of abduction could be beneficial for knee health and that these variations result in similar increases in core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity. The Brookbush Institute&apos;s recommendation with the intent of increasing core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity/strength and reducing the risk of injury is to progress planks with the addition of isometric resisted hip abduction, <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> hip abduction, increasing abduction angle, and the addition of hip adduction should be avoided.

A variety of additional plank modifications have been researched. Kim et al. used ultrasound to demonstrate an increased thickness of the transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, and multifidus when the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) was added to a stable or <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> plank, with the largest change in thickness noted during the <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> plank with <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> (28). Another study by Kim et al. demonstrated that increasing shoulder flexion angle (elbows positioned more <a id="cephalad" data-tip="1560" target="_blank" href="/glossary-term/cephalad" class="glossary">cranially</a>) increased activity of the transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>&#xA0;and that adding abdominal hollowing (a more intense version of the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) further increased activity (29). These studies suggest that incorporating the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> may be beneficial for increasing core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment during a plank.
Several studies have investigated shoulder girdle and pelvic position during a plank. As mentioned above, the study by Kim et al. demonstrated that increasing shoulder flexion angle (elbows positioned more <a id="cephalad" data-tip="1560" target="_blank" href="/glossary-term/cephalad" class="glossary">cranially</a>) increased core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity (29). Further, Schoenfeld et al. demonstrated that increasing shoulder flexion angle increased <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> activity, incorporating a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt increased <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> activity, and combining both modifications further increased <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> activity during a plank (30). Cortell-Tormo et al. compared scapular and pelvic positions during a plank, demonstrating a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt resulted in more core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity than an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt, and that retraction resulted in more core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity than protraction (31). Note, although it may be tempting to interpret the findings of the study by Cortell-Tormo et al. (31) as a reason to cue retraction during a plank, the Brookbush Institute does not recommend this due to the potential for reinforcing poor scapular stabilization and potentially increasing the risk of shoulder pain and injury. Based on these findings it may be recommended to progress a plank by increasing shoulder flexion angle, and/or cueing a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt to further increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>.
Individual studies have investigated other interesting alterations. Kim et al. compared the <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity of the <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>, and <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> during six variations of plank exercises, including three changes in head position and two changes in leg position (wide and narrow), demonstrating that the head-down position significantly increased <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity, the head-up position significantly increased <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> activity, and legs wide resulted in an increase in <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity when compared to legs neutral (32). Kim et al. demonstrated that the addition of a resistance band held in the hands and wrapped around the feet significantly increased deltoid and core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a plank and side-plank (34). Lee et al. demonstrated that modified planks (on knees) resulted in a significant decrease in <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> activity, <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surfaces increased <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity in both conventional and modified versions, and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity was similar for all variations (33). Last, Choi et al. demonstrated that low back pain patients adding active dorsiflexion to a plank increased activity and thickness of the transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a>, and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> more than planks with plantar flexion or without ankle <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> contraction (77). These studies suggest that foot position and head position may have a significant effect on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, that adding resistance band may be recommended for progressing the plank, and modified planks (on knees) may be an appropriate <a id="exercise-regression" data-tip="1179" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regression</a> for individuals who lack the core strength to maintain a conventional plank with good <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a>.
In summary, the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> (or hollowing), an increase in shoulder flexion angle, a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, altering foot position, adding active dorsiflexion, and the addition of resistance band may be used as plank <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> to increase core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, while a modified plank (on knees) may be used as a <a id="exercise-regression" data-tip="1179" target="_blank" href="/glossary-term/exercise-regression" class="glossary">regression</a>. Additional consideration should be given to head and scapular position, which may result in undesired increases in activity of muscles that were not the intent of the exercise.

Stable versus Unstable

<h4>Hypertrophy</h4>
Several studies have investigated the efficacy of planks based on outcomes following 4 - 12 weeks of training. As mentioned above, Ko et al. compared core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness following a progressive 4-week routine (5 days per week, 5 sets per day) of planks, planks with adduction, and bridges, demonstrating that planks with adduction resulted in the largest increase in thickness of the transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and multifidus (18). Also mentioned above, Kang et al. compared <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness of the <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> following 4 weeks of training 3/week with planks, planks on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball, or planks on a sling apparatus, demonstrating that all variation resulted in increased thickness, but the <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball group exhibited the largest increase (43). Both of these studies demonstrate that incorporating planks into a training routine is effective for increasing core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness (hypertrophy).
<img src="https://www.datocms-assets.com/25800/1648089963-1642105236-rectus_abdominis.png" title="The location of the rectus abdominis muscle on the anterior side of the body" alt="The rectus abdominis muscle">
<h4>Transference</h4>
Additional studies have demonstrated that incorporating planks into a routine may result in an increase in strength and endurance during other strength training activities (transference). Patil et al. demonstrated that 6-weeks, 3-days/week of a graded plank protocol resulted in an increase from an average of 20.6 to 30.4 seconds on a <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> hip bridging endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> in previously sedentary dentists (49). And, a <a id="randomized-control-trial" data-tip="1403" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">randomized controlled </a><a id="randomized-control-trial" data-tip="1407" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">trial</a> (RCT) by Kumar et al. compared 12 weeks of core <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> exercise to standard physical education classes in school-going males 18 - 24 years old and females 14 - 20 years old. The findings suggest that the core <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> group demonstrated significantly larger increases in chest, back, leg, and core strength (50). Although these studies investigated the effects of planks on individuals who may have been previously sedentary, the contribution of planks to strength and endurance during other activities should be investigated further.
<h4>Additional Exercises</h4>
A study by Park et al (2019), compared <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness following 4 and 8-weeks of planks, or planks with breathing exercise and arm movements, demonstrating that all groups exhibited significant increases in transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> thickness; however, the addition of breathing and arm exercise resulted in a larger increase in thickness (51). This study may imply that incorporating planks into an <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> routine may result in additional benefits.
<h4>Patient Outcomes</h4>
Additional studies have demonstrated that planks may have a positive effect on outcomes for symptomatic patients. Park et al. (2018) compared <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness following training with floor planks, standing planks, and side-planks for those individuals with an assessed asymmetric pelvic tilt. The results demonstrate that transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> thickness increased more with floor planks than standing planks, and side planks resulted in greater thickness on the side the exercise was performed (52). An RCT by Akhtar et al. compared 6 weeks of core stabilization exercise to a more general program of stretching and dynamic strengthening for the treatment of chronic non-specific low back pain, demonstrating core stabilization exercises resulted in larger improvements in pain at 2, 4, and 6 weeks (53). Jeong et al. compared 4 weeks of planks to general stretching for the treatment of low back pain, demonstrating that at 4 weeks both groups exhibited increased thickness of the abdominal muscles; however, the plank group exhibited larger increases in thickness of the <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> and lower visual analog pain scores (54). Last, An RCT by Walton et al. compared the effects of 2 programs on diastasis recti in post-partum females. The traditional program was abdominal crunch, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, Kegels, and Russian twists, and the experimental program was abdominal bracing: plank, <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, Kegels, and Russian twists. Both groups exhibited improvements; however, a small but significant difference between groups favored the traditional program (non-plank group) (55). These studies suggest that planks may be beneficial for improving core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> hypertrophy in individuals with pelvic asymmetry, and may be more effective for reducing symptoms of low back pain than general stretching and strengthening routines; however, planks may not be recommended for the treatment of diastasis recti.

Several studies have compared planks to other exercises based on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and recruitment. Bautista et al. demonstrated that <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity was higher during planks than during 3-RM front squats or back squats (56). Gottschall et al. compared the activity of the <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">anterior deltoid</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>, and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> during variations of crunches, lumbar extensions, and planks, demonstrating a correlation between exercises with the highest <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">anterior deltoid</a> and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity and exercises with the highest trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity (e.g. planks) (57). Boren et al. compared gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity by percent maximal voluntary isometric contraction (%MVIC) for several exercises. Five exercises surpassed 75% MVIC for the gluteus medius including, side plank with abduction with the dominant leg on the bottom (103% MVIC), side plank with abduction with the dominant leg on top (89%MVIC), single-limb squat (82%MVIC), clamshell (hip clam) <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> 4 (77%MVIC), and front plank with hip extension (75%MVIC). Additionally, five exercises surpassed 70% MVIC for the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> including front plank with hip extension (106%MVIC), gluteal squeeze (81%MVIC), side plank with abduction with the dominant leg on top (73%MVIC), side plank abduction with the dominant leg on the bottom (71%MVIC), and single-limb squat (71%MVIC) (58). Bae et al. compared transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> activity both during and after planks and Kegal exercises, demonstrating that both exercises increased transverse abdominis activity. Plank exercises increased transverse abdominis activity more during the exercise, but thickness was similar for both exercises immediately after (59). Park et al. demonstrated that <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity was higher during a leg raise when compared to a plank, and the nearly horizontal position of the leg raises also resulted in greater <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique activity</a> (60). These studies suggest that planks are among the most effective exercises for increasing <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, single-leg planks with hip extension are effective for increasing gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity, and planks may be more effective than Kegels for recruiting the transverse abdominis. Leg raises may increase <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity more than planks; however, the Brookbush Institute does not recommend their use due to the potential risk of increasing hip flexor over-activity and lumbar spine stress.
<img alt="The leg raise exercise" title="Image of a leg raise exercise" src="https://www.datocms-assets.com/25800/1632846046-straight-leg-test.gif">

