Introduction

Exercise Comparison

Quadrupeds for Other Pathologies

Progressions and Form

Research Summary

Motor Behavior and Recommendations

Electromyographic (EMG) Activity During Quadrupeds

Comparing Exercises

Comparing Exercise Outcomes:

Altered Muscle Activity

Optimizing/Normalizing Recruitment

Outcomes Following Intervention Plans that Include Quadrupeds

Transverse Abdominis (TVA) Activation: Quadruped Exercise and Progressions

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Transverse Abdominis Activation (Quadruped Exercise and Progressions)

Transverse Abdominis Activation (Quadrupeds and Progressions)

This course describes transverse abdominis exercises (commonly referred to as transverse abdominis activation, TVA activation, TA activation, TV <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activation, intrinsic core <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> exercises, and included in the terms core exercise and lumbar (lower back) stabilization exercises). Performing quadrupeds, 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 (belly button to spine), dorsiflexion of the ankle, and maintenance of a neutral spine has significant advantages. For example, quadrupeds with these additional cues may improve recruitment (isolation) of the transverse abdominis <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>, while decreasing recruitment of commonly over-active muscles such as the rectus abdominis. Although the forearm plank may be an excellent abdominal exercise, it does not improve the activity of the transverse abdominis relative to the activity of the superficial core muscles.&#xA0;&#xA0;
The transverse abdominis, internal obliques, pelvic floor, diaphragm, and multifidus act as stabilizers of the thoracic spine, rib cage, lumbar spine, sacroiliac joint, and pelvis. These muscles increase <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> by increasing intra-abdominal pressure, and <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> in the thoracolumbar fascia. Note, this increases lumbar <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> (lower back) without <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> of the lumbar spine. <a id="compression" data-tip="1595" target="_blank" href="/glossary-term/compression" class="glossary">compression</a> of the lumbar spine does occur with increased <a id="muscle-cell" data-tip="1377" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle fiber</a> recruitment of the more superficial core muscles (ab <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a>).
It is common to include these exercises in programs designed to address lower back pain correlated with signs of lumbopelvic hip complex dysfunction, including an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt, asymmetrical weight shift, and/or inadequate forward lean. However, these exercises may also be recommended to reduce arms fall, knees bow in (functional valgus), knee bow out (functional varus), feet turn out, and feet flatten (pes planus). Addressing these signs has been correlated with improving and reducing the risk of back pain, diastatis recti, neck pain, hip pain, knee pain, sacroiliac joint dysfunction, ankle dysfunction, and improving sports performance. Movement professionals (personal trainers, fitness instructors, physical therapists, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) should consider adding these 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> exercise programs and therapeutic (rehabilitation) interventions.
<h4>Isolated Muscle Activation Exercises:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/transverse-abdominis-tva-isolated-activation-quadruped">Quadrupeds</a></li>
 <li><a href="https://brookbushinstitute.com/videos/quadruped-progression-gali-peds">Quadruped </a><a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">Progressions</a> (Gali Pedis)</li>
</ul>
<h4>Reactive Muscle Activation Exercises:</h4>
<ul>
 <li><a href="https://brookbushinstitute.com/videos/quadruped-crawl">Quadruped Crawl</a></li>
 <li><a href="https://brookbushinstitute.com/videos/quadruped-crawl-sled-pull">Quadruped Sled Drag</a></li>
 <li><a href="https://brookbushinstitute.com/videos/core-transverse-abdominis-reactive-integration-crunch-catch">Crunch and Catch</a></li>
</ul>
<h4>Subsystem Integration Exercises</h4>
Last, it is important to <a id="integration" data-tip="1476" target="_blank" href="/glossary-term/integration" class="glossary">integrate</a> the increase in transverse abdominis activity into functional exercise. The Brookbush Institute accomplishes this with <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> oblique subsystem and <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> oblique subsystem <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>. Some example movements for these purposes include:
<ul>
 <li><a href="Chop%20(AOS)">Kneeling Chop (AOS)</a></li>
 <li><a href="https://brookbushinstitute.com/videos/static-standing-chop-pattern">Static Standing Chop (AOS)</a></li>
 <li><a href="https://brookbushinstitute.com/video/reverse-lunge-to-row-posterior-oblique-subsystem-progressions">Reverse Lunge To Row (POS)</a></li>
</ul>
<img title="Dr. Brent Brookbush demonstrating a dynamic quadruped exercise" src="https://www.datocms-assets.com/25800/1646155825-dynamic-quadruped.png" alt="Dynamic quadruped exercise">