Several studies have investigated the utility of the plank as an <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>. Tong et al. investigated whether the plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> was a <a id="validity" data-tip="1514" target="_blank" href="/glossary-term/validity" class="glossary">valid</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> of core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> endurance, demonstrating that a plank resulted in at least 50% of trunk flexor MVIC throughout the duration of the <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, and subsequent trials resulted in a 30% decrease in time to fatigue (61). Saporito et al. investigated the <a id="reliability" data-tip="1515" target="_blank" href="/glossary-term/reliability" class="glossary">reliability</a> of the plank <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, demonstrating no significant differences in time to fatigue between tests and re-tests 72-hours apart, even when comparing tests with and without verbal encouragement (62). Boyer et al. demonstrated that a plank without a time limit may be a more <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a> than the partial curl-up <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> for adolescents 8-12 (63). Chase et al. established some <a id="normative-data" data-tip="1508" target="_blank" href="/glossary-term/normative-data" class="glossary">normative data</a> for the plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, with a study of 168 male and female participants, between 18 - 25 years old attending college courses. After a 5-minute warm-up, participants were asked to plank until fatigue with elbows bent at 90&#xB0; directly below the shoulders, hands unclasped, neutral pelvis, feet hip-width apart with ankles at 90&#xB0;. The results by quartile for women were 63 seconds (sec) for the 25th percentile, 90 sec for the 50th percentile, and 121 sec. for the 75th percentile, and for men 77 sec for the 25th percentile, 106 sec for the 50th percentile, and 128.5 sec. for the 75th percentile (64). Musalem et al. investigated differences between the v-sit and plank endurance tests, which previous studies have demonstrated are weakly correlated. <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">Posture</a> and activity analysis of trunk flexors and extensors revealed that <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> abdominal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity was similar for both tests, that the spine was an average of 28&#xB0; more flexed during the v-sit, and that <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">thoracic extensor</a> and <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a> activity was higher during the plank. These findings suggest that the primary difference between the two tests is spine flexion angle and the activity of thoracic muscles (65). In summary, these studies demonstrate the plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> is a <a id="validity" data-tip="1514" target="_blank" href="/glossary-term/validity" class="glossary">valid</a> and <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> <a id="assessment" data-tip="1478" target="_blank" href="/glossary-term/assessment" class="glossary">assessment</a>, that some <a id="normative-data" data-tip="1508" target="_blank" href="/glossary-term/normative-data" class="glossary">normative data</a> has been established, and the <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> differs significantly from the v-sit endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>.
Additional studies have investigated correlations between the plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> and physical attributes. Imai et al. demonstrated that plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> performance was highly correlated with the Yo-Yo intermittent recovery <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, moderately correlated with the Cooper <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, poorly correlated with the step 50 agility <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, and not correlated with vertical jump performance (66). These correlations imply that the plank <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> is an anaerobic endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, and not correlated with the performance of high-velocity tasks. Pardeshi et al. demonstrated a moderate correlation between BMI and plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> performance, demonstrating that obesity was moderately correlated with faster times to fatigue (67). These studies suggest that plank endurance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> performance is correlated with anaerobic endurance and not high-velocity activity and that obesity is likely to have a negative impact on time to fatigue.

Some interesting observations have been made in a few additional research studies. Calatayud et al. demonstrated that focusing on the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> abdominal muscles during a plank increased <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity, but had no effect on the <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> or <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a>. Further, other changes to internal focus had no effect on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity (68). Herring et al. demonstrated that caffeine did not have a significant effect on plank endurance or <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>. Note, changes in <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> were based on velocity and amount of change of the center of pressure (69). A study by Kim et al. demonstrated that planks with the addition of slings may aid in abdominal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> stabilization, reduce the circumference of the waistline, and contribute to weight loss; however, this was not a comparative study and these results may be more indicative of planks being an effective intervention for weight loss goals (70). Last, an interesting study by Pagoto et al. investigated the spread of a twitter-based core-strengthening challenge (#PlankADay). Of 407 individuals who joined the challenge, 105 returned surveys, reporting that the challenge increased enjoyment of exercise, resulted in as much positive social <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> as was received by family and in-person friends, and more than 70% of individuals who participated in the challenge recruited additional participants with 6% recruiting 10 people or more (71). In summary, attentional focus on muscles and caffeine are likely to have little if any effect on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment or plank performance; however, planks are likely an effective intervention for aiding in the achievement of weight loss goals. Last, social media challenges may be an effective means of spreading education and motivating for participation in fitness activities, including planks.

<h4>Stable versus Unstable</h4>
Several studies have compared the effects of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments on the activity of trunk muscles during a side plank. As mentioned above, Imai et al. used fine wire electrodes to demonstrate that adding an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environment (lower extremity on Bosu ball) to planks or side-planks increased <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, multifidus, and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity (41). Babakhani et al. demonstrated that adding a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball under the forearm during a side-plank significantly increased <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, and gluteus medius EMG activity, but not <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a> activity (72). Baritello et al. compared trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during a side-plank, side-plank on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface, side-plank with perturbation, and side-plank on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface with perturbation. The findings demonstrated that <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> and perturbation conditions resulted in significantly more activity than a floor plank; however, there was no significant difference between the <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> and perturbation conditions (73). Also mentioned above, Mirmohammad et al. compared side-planks on the floor with or without a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball under the forearm(s), demonstrating that all <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> resulted in similar increases in activity and thickness of the <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, multifidus, or quadratus lumborum (38). The studies by Babakhani et al., Mirmohammad et al., and Baritello et al. (38, 72, 73) may imply that once an upper limit of EMG activity is reached, further <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> do not result in further increases in activity and thickness. This may be especially true for deep stabilizations muscles, such as the <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, which may be recruited first and reach peak EMG sooner. The &quot;upper limit&quot; trend was noted while reviewing research comparing stable and <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments for a variety of core and resistance training exercises and mentioned in <a href="https://brookbushinstitute.com/courses/stability-training" target="_blank" rel="noopener">Stability Training: </a><a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> Surface and Load Training. These findings should not be misinterpreted to imply that additional benefits are not achieved from the additional <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>. In summary, these studies suggest that the addition of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments during a side plank may increase <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity; however, there is likely an upper limit to the increase in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity that can be expected from the addition of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments alone.
<img src="https://www.datocms-assets.com/25800/1647305838-side-plank.jpg" title="Image of the side plank exercise, targeting the abdominial muscles" alt="A side plank exercise">

Additional studies have compared the side-plank to other core exercises. Ekstrom et al. (2007) compared active hip abduction, bridges, unilateral-bridges, side planks, front planks, quadruped opposite arm/leg raise, <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> step-up, and static body-weight lunges, demonstrating that only the side-plank required more than 45% MVIC activity from the <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a> (74). Boren et al. compared gluteus medius and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity by percent maximal voluntary isometric contraction (%MVIC) for several exercises. Five exercises surpassed 75% MVIC for the gluteus medius including the side plank with abduction with the dominant leg on the bottom (103% MVIC), side plank with abduction with the dominant leg on top (89%MVIC), single-limb squat (82%MVIC), clamshell (hip clam) <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> 4 (77% MVIC), and front plank with hip extension (75% MVIC). Additionally, five exercises surpassed 70% MVIC for the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> including front plank with hip extension (106% MVIC), gluteal squeeze (81% MVIC), side plank with abduction with the dominant leg on top (73% MVIC), side plank abduction with the dominant leg on the bottom (71% MVIC), and single-limb squat (71% MVIC) (58). Last, Escamilla et al. demonstrated that planks result in more EMG activity than side planks for the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk muscles; <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a>, and <a href="https://brookbushinstitute.com/courses/rectus-femoris" target="_blank" rel="noopener">rectus femoris</a> (35). These studies suggest that side-planks are more effective than many common core exercises for increasing <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> and gluteus medius recruitment, are an effective exercise for increasing recruitment of the <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a>&#xA0;but are less effective than planks for recruiting <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> trunk musculature.
Two studies have compared the recruitment of the lumbar erectors during side-planks. In a study mentioned above, Escamilla et al. demonstrated side planks resulted in greater multifidus and <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity than a plank (35). However, Ekstrom et al. (2008) compared variations of planks, side planks, crunches, and lumbar extension exercises, demonstrating that side-planks (along with <a href="https://brookbushinstitute.com/courses/bridge-progression" target="_blank" rel="noopener">bridges</a> and quadrupeds) resulted in less than 50% MVIC of the <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">longissimus thoracis</a> and lumbar multifidus, and only resisted and <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> lumbar extension exercises surpassed 50% of MVIC (75). These studies suggest that side-planks should not be considered an exercise that primarily recruits the lumbar erectors; however, lumbar erector activity is higher during side-planks than planks. This may have implications for training, but likely has larger implications for intervention selection and <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> in settings addressing patient populations with low back pain.
<img src="https://www.datocms-assets.com/25800/1649307647-plank.jpg" title="A recruit performing a plank exercise testing abdominial endurance" alt="A plank exercise ">
Two additional studies have made comparisons worthy of further investigation. Mcgill et al. demonstrated that side-plank hold time for men was 65% of their isometric lumbar extension hold time and 99% of their isometric sit-up hold time, and for women side-plank hold time was 39% of their isometric lumbar extension hold time, and 79% of their isometric sit-up hold time (76). As mentioned above, Park et al. (2018) compared <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness following training with floor planks, standing planks, and side-planks for those individuals with an assessed asymmetric pelvic tilt. The results demonstrate that transverse abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, and <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> thickness increased more with floor planks than standing planks, and side planks resulted in greater thickness on the side the exercise was performed (52). These studies suggest that despite shorter times to fatigue when compared to lumbar flexion or extension endurance, side planks may result in hypertrophy of trunk musculature on the engaged side (bottom side), which may be beneficial for addressing lumbopelvic asymmetries.

<h3>Quick Summary:</h3>
<ul>
 <li>Support: Modified (knees), to <a id="bilateral" data-tip="1552" target="_blank" href="/glossary-term/bilateral" class="glossary">bilateral</a> (both feet), to <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> (one foot)</li>
 <li>Unstable Environment: Floor plank, to inflatable disks or <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> pads, to <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball or suspension trainer</li>
 <li>Placement of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">Unstable</a> Environment: Under the feet, to under the hands/forearms, to under the feet and forearms</li>
 <li>Additional Progressions: Cue <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt, add <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> hip abduction, increase shoulder flexion angle</li>
</ul>
<h3>Plank progression:</h3>
<ol>
 <li>Modified Plank: Elbows and knees on a stable surface
 <ul>
 <li>Stable Surface</li>
 </ul>
 </li>
 <li>Elbows with one knee and one foot on a stable surface</li>
 <li>Elbows and feet on a stable surface</li>
 <li>Elbows and one foot on a stable surface with non-supporting leg extended</li>
 <li>Elbows and one foot on a stable surface with non-supporting leg extended and abducted
 <ul>
 <li>Note, planks can be progressed by increasing the hip abduction angle of the non-supporting leg (20)</li>
 <li>Lower-extremity Unstable</li>
 </ul>
 </li>
 <li>Elbows or push-up position (hands under the chest with arms straight) with knees on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface.
 <ul>
 <li>Note, planks with legs on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface can be progressed by adjusting the placement of <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> by a ball or sling. More <a id="proximal" data-tip="1564" target="_blank" href="/glossary-term/proximal" class="glossary">proximal</a> (e.g. thighs) is easier than more <a id="distal" data-tip="1563" target="_blank" href="/glossary-term/distal" class="glossary">distal</a> (e.g. feet).</li>
 </ul>
 </li>
 <li>Elbows or push-up position (hands under the chest with arms straight) with one knee on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface, and one foot on a stable surface.</li>
 <li>Elbows or push-up position with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Elbows or push-up position with one foot on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Elbows or push-up position with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and alternating knee ups</li>
 <li>Elbows or push-up position with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and alternating hip extension</li>
 <li>Elbows or push-up position with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and alternating hip extension and abduction
 <ul>
 <li>Upper-extremity unstable</li>
 </ul>
 </li>
 <li>Elbows or push-up position with upper extremity on <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and knees on a stable surface</li>
 <li>Elbows or push-up position with upper extremity on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and one knee and one foot on a stable surface</li>
 <li>Elbows or push-up position with upper extremity on <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and feet on the floor</li>
 <li>Elbows or push-up position with upper extremity on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and one foot on the floor</li>
 <li>Elbows or push-up position with upper extremity on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and one foot on the floor and alternating knee ups</li>
 <li>Elbows or push-up position with upper extremity on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and one foot on the floor and alternating hip extension</li>
 <li>Elbows or push-up position with upper extremity on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface and one foot on the floor and alternating hip extension and abduction
 <ul>
 <li>Unilateral Upper-extremity Support</li>
 </ul>
 </li>
 <li>Push-up position (hands under chest with arms straight and feet on the floor) with march with hands</li>
 <li>Push-up position alternating opposite shoulder touch</li>
 <li>Push-up position with alternating scaption
 <ul>
 <li>Unilateral or <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">Unstable</a> Upper-extremity and <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> or <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">Unstable</a> Lower-extremity</li>
 </ul>
 </li>
 <li>Push-up position (hands under chest with arms straight and feet on the floor) with march with hands with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Push-up position alternating opposite shoulder touch with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface</li>
 <li>Push-up position with alternating scaption with feet on an <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> surface
 <ul>
 <li>There are many additional <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> that can be developed from the combination of <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> and/or <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> apparatus for both upper and lower extremities.</li>
 </ul>
 </li>
</ol>
<hr>
<h3>Optimal Form:</h3>
<a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">Optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> for any exercise should be modeled with the intent of reducing signs that have been correlated with an increased risk of future pain and injury (e.g. absence of forward head, knees bow in, etc.). Generally, this results in cues that focus on the alignment of joints.
<ul>
 <li>Cervical and thoracic spine neutral</li>
 <li>Scapula protracted and depressed</li>
 <li>Neutral shoulder rotation (hands unclasped)</li>
 <li>Neutral lumbar spine with abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>)</li>
 <li>Neutral pelvis (no <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt)
 <ul>
 <li>Cueing a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt may be appropriate</li>
 </ul>
 </li>
 <li>Hips, knees, and ankles in alignment</li>
 <li>Ankles dorsiflexed</li>
</ul>

Plank Progressions and Form

Videos

Plank

Plank Progressions

<h3><iframe src="https://player.vimeo.com/video/104151656" frameborder="0" allowfullscreen="allowfullscreen"></iframe></h3>
<h4>Side Plank:</h4>
<ol>
 <li>Start by having your patient/client assume a side-lying position with their elbows under their shoulder and forearm perpendicular to the body (shoulder rotation neutral).</li>
 <li>Ensure safe and <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> placement of any additional piece of equipment.</li>
 <li>Cue scapula protraction on the engaged side (bottom arm) by having the client/patient attempt to move the scapula toward the floor.</li>
 <li>Address any deviations in cervical or thoracic alignment (&quot;head back with chin tucked&quot; and &quot;reaching with the top of the head as if trying to get taller&quot; are often helpful cues).</li>
 <li>Ensure your client/patient&apos;s torso, <a href="https://brookbushinstitute.com/courses/hip-joint" target="_blank" rel="noopener">hips</a>, <a href="https://brookbushinstitute.com/courses/knee" target="_blank" rel="noopener">knees</a> and <a href="https://brookbushinstitute.com/courses/ankle-joint-talocrural-subtalar-tibiofibular-joints" target="_blank" rel="noopener">ankles</a> are in alignment.</li>
 <li>Have your patient/client perform the abdominal <a id="drawing-in" data-tip="1580" target="_blank" href="/glossary-term/drawing-in" class="glossary">drawing-in</a> maneuver (<a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>).</li>
 <li>Ask your patient to elevate their torso off the floor/mat by squeezing their glutes, and reaching away and back (combination of hip abduction and extension) with their knees/foot.
 <ul>
 <li>Common compensation: A common compensation is to shift into hip flexion while abducting, or rotate the pelvis forward (hip internal rotation) to increase reliance on an over-active <a href="https://brookbushinstitute.com/courses/tensor-fascia-latae-tfl" target="_blank" rel="noopener">tensor fasciae latae</a> and reduce emphasis on the gluteus medius. Cue the patient to squeeze their glutes and extend the bottom hip.</li>
 </ul>
 </li>
 <li>Hold position for as long as <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> can be maintained.
 <ul>
 <li>Repeat for the desired number of sets</li>
 </ul>
 </li>
</ol>
Additional Cues for <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">Unilateral</a> Progressions:
<ul>
 <li>Adding <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">Contralateral</a> Abduction: Most of the client/patient&apos;s attention should be on the <a id="base-of-support" data-tip="1197" target="_blank" href="/glossary-term/base-of-support" class="glossary">support</a> leg (bottom leg); however, incorporating a side-lying leg raise with the top leg can add additional challenge and <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">integrate</a> <a href="https://brookbushinstitute.com/courses/gluteus-medius-activation-progression" target="_blank" rel="noopener">gluteus medius activation</a>. This can be done statically or dynamically, and resistance can be added using resistance band loops.</li>
 <li>Straight-leg Variations: Straight-leg variations are far more challenging, but also add a significant amount of <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> stress to the knee. The Brookbush Institute has largely moved away from straight-leg variations, as practical experience suggests they commonly exacerbate or contribute to knee pain.</li>
</ul>

Side Plank

Modified Mountain Climbers for Core Reactive Stabilization:

Bibliography

© 2011 Brent Brookbush, © 2020 Brent Brookbush
Questions, comments, and criticisms are welcomed and encouraged

Copyright

A-Band - Refers to the part of the muscle cell that looks darker under a microscope.  This area of the cell is darker due to parallel arrangement of thicker filaments (myosin) and overlap with the thinner filaments (actin).
<ul>
 	<li>As a muscle contracts, the A-band is where actin and myosin interact.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Accuracy - the proportion of individuals correctly identified by the test results.
<ul>
 	<li>For example, a special test with perfect accuracy would imply a test has 100% specificity, 100% sensitivity, 100% positive predictive value and 100% negative predictive values.</li>
</ul>

Action Potential - A rapid change in voltage, resulting in a wave of excitation, that may result in stimulation of a nerve or muscle cell.
<ul>
 	<li>In order for an action potential to be initiated, the resting membrane voltage must exceed the excitation threshold, which then results in a cascade of depolarization and the "wave of excitation." Any stimulus below that threshold will not result in an action potential, and a stimulus greater than the threshold will not increase a single action potential, but may result in additional action potentials.  In this way, the action potential functions more like an on/off switch (all or none), and less like a dimmer switch.</li>
</ul>

A single-joint movement pattern (most often) designed to load a specific under-active muscle(s), while minimizing the contribution of over-active synergists via specific cues/joint motions.
<ul>
 	<li style="text-align: left;">Activation techniques/exercises are performed with the intent of addressing a muscle exhibiting a reduction in activity (tone) as a result of, or contributing to postural dysfunction.</li>
 	<li style="text-align: left;">Activation techniques/exercises cannot be multi-joint movement patterns due to relative flexibility, altered reciprocal inhibition, and synergistic dominance resulting in compensation patterns.</li>
</ul>
Example, <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/activation/gluteus-medius-activation-progression/" target="_blank">gluteus medius activation</a> involves resisted hip abduction while minimizing the contribution of the TFL via hip extension.