Course Description: Transverse Abdominis Activation (Quadrupeds and Progressions)

<table>
 <tbody>
 <tr>
 <td>Note: Quadrupeds may be used as either a &quot;transverse abdominis activation&quot; or a &quot;core integration&quot; technique within the Brookbush Institute Templates. This was not intended to complicate optimal intervention order, and only implies that this exercise should likely be performed after more isolated activation techniques, or prior to other core integration techniques (see &quot;Sample Program&quot; below).</td>
 </tr>
 </tbody>
</table>
<h3>Target Musculature:</h3>
<ul>
 <li>Transverse Abdominis (TVA)</li>
 <li><a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">Internal Obliques</a></li>
 <li>Pelvic Floor (Levator ani, coccygeus, and associated fascia)</li>
 <li>Diaphragm</li>
 <li>Multifidus</li>
 <li>Rotatores, Interspinales &amp; Intertransversarii</li>
</ul>
<h3>Target Subsystem:</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem (ISS)</a></li>
</ul>
<h3>Signs of Under-activity (<a href="https://brookbushinstitute.com/article/transverse-abdominis" target="_blank" rel="noopener">TVA</a>):</h3>
<ul>
 <li><a href="https://brookbushinstitute.com/courses/solutions-table-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></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>
 <li><a href="https://brookbushinstitute.com/video/overhead-squat-assessment-15-sign-clusters-asymmetrical-weight-shift" target="_blank" rel="noopener">Asymmetrical Weight Shift</a></li>
 </ul>
 </li>
 <li>Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Testing for an Active Population (MMT):
 <ul>
 <li>Spinal Flexion Manual <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> MMT and Modifications (video coming soon): A common result indicating dysfunction is strong with compensation. That is, the individual can resist considerable force, but does so with additional motion. The most common compensation is abdominal distension indicating altered recruitment of the <a href="https://brookbushinstitute.com/courses/transverse-abdominis" target="_blank" rel="noopener">transverse abdominis</a>.</li>
 </ul>
 </li>
</ul>
<h3>Overactive Synergists:</h3>
Muscles that commonly become <a id="synergistic-dominance" data-tip="1649" target="_blank" href="/glossary-term/synergistic-dominance" class="glossary">synergistically dominant</a> when the TVA and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> are inhibited &#x2013; <a id="release" data-tip="1249" target="_blank" href="/glossary-term/release" class="glossary">Release</a> and stretch prior to activation and cue joint motion to reciprocally inhibit these muscles during <a id="activation-technique" data-tip="1529" target="_blank" href="/glossary-term/activation-technique" class="glossary">activation exercise</a>.
<ol>
 <li><a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">Latissimus Dorsi</a> (inhibit w/ shoulder flexion and abduction)
 <ol>
 <li><a href="https://brookbushinstitute.com/video/teres-major-and-latissimus-dorsi-sa-static-release" target="_blank" rel="noopener">Release</a></li>
 <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-and-erector-spinae-static-stretch-childs-pose" target="_blank" rel="noopener">Stretch</a></li>
 </ol>
 </li>
 <li>Psoas (inhibit w/ &#x201C;drawing in maneuver&#x201D;, hip extension, and/or <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt)
 <ol>
 <li><a href="https://brookbushinstitute.com/video/kneeling-hip-flexor-static-stretch" target="_blank" rel="noopener">Stretch</a></li>
 </ol>
 </li>
</ol>
<h3>Acute Variables:</h3>
<ul>
 <li>Sets: 1- 3</li>
 <li>Repetitions: 30 - 120 seconds</li>
 <li>Frequency:
 <ul>
 <li>Strength: 2 - 3 days/week</li>
 <li>Corrective/Therapeutic: Up to 1-2 submaximal sets performed 1-2 times daily</li>
 </ul>
 </li>
</ul>
<h2>Sample Program (Anterior Pelvic Tilt)</h2>
<h3>Mobility</h3>
<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/teres-major-and-latissimus-dorsi-sa-static-release" target="_blank" rel="noopener">Latissimus dorsi release</a></li>
 </ul>
 </li>
 <li>Mobilization
 <ul>
 <li><a href="https://brookbushinstitute.com/video/thoracic-spine-mobilization-posterior-anterior-transverse" target="_blank" rel="noopener">Thoracic spine mobilization</a></li>
 <li><a href="https://brookbushinstitute.com/video/self-administered-hip-mobilization-anterior-to-posterior-with-flexion" target="_blank" rel="noopener">Self-administered Hip Mobilization (</a><a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">Anterior</a> to <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">Posterior</a> with Flexion)</li>
 </ul>
 </li>
 <li>Lengthen
 <ul>
 <li><a href="https://brookbushinstitute.com/video/latissimus-dorsi-and-erector-spinae-static-stretch-childs-pose" target="_blank" rel="noopener">Child&apos;s pose</a></li>
 <li><a href="https://brookbushinstitute.com/video/kneeling-hip-flexor-static-stretch" target="_blank" rel="noopener">Kneeling hip flexor static stretch</a></li>
 </ul>
 </li>
</ul>
<h3>Activity</h3>
<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">Quadrupeds: Introduction</a></li>
 </ul>
 </li>
 <li>Core
 <ul>
 <li><a href="https://brookbushinstitute.com/video/ball-bridge" target="_blank" rel="noopener">Ball bridge</a></li>
 <li><a href="https://brookbushinstitute.com/video/kneeling-chop-pattern" target="_blank" rel="noopener">Kneeling chop pattern</a></li>
 </ul>
 </li>
 <li><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>