Active stretching is a term used to describe a stretch that involves an active contraction of opposing musculature to lengthen a muscle to its end range. Generally these stretches are held for 2-5 seconds and repeated for 8-15 repetitions.

Adenosine triphosphatase (ATPase): is the enzyme responsible for catalyzing (initiating and accelerating) the decomposition of ATP to ADP.
<ul>
 	<li>This dephosphorylation (breakdown) reaction releases energy for processes like muscular contraction.</li>
</ul>

Adenosine triphosphate (ATP): The molecule that functions as a universal energy-transfer molecule, providing most of the energy associated with muscular contraction and human movement. ATP is composed of an adenine group, a ribose group, and three molecules of inorganic phosphates.
<ul>
 	<li>Energy is provided when hydrolysis results in the cleaving of a phophate group; resulting in adenosine diphosphate, an inorganigic phosphate group, and energy.</li>
</ul>

Algometry - measuring the amount of pressure to result in sensitivity or pain, using an algometer.
<ul>
 	<li>Generally, research uses algometry to establish a minimum pain pressure threshold (PPT), in which a lower PPT implies more sensitivity and pain, and a higher PPT implies less sensitivity and pain. PPT is a common outcome measure in trigger point research.</li>
</ul>
<a href="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg"><img class="aligncenter wp-image-140177" src="https://brentbrookbush.com/wp-content/uploads/2019/07/Algometer.jpg" alt="Image of an Algometer" width="500" height="333" /></a>

All-or-none principle - a nerve or muscle cell's response to a stimulus is independent of the strength of the stimulus. If that stimulus exceeds the threshold potential (threshold of an action potential), the nerve or muscle fiber will respond completely; otherwise, there is no response.

Example, when a motor unit in the biceps brachii is stimulated it contracts the same way whether a 10 lb or 50 lb dumbbell is lifted.  It is actually the number of muscle cells and the size of the motor unit that determines force output.

&nbsp;

The transition period between eccentric load and concentric contraction during a repetition of an exercise.  This term is most often used in reference to power/plyometric exercises, in which a shorter amortization phase is believed to be beneficial.  The shorter amortization phase may better use the stored energy from the elastic deformation of connective tissue and enhance synchronization of myotatic (stretch) reflex with maximum voluntary contraction.

Example, the athlete was cued to spend as little time as possible in the bottom of their squat stance (the amortization phase) during a set of box jumps.

Muscles that oppose the prime mover and synergists for a given joint action.

That is, all the muscles that can perform the opposing joint action.

Example: The triceps and anconeus are antagonists during elbow flexion.

An anatomical direction; toward the front

Example, the face is on the anterior aspect of the head

Appendicular Skeleton - referring to the bones the bones of the arms and legs, as well as the bones that support them. This includes the pelvis, clavicle and scapula. There are approximately 126 bones in the appendicular skeleton.
<ul>
 	<li>Etymology - Appendicular, as in appendage, "that which is appended to something as a proper part," 1640s, from <a class="crossreference" href="https://www.etymonline.com/word/append?ref=etymonline_crossreference">append</a> + <a class="crossreference" href="https://www.etymonline.com/word/-age?ref=etymonline_crossreference">-age</a>. - <a href="https://www.etymonline.com/word/appendage" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Appendicular skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/axial-skeleton/" target="_blank" rel="noopener">axial skeleton</a>".

A reflexive decrease in muscle activity due to joint dyskinesis.
For example, a reduction in deep cervical flexor activity as a result of cervical spine dyskinesis.

Arthrokinematic Motion - Small amplitude motions between bone surfaces at a joint.  The arthrokinematic motions are roll, glide (slide or translation), spin, compression and distraction (traction). Arthrokinematic motions accompany osteokinematic motions to maintain joint congruence.
<ul>
 	<li>Example, arthrokinematic motion of the talus includes posterior glide on the tibia during ankle dorsiflexion.</li>
</ul>
Synonyms include: arthrokinematics, passive accessory motion, joint play and component motion

&nbsp;

Assessment - is the act of assessing, i.e. determining the importance, size, or value of -

In most cases, the results of an assessment are compared to normative data. If the individual exhibits values that are within normal parameters, it may be assumed that the aspect of health or motion assessed is not contributing to the patient's complaint, symptoms or movement impairment. If the results fall outside of normal parameters, it may indicate that the aspect of health or motion assessed is contributing to, or being affected by the patient/client's complaint, symptoms, or movement impairment. In some cases, the results of an assessment are compared to an "ideal model." In this case, deviations from the ideal are noted as potential issues. For example, deviations noted in the <a title="Introduction to the Overhead Squat Assessment" href="https://brentbrookbush.com/online-courses/articles/assessment/introduction-overhead-squat-assessment/" target="_blank">Overhead Squat Assessment</a> are compared to an "ideal model" of posture and motion.

Assessments used by human movement professionals can be divided into three broad categories:
<ul>
 	<li>"Clear" the Patient/Client for Intervention - These are tests, assessments and evaluations used to determine if a patient/client's issue may improve given the assessing professional's scope, skills, abilities and willingness to treat that individual.
<ul>
 	<li>For example, many of the special tests used in orthopedic medicine assist in determining the level of pathology or likelihood of a particular diagnosis. Certain issues and diagnoses are beyond the scope of the human movement professional, and are better treated by diagnostic professionals in the medical community (physicians, podiatrists, surgeons, etc.). A Calf Squeeze (Thompson) Test is one example, in which a positive sign may indicate a rupture of the Achilles tendon that may be better treated via surgical intervention.</li>
</ul>
</li>
 	<li>Highlight Contraindications - Tests, assessments and evaluations used to stratify risk or preclude a professional from addressing certain tissues, motions or using a particular technique.
<ul>
 	<li>For example, the Vertebral Artery Test (VBI) is often used to determine if high velocity thrust mobilizations (manipulations) are safe for a patient with cervical dysfunction.</li>
</ul>
</li>
 	<li>Refine Exercise/Intervention Selection: Tests, assessments and evaluations used to assist the professional in determining which techniques, modalities and exercises will best address a patient/client's complaints or desired goals.
<ul>
 	<li>Most movement assessments fall into this category. For example, a positive <a href="https://brentbrookbush.com/vimeo_videos/elys-test-rectus-femoris-flexibility-assessment/" target="_blank">Ely's Test</a> may indicate a need to release and/or lengthen the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/rectus-femoris/" target="_blank">rectus femoris</a>.</li>
</ul>
</li>
</ul>
Note: An assessment, or assessment result, may fall into more than one category. For example, although goniometry is an assessment most often used to Refine Exercise/Intervention Selection, if a range of motion is significantly altered, with an abnormal end-feel, and/or causes the patient or client/pain, the individual may need to be referred to a physician for further testing and Clearance to resume rehab activities.  Further, that same patient may return to the human movement professional with a list of Contraindicated Activities from the physician. - "When in doubt, refer out!"

Axial Skeleton - referring to the bones of the head, neck, trunk and spinal column (does not include pelvis). There are approximately 80 bones in the axial skeleton.
<ul>
 	<li>Etymology - Axial, as in "axis", referring to "imaginary motionless straight line around which a body (such as the Earth) rotates," from Latin axis "axle, pivot, axis of the earth or sky" - <a href="https://www.etymonline.com/word/axis" target="_blank" rel="noopener">Etymology Online</a></li>
</ul>
"Axial skeleton" is a label referring to a set of bones whose function is distinct from the bones of the "<a href="https://brentbrookbush.com/glossary/appendicular-skeleton/" target="_blank" rel="noopener">appendicular skeleton</a>".

Balance - The ability to maintain a body’s center of mass over its base of support. Balance can be static or dynamic.
<ul>
 	<li>For example, maintaining balance is harder on one leg because the center of mass must stay over a much smaller base of support.</li>
</ul>

A ball and socket joint (also called a spheroid joint or spheroidal joint) is a synovial joint in which the rounded or spherical end of one bone fits into a cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. Examples include the hip and shoulder (glenohumeral joint)

Base of support (BoS) - refers to the area beneath an object or person, and the area within the perimeter created by every point of contact that the object or person makes with the supporting surface. This may include the <a href="https://brentbrookbush.com/articles/anatomy-articles/muscular-anatomy/gluteus-maximus/" target="_blank" rel="noopener">glutes</a> of someone sitting on a chair, or the back of someone leaning against a wall.
<ul>
 	<li>For example, during a single leg balance the BoS is the area of the foot in contact with the surface; however, when a person is standing on two feet, the BoS is the area of both feet and the surface between them.</li>
</ul>

Pertaining to both sides

Example, bilateral rows are performed with both arms at the same time.

Case-control Study - a particular form of retrospective study that samples a matched group of people who have, and do not have the outcome being studied. A case-control study is a quasi-experimental design, often used in medicine to aid in determining potential contributing factors (cannot determine causality). In this study type exposure is the dependent variable and outcome is independent.
<ul>
 	<li>Example, in this retrospective case-control, medical records were investigated for trends correlated with cervical pain (1).
<ol>
 	<li>Mäkela, M., Heliövaara, M., Sievers, K., Impivaara, O., Knekt, P., &amp; Aromaa, A. (1991). Prevalence, determinants, and consequences of chronic neck pain in Finland. American journal of epidemiology, 134(11), 1356-1367.</li>
</ol>
</li>
</ul>

An anatomical direction; toward the tail, relative to humans this term is often used to refer to "in the direction of the tale (toward the feet)".

Example, to release the trapezius muscle the therapist used a force directed caudally.

Center of mass (CoM) - an object's mean position of mass; that is, a point that is perfectly surrounded by an equal amount mass in all directions.

Center of gravity (CoG) - point where gravity appears to act. Since the human body is so small compared to the earth, we can assume gravity acts uniformly on the body, and that CoG and CoM are the same.
<ul>
 	<li>Example, the CoM of the human body while lying down or standing straight up is close to our navel. However, it is possible that during a resistance exercise, the combination of the body's weight and the weight of the resistance will place the combined CoM outside the body. For example, during the mid-portion of a <a href="https://brentbrookbush.com/vimeo_videos/back-squat/" target="_blank" rel="noopener">back squat</a> the CoM would be several anterior to the naval.</li>
</ul>

An anatomical direction; toward the head (synonym: cranial)

Example, hip pain was felt with any force directed cephalad.

Cohort Study - a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic), performing a cross-section at intervals through-out a period of time. A cohort study is a quasi-experimental design often used in medicine to aid in determining etiology or a cause-and-effect relationship. In this study type exposure is the independent variable and outcome is dependent.
<ul>
 	<li>Example, the study by Cholewicki et al. (1) investigated Yale Varsity Athletes (the cohort) with 2 and 3 year follow up (longitudinal design) and found that trunk muscle response time to off-loading was predictive of future low back injury.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/core/increased-trunk-muscle-latency-may-cause-rather-than-result-from-low-back-pain/" target="_blank" rel="noopener noreferrer">Cholewicki, J., Silfies, S., Shah, R., Greene, H., Reeves, N. Alvi, K., Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 30(23), 2614-2620</a></li>
</ol>

Comparable Sign: A combination of pain, stiffness and/or spasm during examination that is comparable to the patients symptoms.
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

An alternative movement pattern that has been adopted to compensate for dysfunction/impairment in the human movement system.
Example: A lack of calf extensibility may limit dorsiflexion, leading to the knees bowing inward (functional valgus) and excessive forward lean of the torso during a squat.

An arthrokinematic motion - the approximation of joint surfaces; that is, a force that directs one bone surface into another resulting in a reduction in intra-articular volume. Although widely thought of as a "destructive force", it is likely best to consider compression as a naturally occurring, stabilizing force. Any arthrokinematic force in excess (spin, glide, roll, traction) may be viewed as potentially deleterious.

For example, during a squat the femoral head is compressed into the acetabulum by muscular forces, bodyweight and any additional external load.

Concave (Concavity) - Having an outline or surface curved like the interior surface of a bowl or sphere - to cave-in or curve inward.
<ul>
 	<li>Example, the internal surfaces of the pelvis is concave, holding some of the bodies viscera.</li>
</ul>

Concordant Sign - The patient's specific pain, symptom or complaint. 
<ul>
 	<li>One common error made during evaluation with special tests is attention given to any discomfort or pain, rather than attempting to identify the pain/discomfort related to the patient's complaint (concordant/comparable sign). Many special tests purposefully test tissue limits and are at least mildly uncomfortable in every individual. Basing your assessment on positive tests that resulted in "concordant/comparable signs" will improve your chances of arriving at the correct diagnosis.</li>
</ul>

Conductivity: Stimulation results in more than a local effect (1).
<ul>
 	<li>For example, in a muscle cell the stimulation of a motor endplate results in a change in cell membrane polarity that rapidly propagates (is conducted) along the entire length of the muscle cell, stimulating all sacromere.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

A condyloid joint (also called condylar, bicondylar, ellipsoid, or ellipsoidal) is an ovoid articular surface, or condyle, that is received into an elliptical cavity.  These joints permit movement in two planes.  Examples include the knee, metacarpophalangeal joints and metatarsophalangeal joints.

Connective Tissue Cell - One of the four basic types of animal tissue, consisting mostly fibers and ground substance.  These cells are specialized to binds organs together, holds them in place, protect them from external forces, and may fill space in the body's cavities.

Example, the body's muscles are enclosed in durable connective tissue sheets known as the "epimysium", "perimysium", and "endomysium," which and in support and transmitting force.
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Contractility: The ability to shorten (1).
<ul>
 	<li>Contractility: Muscle cells are unique in the amount they can shorten when stimulated; this is this largerly due to the highly organized and unique arrangement of myofilaments (actin and myosin).</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Pertaining to the opposite side

Example, the external oblique muscle performs contralateral rotation; rotation to the opposite side.

Convex (Convexity) - Having an outline or surface curved like the exterior of a circle or sphere - to bulge or curve outward.
<ul>
 	<li>Example, the top of your head is shaped by the convex exterior surface of your skull.</li>
</ul>

Correlational Research - Non-experimental <a href="https://www.questionpro.com/blog/what-is-research/">research</a> method in which the statistical relationship between two variables is investigated.
<ul>
 	<li>In this research by Kwon et al., a correlation was noted between a decrease in extensibility during a hamstring length test (goniometry) and current knee pain (1).</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/correlation-patellofemoral-pain-syndrome-pfps-hamstring-activity/" target="_blank" rel="noopener">Kwon O, Yun M, and Lee W. (2014). Correlation between intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. J. Phys. Ther. Sci. 26: 961-964</a></li>
</ol>

Counter-nutation - posterior rotation of sacrum relative to ilium, and/or anterior rotation of ilium relative to sacrum.
<ul>
 	<li>The pelvic floor muscles are examples of muscle that may counter-nutate the sacrum.</li>
</ul>
[caption id="attachment_126335" align="aligncenter" width="400"]<a href="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png"><img class=" wp-image-126335" src="https://brentbrookbush.com/wp-content/uploads/2018/10/Nutation.png" alt="Nutation and Counter-nutation of the Sacroiliac Joint" width="400" height="967" /></a> Nutation and Counter-nutation of the Sacroiliac Joint[/caption]

&nbsp;

Crossover (Study) Design - A type of longitudinal, repeated measures quasi-experimental design in which each group receives both treatments, but at different times. It is named "crossover" due to the patients "crossing-over" to the other treatment or sham group after a specified period of time.
<ul>
 	<li>This type of study has the advantage of every individual serving as their own control, which may reduce the influence of confounding variables.</li>
 	<li>Unfortunately, the design itself introduces the chances that anyone receiving the experimental variable in the first period will continue to be effected in the second period.</li>
</ul>
In a study by Senna et al., a cross-over design was used to investigate the difference load made on inter-set rest intervals (1).
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/strength-training-research-corner/heavy-vs-light-load-single-joint-exercise-performance-with-different-rest-periods/" target="_blank" rel="noopener">Senna, G.W., Rodrigues, B.M., Sandy, Scudese, Bianco, A, &amp; Dantas, E.H.M. (2017). Heavy vs light load single-joint exercise performance with different intervals. Journal of Human Kinetics, 58, 197-206. </a></li>
</ol>

Cross-sectional Study - a research design that involves gathering data from a population or representative subset at a specific point in time.
<ul>
 	<li>Example, the study by Karimi-Mobarake et al.(1) investigated the prevalence of genu varum and genu valgum among school children 7-11 years old in Iran.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/low-prevalence-of-genu-varum-and-valgum-among-elementary-school-children/" target="_blank" rel="noopener noreferrer">Karimi-Mobarake, M., Kashefipour, A., Yousfnejad, Z. The prevalence of genu varum and genu valgum in primary school children in Iran 2003-2004. (2005) Journal of Medical Science 5(1). 52-54</a></li>
</ol>

Cytokine - A broad and loose category of small proteins that act through receptors, and are especially important to immune function (inflammation).
<ul>
 	<li>Cytokines include substances such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells. Their definite distinction from hormones is a topic of continued research.</li>
</ul>
&nbsp;

Dependent variable - in research, this is the variable that is changed by the independent variable, most often this is the "outcome" of the study.
<ul>
 	<li>Example, in the study by Cleland et al. (1), the independent variable is "thoracic manipulation," and the dependent variable is "lower trapezius muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/short-term-effects-lower-thoracic-manipulation-lower-trapezius-muscle-strength/" target="_blank" rel="noopener noreferrer">Cleland J, Selleck B, Stowell T, Brown L, Alberini S, St. Cyr H, Caron T. Short-term Effects of Thoracic Manipulation on Lower Trapezius Muscle Strength.  Journal of Manual &amp; Manipulative Therapy. 2004; 12(2): 82-90</a></li>
</ol>

An anatomical direction; further from the trunk or center of the body

Example, the foot is at the distal end of the leg.

An arthrokinematic motion - a force applied to a body part that may result in the separation of joint surfaces, a reduction in intra-articular pressure, and/or an increase in intra-articlar space.

For example, to hang from one's hands (i.g. in preparation for a pull-up) results in a traction force on the glenohumeral joint (shoulder).