<table>
 <tbody>
 <tr>
 <td>
 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; color: var(--color); letter-spacing: 0px;"> In asymptomatic individuals, the TVA<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; color: var(--color); letter-spacing: 0px;"> and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" style="letter-spacing: 0px;" rel="noopener">ISS</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; color: var(--color); letter-spacing: 0px;"> may be recruited prior to the motion to aid in the stabilization of the lumbar spine and pelvis. Latent firing and a reduction in activity (under-activity) of the TVA<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; color: var(--color); letter-spacing: 0px;"> and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" style="letter-spacing: 0px;" rel="noopener">ISS</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; color: var(--color); letter-spacing: 0px;"> may result from, or increase the risk of, low back pain and injury, and may be an issue that warrants attention during therapeutic intervention.
 Recommendation: 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. <a href="https://brookbushinstitute.com/courses/gluteus-medius-activation-progression" target="_blank" rel="noopener">Gluteus Medius Activation</a>) precede more <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> techniques like quadrupeds. Note, quadrupeds may be used as either a &quot;transverse abdominis activation&quot; or a &quot;core integration&quot; technique within the Brookbush Institute Templates. This was not intended to complicate <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> intervention order and only implies that this exercise should likely be performed after more isolated <a id="activation-technique" data-tip="1531" target="_blank" href="/glossary-term/activation-technique" class="glossary">activation techniques</a>, but prior to other core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques. It should also be noted that the research below demonstrates that even when quadrupeds and quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> are performed alone, they are effective for increasing activity, recruitment, and hypertrophy of core musculature.
 <h3>Electromyographic Activity:</h3>
 <ul>
 <li>Muscle Activity in Healthy Individuals: Quadrupeds effectively recruit and challenge trunk stabilizers and rotators, reducing weight shift may increase trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> activity, and altered pelvic position (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> or <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tilt) 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.</li>
 <li>Progressions: Quadrupeds may be progressed from arm raise to opposite arm/leg raise, to leg raise, to increasing abduction angle, to the addition of external load, to potentially a decrease in hip flexion angle.</li>
 <li>Effect on Upper Extremity: Quadrupeds may be beneficial for improving scapular stabilization, especially when performed with protraction, and further leg raise on the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> side may further increase <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity and improve the <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> to <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> activity ratio.</li>
 </ul>
 <h3>Comparing Exercise</h3>
 <ul>
 <li>Targeting the TVA: When compared to other core exercises, quadrupeds are effective for increasing TVA and potentially <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity, without comparable increases in <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 multifidus activity.
 <ul>
 <li>Quadrupeds or Deadbugs?: TVA, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal obliques</a>, and multifidus activity are higher during quadrupeds when compared to <a id="supine" data-tip="1562" target="_blank" href="/glossary-term/supine" class="glossary">supine</a> &quot;deadbugs,&quot; suggesting that quadrupeds may be a <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> intervention for targeting the TVA and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a>.</li>
 </ul>
 