An anatomical term of location; back or upper surface

Example, shoe laces may compress tissues on the dorsal surface of the foot

The "drawing-in" maneuver is a common cue used during exercise and rehabilitation programs. A light contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abominis</a> (and potentially the entire <a href="https://brentbrookbush.com/articles/corrective-exercise-articles/core-subsystems/intrinsic-stabilization-subsystem/" target="_blank" rel="noopener">intrinsic stabilization subsystem</a>) achieved by gently pulling the lower abdominal region away from one's waist band. This should have minimal effect on breathing, and should not be confused with a maximal contraction of the <a href="https://brentbrookbush.com/articles/muscular-anatomy/transverse-abdominis/" target="_blank" rel="noopener">transverse abdominis</a> resulting in a "vacuum pose".
<ul>
 	<li>Research often refers to this maneuver as the "abdominal drawing-in maneuver"; abbreviated ADIM.</li>
</ul>
Development and introduction of this cue into practice is based on the pivotal research and resulting text:
<ol>
 	<li>Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004</li>
</ol>

Faulty or abnormal movement; an alteration of normal kinematics.

For example, joint stiffness or a reduction in arthrokinematics motion that results in limited osteokinematic range of motion - inadequate inferior glide of the femoral head resulting in limited abduction of the hip.

The seeping into, or abnormal collection of fluid in a body cavity.

For example, knee effusion describes swelling within the knee joint.

Note: the word "effusion" is used differently in medicine than it is used in reference to the movement (seeping out) of liquids and gases, for example in chemistry.

&nbsp;

A trait of body tissues that allows a tissue to return to its resting length or state after deformation or stretch.
Example:  Muscle is elastic tissue; many muscles will return to their resting length after being stretched to 150% of that length without any appreciable change in tissue quality.

Elasticity: Elasticity refers to the ability of a cell to return to its resting length after being stretched/lengthened.
<ul>
 	<li>Note: this term is often confused with extensibility. Elasticity is not the ability to stretch; it is the ability to return to normal length after being stretched. Muscle tissue, connective tissue and even nerve tissue have varying levels of elasticity.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Epithelial cell - One of the four basic cell types, found lining the body's cavities, blood vessels, organs and constitutes most gland tissue.  These cells are specialized to aid with absorption, secretion, or act as a barrier from foreign objects.
<ol>
 	<li>Saladin, K. S., &amp; Miller, L. (1998). Anatomy &amp; physiology. New York (NY): WCB/McGraw-Hill.</li>
</ol>

Equilibrium - a state in which opposing forces or influences are balanced.
<ul>
 	<li>For example, to maintain a neutral trunk while pushing or pulling a weight in one hand, your core musculature must balance the force by creating an equal amount of force in the opposite direction.</li>
</ul>

The study of causation, or origination. The word is commonly used in the medical professions, where it may refer to the study of why things occur, or the reason behind why things act a certain way.

For example, the etiology of low back pain is a complex subject, with multiple contributing factors and various structures implicated.

<div class="gs_citr" tabindex="0">Evidence-based medicine (practice) is the integration of best research evidence with clinical expertise and patient(client) values (2)."</div>
<ul>
 	<li class="gs_citr" tabindex="0">...the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (clients).  It involves the integration of at least (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (1).</li>
</ul>
&nbsp;
<ol>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., &amp; Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. Bmj, 312(7023), 71-72.</li>
 	<li class="gs_citr" tabindex="0">Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh, 2000, p.1</li>
</ol>

Excitability: The ability of a cell to change in membrane conductance as a response to stimulation.

<ul>
 	<li>For example, muscle cells are specialized to react to a change in membrane potential with contraction, where as nerve cells are specialized to propagate a change in membrane potential along there axons and communicate that message to other tissues via neurotransmitters.
</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

Excitation threshold: The level that a depolarization must reach for an action potential to occur.
<ul>
 	<li>The excitation threshold is a contributing factor to the "all-or-none" response of muscle and nerves cells to a stimulus.</li>
</ul>

Exercise Progression - Modification of an exercise with the intent of promoting adaptation by increasing demand. This can be accomplished by increasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise progression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise, or series of exercises that make it harder to maintain stability with good form.
<ul>
 	<li>Sample Exercise Progression: <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a></li>
</ul>
</li>
</ul>

Exercise regression - The opposite of progression; that is, modification of an exercise with the intent of reducing demand. This can be accomplished by decreasing reps, load, tempo, range of motion, complexity, and/or challenge to an individual's stability. Generally, regressions are used to modify an exercise to the client's current level of ability, with the intent of improving form, motor learning and retention.
<ul>
 	<li>Because load, reps, tempo and complexity are often explicitly noted, the term "exercise regression" is most often used throughout Brookbush Institute (BI) content to refer to an exercise or series of exercises that make it easier to maintain stability with good form.
<ul>
 	<li>Sample Exercise Regression: <a href="https://brentbrookbush.com/vimeo_videos/single-leg-chop-pattern/" target="_blank" rel="noopener">Single-leg Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/static-standing-chop-pattern/" target="_blank" rel="noopener">Standing Chop</a> to <a href="https://brentbrookbush.com/vimeo_videos/kneeling-chop-pattern/" target="_blank" rel="noopener">Kneeling Chop</a></li>
</ul>
</li>
</ul>

Experimental Research - Studies in which the researchers introduce the variable to be studied, with the intent of observing the outcome. This is different than observational research which observes the effect of a variable already present. Many texts also assert that experimental research should include randomization and ideally a control group, as is seen in Randomized Control Trials. Studies in which the variable is introduced by the researchers, but participants are not randomized may be considered Quasi-experimental research.
<ul>
 	<li>In this study by Esformes, the experimental variable was squat depth and the outcome measures observed were various performance measures related to power (1).</li>
</ul>
<ol>
 	<li><a href="https://brookbushinstitute.com/article/back-squat-depth-lower-body-post-activation-potentiation/" target="_blank" rel="noopener">Esformes, J., &amp; Bampouras, T. (2013). Effect of back squat depth on lower-body postactivation potentiation. Journal of Strength and Conditioning Research, 27(11), 2997-3000.</a></li>
</ol>
&nbsp;

Extensibility: The ability of a cell to be stretched or lengthened without damage (1).
<ul>
 	<li>For example, most cells would rupture with even a modest stretch, but muscles can stretch up to 3 times their contracted length.</li>
</ul>
<ol>
 	<li>Saladin, K. (2012). Anatomy &amp; Physiology: The unity of form and function. (6th ed.). New York: McGraw-Hill.</li>
</ol>

False Negative - the proportion of negatives in a group that were assessed incorrectly (assessed as negative when the patient was actually positive)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

False Positive - the proportion of positives in a group that were assessed incorrectly (assessed as positive when the patient was actually negative)
<ul>
 	<li>Test Results: Although most tests/assessments result in either a positive or negative, the accuracy of a test is dependent on the number  of positives and negatives that are correct. Therefore, when the accuracy of a test is determined, their are 4 possible results, because a positive or negative result could be right (true) or wrong (false).</li>
</ul>

The function of fascia is to transmit force, provide support, and protect tissues. Fascia can effect motion by:
Transmitting force from one or more muscles (example: the thoracolumbar fascia)
Restricting motion in cases of adaptive shortening and/or adhesion to proximal structures (example: iliotibial band in cases of lower-leg dysfunction)
Elastic recoil after stretching can contribute to force production (example: plyometric exercise)

Note: There is evidence that fascia may house more receptors related to human movement than other tissues. In this way fascia may act as a motherboard for the nervous system

The fascial system does not contract or develop trigger points, and its capacity to adapt to stretching and or strengthening exercise is limited, especially when compared to the adaptive capacity of muscle tissue.

Fibromyalgia - A loosely defined diagnosis that is associated with a combination of widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. Consideration may also be given to the presence of psychosocial stressors and inflammatory disease in the patients history. Newer research suggests that fibromyalgia may be at least in part due to central sensitization of myofascial pain, often associated with trigger points (1 - 4).
<ol>
 	<li>Wolfe, F. (2018). Fibromyalgia Syndrome and Fibromyalgia Syndrome Criteria: Problems in Definition and Validity. Fibromyalgia Syndrome and Widespread Pain: From Construction to Relevant Recognition.</li>
 	<li>Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., ... &amp; Fam, A. G. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis &amp; Rheumatism: Official Journal of the American College of Rheumatology, 33(2), 160-172.</li>
 	<li>Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., Zarco-Moreno, P., Ge, H. Y., &amp; Florez-García, M. (2011). Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. The Clinical journal of pain, 27(5), 405-413.</li>
 	<li>Staud, R., Nagel, S., Robinson, M. E., &amp; Price, D. D. (2009). Enhanced central pain processing of fibromyalgia patients is maintained by muscle afferent input: a randomized, double-blind, placebo-controlled study. PAIN®, 145(1-2), 96-104.</li>
</ol>
&nbsp;

Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.
Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.

An increase in joint stability via compressive forces resulting from muscular contraction and increased tension in fascial structures (1,2).
<ul>
 	<li>This term is most often used in reference to core intrinsic stabilizers, the thoracolumbar fascia and the sacroiliac joint; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Form closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

The relative contribution of joint shape and structure to the stability of a joint (1,2).
<ul>
 	<li>This term is most often used in reference to the "rough" articulating surfaces of the sacroiliac joint and the wedge shape of the sacrum; however, force closure and form closure have been mentioned in the literature referring to other joints.</li>
 	<li>Related term: Force closure</li>
</ul>
<ol>
 	<li>Andry Vleeming, Vert Mooney, Rob Stoeckart. Movement, Stability &amp; Lumbopelvic Pain: <a class="glossaryLink " title="Glossary: Integration" href="https://brentbrookbush.com/glossary/integration/" target="_blank" rel="noopener noreferrer" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Integration&lt;/div&gt;&lt;div class=glossaryItemBody&gt;Making a whole of parts.&lt;br /&gt;&lt;br /&gt;Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.&lt;/div&gt;">Integration</a> of Research and Therapy. (c) 2007 Elsevier Limited</li>
 	<li id="gs_cit1" class="gs_citr" tabindex="0">Vleeming, A., Pool-Goudzwaard, A. L., Stoeckart, R., van Wingerden, J. P., &amp; Snijders, C. J. (1995). The Posterior Layer of the Thoracolumbar Fascia| Its Function in Load Transfer From Spine to Legs. Spine, 20(7), 753-758.</li>
</ol>

An arthrokinematic motion - linear motion across a joint surface parallel to the plane of the adjacent joint surface, just as your posterior moves relative to a "slide" in a park.

For example, the glide of facet joint in the spine during spinal flexion and extension, or the posterior glide of the humeral head that must accompany anterior roll to maintain congruence with glenoid fossa during shoulder horizontal adduction.

A plane joint (also called an arthrodial joint, gliding joint or plane articulation) is a synovial joint which allows only gliding movement in the plane of the articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement generally limited by tight capsules and ligaments. Plane joints are numerous, are most often small, and allow very little motion.  Examples include the carpal joints of the wrist, the tarsal joints of the ankle, and the facet joints of the spine.

"...refers to the measurement of angles, in particular the measurement of angles created at human joints by the bones of the body (1).

&nbsp;
<ol>
 	<li>Cynthia C. Norkin, D. Joyce White. Measurement of Joint Motion: A Guide to Goniometry 3rd Edition. Copyright (C) 2003 by F.A. Davis Company</li>
</ol>

Ground reaction force (GRF) - The force exerted by the ground on the body in contact with it.

For example, when a runner's foot strikes the ground with a force equal to the mass of the individual times their acceleration due to gravity, momentum and muscular exertion, the ground exerts an equal and opposite force on the runner's foot.
<ul>
 	<li>GRF is often measured in research studies using force plates as a means of quantitatively measuring the force generated by an individual.</li>
</ul>

H-Band - Refers to the central zone of a sarcomere that looks lighter under a microscope.  This area of the sarcomere is a lighter portion of the A-band where there is no overlap between the thinner filaments (actin), and the thicker filaments (myosin).
<ul>
 	<li>Example, when a muscle contracts, actin and myosin cross-bridging occurs in the region of the A-band until the H-band is reached where no overlap occurs.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

A hinge joint (also called a ginglymus) is a synovial joint in which the articular surfaces fit one another in a way that only permits motion in one plane. Examples include the elbow, the knee (unless considered a condyloid joint) and the interphalangeal joints.

Holism (holistic) (biological holism) - (from Greek holos "all, whole, entire") is the idea that systems and their properties should be viewed as wholes, not just as a collection of parts.
<ul>
 	<li>Summarized by Aristotle in his "Metaphysics": "The whole is more than the sum of its parts". However, the term "holism" was introduced into language by the South African statesman Jan Smuts as recently as 1926. (Smuts J. C. 1987 [1926]. Holism and evolution. Cape Town: N &amp; S Press.)</li>
</ul>
Example: The Brookbush Institute promotes a holistic approach to human movement science, in which the muscular, fascial, articular and neural systems are not viewed as separable and all proximal segments are considered.

Hormone: Chemical messengers produced by the endocrine system, transported via tissue fluids such as blood, to stimulate cells to "act."
<ul>
 	<li>Example: Growth hormone is secreted by the pituitary gland in the brain; stimulating growth, cell reproduction and cell regeneration in certain types of cells</li>
</ul>
The English physician E. H. Starling discovered in collaboration with the physiologist W. M. Bayliss secretin, the first hormone, in 1902. (1).
<ol>
 	<li>Henriksen, J. H., &amp; de Muckadell, O. S. (2000). Secretin, its discovery, and the introduction of the hormone concept. Scandinavian journal of clinical and laboratory investigation, 60(6), 463-472.</li>
</ol>

A range of motion achieved by the patient/client that is more than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If an individual can place their forehead on their knees they are likely hypermobile at one, if not several joints

Example 2: 110° of shoulder external rotation would be considered hyper-mobile.

Hyperplasia is an increase in organic tissue size due to an adaptive increase in the number of cells per organ.
<ul>
 	<li>Although muscle hyperplasia has been noted in some animals, human muscle tissue does not seem to have this adaptive ability.</li>
</ul>

A condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.  May be related to increased neural drive, synergistic dominance, trigger points, reflexive over-activity, and/or muscle length.
Example:  Individuals who exhibit ankle eversion and abduction during an overhead squat assessment likely have hypertonic fibularis (peroneal) muscles.

Muscular hypertrophy is an increase in muscle mass/size due to increase in the volume and cross-sectional area (CSA) of individual muscle cells. The increase in cross-sectional area can be attributed to an an increase in contractile proteins and structural elements (myofibrillar hypertophy), as well as an increase in glycogen storage and elements related to metabolism (sarcoplasmic hypertophy). Hypertrophy is an adaptation of both cardiac and skeletal muscle fibers in response to progressive increases in workload.
<ul>
 	<li>Note: Hypertrophy is not hyperplasia. Hyperplasia is an increase in muscle size due to an adaptive increase in the number of muscle fibers/cells per muscle. This type of adaptation does not occur in human muscle tissue.</li>
</ul>

A range of motion achieved by a patient/client that is less than normal.
<ul>
 	<li>Note: Both hyper-mobility and hypo-mobility may adversely affect motion and may lead to deleterious effects on joints and soft tissue over time. There is no evidence to suggest that more or less flexibility than normal is beneficial.</li>
</ul>
Example: If the end range of shoulder external rotation is reached and measured as 75° during goniometric assessment, the client/patient is exhibiting hypomobility of the glenohumeral joint (shoulder).

Hypothesis - a proposed explanation for a phenomenon; "scientific hypotheses" are generally constructed in a way that is testable or falsifiable.
<ul>
 	<li>Example: The hypothesis, "excessive knee valgus may be correlated with future knee pain and injury," has been the subject of several studies published over the last decade.</li>
</ul>

Diminished tone of skeletal muscles; diminished resistance of muscles to passive stretching.   May be related to inhibition, reciprocal inhibition, arthrokinematics inhibition and/or  increased resting length of muscle.
Example:  If your knees cave (hip adduction) during a squat or leg-press it is likely that your gluteus medius is hypotonic.

I-Band - Refers to the part of the muscle cell that looks lighter under a microscope.  This area of the cell is lighter due to parallel arrangement of thinner filaments (actin), and no overlap with the thicker filaments (myosin).
<ul>
 	<li>As a muscle contracts, the I-bands will decrease in width and move closer to one another.</li>
</ul>
<ol>
 	<li>Saladin, K. (2014). Anatomy &amp; physiology: The unity of form and function. McGraw-Hill Higher Education, New York. ISBN: 9780073403717</li>
</ol>

Independent variable - in research, this is the variable or phenomenon being manipulated in the study.
<ul>
 	<li>Example, in the study by Ghanbari et al. (1), the independent variable is "knee joint mobilization", the dependent variable is "quadriceps muscle strength."</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/effect-knee-joint-mobilization-quadriceps-muscle-strength/" target="_blank" rel="noopener noreferrer">Ghanbari A. and Kamalgharibi S. (2013). Effect of knee joint mobilization on quadriceps muscle strength. International Journal of Health and Rehabilitation Sciences. 2(4): 186-191</a></li>
</ol>

An anatomical direction; toward the bottom (below)

Example, the mouth is inferior to the eyes

A reduction in neural drive, muscular activity, and or force output due to altered neuromuscular reflex.  Alterations in neuromuscular reflex may occur due to increases in muscle length (hypothesis: increased excitation threshold), altered reciprocal inhibition in response to increased antagonist tone, and or alterations in joint motion (arthrokinematics inhibition).

Making a whole of parts.

Example, The Brookbush Institute uses an integrative approach to explaining and addressing human movement.

Intermuscular Coordination - Optimal timing and motor unit recruitment of agonists, antagonists, synergists, neutralizers, stabilizers and fixators.

Example: Role of Muscles during Hip Extension
<ul>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Prime Mover" href="https://brentbrookbush.com/glossary/prime-mover/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Prime Mover&lt;/div&gt;The muscle most responsible for a joint action under load -&lt;br /&gt;&lt;br /&gt;That is, the muscle that can produce the most force for a given joint action. Often this term is used synonymously with the term agonist. The prime mover as defined above, may or may not be the most active muscle for a joint action during activities of daily living.&lt;br /&gt;&lt;br /&gt;Example: the gluteus maximus is the most powerful hip extensor and therefore the prime mover; however, the hamstrings are likely the most active hip extensors during low level activities like walking or standing.">Prime Mover</a>:  <a href="https://player.vimeo.com/external/82855344.hd.mp4?s=54c3e7d98fb9d4e0af8d282c85ba9b3e">Gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Synergists" href="https://brentbrookbush.com/glossary/synergists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Synergists&lt;/div&gt;Muscles that assist the prime mover in performing a joint action.&lt;br /&gt;&lt;br /&gt;That is, all muscles that can perform a joint action that are not the prime mover, are termed synergists.&lt;br /&gt;Example: The rectus abdominis is the prime mover of spinal flexion. All other muscles that can perform spinal flexion are synergists including – external obliques, internal obliques and psoas.">Synergists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/biceps-femoris/">Biceps femoris (long head)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/semitendinosus-and-semimembranosus/">semitendinosus, semimembranosus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">posterior head of adductor magnus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Antagonist" href="https://brentbrookbush.com/glossary/antagonists/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Antagonist&lt;/div&gt;Muscles that oppose the prime mover and synergists for a given joint action.&lt;br /&gt;&lt;br /&gt;That is, all the muscles that can perform the opposing joint action.&lt;br /&gt;&lt;br /&gt;Example: The triceps and anconeus are antagonists during elbow flexion.">Antagonists</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/psoas/">Psoas</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/iliacus/">iliacus</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/tensor-fascia-latae-tfl/">tensor fascia latae</a> (TFL),<a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-femoris/"> rectus femoris</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/adductors/">anterior adductors (especially pectineus)</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/sartorius/">sartorius</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Neutralizer" href="https://brentbrookbush.com/glossary/neutralizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Neutralizer&lt;/div&gt;Muscles that oppose unwanted joint motions created by the prime mover and/or synergists, and/or muscles that prevent unwanted ancillary motion.&lt;br /&gt;Example: The teres minor and infraspinatus neutralize the internal rotation force created by the pectoralis major during horizontal adduction of the shoulder.">Neutralizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-minimus/">Gluteus minimus</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-medius/">anterior fibers of gluteus medius</a> neutralize external rotation force of <a href="https://brentbrookbush.com/articles/muscular-anatomy/gluteus-maximus/">gluteus maximus</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Stabilizer" href="https://brentbrookbush.com/glossary/stabilizers/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Stabilizer&lt;/div&gt;Muscles whose primary role is to improve arthrokinematics by maintaining optimal alignment of joint surfaces.&lt;br /&gt;&lt;br /&gt;Most often these muscles are the most intrinsic muscles of a joint, have a larger percentage of Type I muscle fibers and are rich in proprioceptors.&lt;br /&gt;Example: The muscles of the rotator cuff act as stabilizers for most shoulder motions.">Stabilizers</a>: <a href="https://brentbrookbush.com/articles/muscular-anatomy/deep-rotators-of-the-hip/">Deep rotators of hip</a></li>
 	<li><a class="glossaryLink " style="box-sizing: border-box; font-family: roboto; color: #000000 !important; font-size: 15px; outline: none; background: transparent; border-bottom: 1px dotted #000000 !important; text-decoration: none;" title="Glossary: Fixator" href="https://brentbrookbush.com/glossary/fixators/" target="_blank" rel="noopener" data-cmtooltip="&lt;div class=glossaryItemTitle&gt;Fixator&lt;/div&gt;Muscles that act to reduce or prevent movement at proximal joints to improve force transmission.&lt;br /&gt;Example: The muscles of the core are important fixators; reducing motion of the spine/trunk to enhance force transmission between the extremities and environment.">Fixators</a>: <a href="https://brentbrookbush.com/articles/core-subsystems/intrinsic-stabilization-subsystem/">Intrinsic stabilization subsystem</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/rectus-abdominis/">rectus abdominis</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/internal-obliques/">internal</a> and <a href="https://brentbrookbush.com/articles/muscular-anatomy/external-obliques/">external obliques</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/quadratus-lumborum/">quadratus lumborum</a>, <a href="https://brentbrookbush.com/articles/muscular-anatomy/erector-spinae/">erector spinae</a></li>
</ul>
&nbsp;

Example from: <a href="https://brentbrookbush.com/articles/anatomy-articles/introduction-to-functional-anatomy/kinesiology-of-the-hip/" target="_blank" rel="noopener">Introduction to Functional Anatomy: Kinesiology of the Hip</a>

Intramuscular coordination refers to the coordinated recruitment of motor units within a single muscle. This concept is used to explain increases in maximal strength and power; however, the coordinated and sequential recruitment of motor units is also essential to strength endurance and smooth coordinated motion.  Related terminology may include; motor unit recruitment, preferential recruitment, rate coding, sequence, etc..

Example: It is hypothesized that the "shaking" noted during a novice exercisers attempt at an activity like the <a href="https://brentbrookbush.com/vimeo_videos/ball-crunch-and-progressions/" target="_blank">stability ball crunch</a> may be due to relatively poor intramuscular coordination. Rather than smooth, sequential firing of rectus abdominis motor units, groups of motor units turn on and off in an uncoordinated manner.

Pertaining to the same side

Example, the quadratus lumborum performs ipsilateral flexion; lateral flexion toward the same side as the muscle.

An isoform, or variant, is a member of a set of similar proteins, that originate from the same gene, or gene family.
<ul>
 	<li>Example, the variations in myosin heavy chain proteins (MHC I, MHC IIA, MHC IIB/X) that contribute to the characteristic differences between muscle fiber types.</li>
</ul>

“The Prime Assumption”
Everything crossing a joint will influence joint motion during every joint action.

A concept that has expanded over the past several decades to describe the integration of 4 body systems (muscle, joints, fascia and nerves), as well as, the coordinated function of various body segments (e.g. hip, knee and ankle) to produce motion. Kinetic referring to motion, and chain being an analogy for the interdependent link between systems.

Example, the posterior kinetic chain, refers to the integrated function of nerves, muscles, fascia and joints on the posterior side of the body.

The concept of the kinetic chain was originally adapted from the work of a mechanical engineer named Franz Reuleaux (Kinematics of Machinery (1875)) by Dr. Arthur Steindler in 1955 (Steindler A: Kinesiology of the Human Body. Springfield, IL, Charles C. Thomas Co.. 1955).

Latent Trigger Point - A myofascial trigger point that is not painful at rest, only painful when palpated, and may or may not exhibit a characteristic referral pain pattern when palpated.  Latent trigger points do result in an acute point of sensitivity, in a taut band of muscle, and may restrict range of motion (1).

Note: Based on the clinical experience, the Brookbush Institute suggests that latent trigger points (sometimes refereed to as Tender Points) are more common than active trigger points. Further, they are likely addressed more often than trigger points; being the intended target of many soft-tissue mobility techniques.
<ol>
 	<li>David G. Simons, Janet Travell, Lois S. Simons, Travell &amp; Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens</li>
</ol>

An anatomical direction; further from the midline

Example, the anterior deltoid is lateral to the pectoralis major

Length/Tension Relationship - The amount of force generated by a muscle is dependent on sarcomere length.
<ul>
 	<li>The ability of sarcomere to maximally produce force occurs when sarcomere length results in optimal overlap between actin and myosin. Stretching a sarcomere decreases overlap between actin and myosin filaments and reduces force production (1-3). When length is less than optimal, actin from opposite ends overlap and interfere with cross-bridging, and myosin filament are compressed as they contact the the Z-disk also reducing force (4)</li>
</ul>
<ol>
 	<li>Gordon, A. M., Huxley, A. F., &amp; Julian, F. J. (1966). The variation in isometric tension with sarcomere length in vertebrate muscle fibres. The Journal of physiology, 184(1), 170-192.</li>
 	<li>Edman, K. A. P. (1966). The relation between sarcomere length and active tension in isolated semitendinosus fibres of the frog. The Journal of Physiology, 183(2), 407-417.</li>
 	<li>Lieber, R. L., Loren, G. J., &amp; Friden, J. (1994). In vivo measurement of human wrist extensor muscle sarcomere length changes. Journal of neurophysiology, 71(3), 874-881.</li>
 	<li>Lieber, R. L. (2002). Skeletal muscle structure, function, and plasticity. Lippincott Williams &amp; Wilkins.</li>
</ol>
&nbsp;

Levels of Evidence - Relative to evidence-based practice, levels of evidence are an attempt to describe the strength of the results measured in a clinical trial or research study.  Note: levels of evidence do not supersede the critical evaluation of an experienced professional, and should be viewed as guidelines - a meta-analysis may be poorly constructed (Level IA), and a comparative study (Level III) may employ new technologies and a strong methodology.


The Levels of Evidence used by the Brookbush Institute, as described by Shekelle et al.(1):
<ul>
 	<li class="p1">IA - Evidence from meta-analysis of randomized controlled trials</li>
 	<li class="p1">IB - Evidence from at least one randomized controlled trial</li>
 	<li class="p1">IIA - Evidence from at least one controlled study without randomization</li>
 	<li class="p1">IIB - Evidence from at least one other type of quasi-experimental study</li>
 	<li class="p1">III - Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies, and case-control studies</li>
 	<li class="p1">IV - Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both</li>
</ul>
<ol>
 	<li>Shekelle, P. G., Woolf, S. H., Eccles, M., &amp; Grimshaw, J. (1999). Developing clinical guidelines. Western Journal of Medicine, 170(6), 348.</li>
</ol>

Likelihood Ratios - Likilihood ratios are used for assessing the value of performing a diagnostic test. They use sensitivity and specificity to determine whether a test result usefully changes the practitioner's chance (probability) of reaching the correct assessment. Calculation of likelihood ratios is based on Baye's theorem.
<ul>
 	<li>Positive Likelihood Ratio (LR+) - The ratio of a positive test result in people with the pathology to a positive test result in people without the pathology.</li>
 	<li>Negative Likelihood Ratio (LR-) - The ratio of a negative test result in people with the pathology to a negative test result in people without the pathology.</li>
</ul>

Longitudinal Study - a research design that involves observing the same variables, several times over a period of time.
<ul>
 	<li>Example, the study by Hewett et al. (1) is a type of longitudinal study called a "cohort study." This study investigated whether excessive knee valgus during landing was a predictor of knee injury risk in adolescent females over the course of a season.</li>
</ul>
<ol>
 	<li><a href="https://brentbrookbush.com/articles/research-corner/knee/research-review-increased-valgus-during-landing-predicts-acl-injury-in-adolescent-female-athletes/" target="_blank" rel="noopener noreferrer">Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., &amp; Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes A prospective study. The American journal of sports medicine, 33(4), 492-501</a></li>
</ol>

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