 </li>
 <li>Compared to <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> Exercise: Quadrupeds may be recommended when the intent is to target the TVA&#xA0;but may be progressed to <a href="https://brookbushinstitute.com/courses/plank-progression" target="_blank" rel="noopener">planks and side-planks</a> when the intent is to increase recruitment and incorporate additional core musculature.</li>
 <li>Compared to Extension Exercise: Quadrupeds increase <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> and multifidus <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity less than superman&apos;s and resisted lumbar extension exercise, but more than <a href="https://brookbushinstitute.com/courses/plank-progression" target="_blank" rel="noopener">planks</a> and seated exercises. Additionally, quadrupeds with leg raises may result in sufficient <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> activity to be beneficial for strengthening.</li>
 <li>Scapula and Shoulder Stabilization: Quadruped with leg raise, especially the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> leg, and/or the addition of open- or closed-chain PNF patterns, or a vertically held Bodyblade (or Flexibar), may increase <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity, improve the <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> to <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> activation ratio, and increase <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior and middle deltoid</a> activity.</li>
 <li>Incorporating External Devices: Electronic devices may have the potential to optimize <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> and recruitment, the addition of a Bodyblade or Flexi-bar may increase trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and the addition of resistance to leg and arm raises may provide additional challenge.</li>
 <li>Comparing Exercise Outcomes: Research suggests that the addition of quadrupeds (with <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>) may result in both immediate and long-term benefits including improvements in transverse abdominis thickness, movement quality, <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, core endurance, <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, and reactivity; however, quadrupeds are unlikely to have an effect on high-velocity activity.</li>
 </ul>
 <h3>Low Back Pain</h3>
 <ul>
 <li>Altered <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> Activity: Low back pain patients performing quadrupeds exhibit higher levels of <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">thoracic extensor</a>, <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a>, and potentially <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">lumbar erector</a> activity, &quot;abdominal bracing&quot; is likely an unreliable intervention for improving recruitment; however, quadrupeds with leg raise may be an ideal <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> for low back patients attempting to optimize local to global <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">Muscle</a> activity ratios.</li>
 <li>Optimizing/Normalizing Recruitment: Quadrupeds may aid in selectively recruiting the TVA, improve local to global <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity ratios, and improve onset timing, whereas other core exercises, abdominal bracing, and <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments are likely to increase <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity without normalizing recruitment patterns.</li>
 <li>Treatment Program Outcomes: Research demonstrates that 4 - 12 weeks of trunk stabilization exercise (including quadrupeds) may improve outcomes for low back pain patients, including normalized <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, a decrease in guarding during forward bending, improved <a id="arthrokinematics" data-tip="1861" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">joint play</a>, improved pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>, decreased reported pain and pain-related disability, and improvements in sleep quality, depression level, and anxiety level.</li>
 <li>Exercise Comparison: Stabilization exercise (including quadrupeds) may result in similar outcomes for pain, but is likely <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> for improving function (decreasing disability) when compared to conventional physiotherapy, flexibility programs, extension-based programs, and Pilates.</li>
 <li>Adding Stabilization Exercise to an Existing Program: Research suggests that replacing a program with stabilization exercise may be less beneficial than adding stabilization exercise to a program. Research has demonstrated that prevention and outcomes improved significantly when stabilization exercise was added to gluteal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strengthening, general strength training, <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> physical therapy program, and/or an educational brochure.</li>
 </ul>
 <h3>Quadrupeds for Other Pathologies</h3>
 <ul>
 <li>Additional Pathologies: These studies suggest that the addition of quadrupeds to a treatment plan should also be considered for neck pain and disability, hip pain and dysfunction, and perhaps post-partum pelvic pain.</li>
 </ul>
 </td>
 </tr>
 </tbody>
</table>

Research Review (Motor Behavior)

The function of the transverse abdominis (TVA) has been relatively well researched and may serve as a <a id="model" data-tip="1469" target="_blank" href="/glossary-term/model" class="glossary">model</a> for other muscles that have demonstrated similar characteristics. Further, the behavior of the TVA may be representative of <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem (ISS)</a> behavior, a subsystem that is comprised of many of the same muscles. Studies have demonstrated synergistic recruitment of the TVA and <a href="https://brookbushinstitute.com/courses/multifidus" target="_blank" rel="noopener">lumbar multifidus</a> during 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>), and research has demonstrated that the pelvic floor, diaphragm, and TVA exhibit similar behavior relative to increased load (1, 7, 12, 20). A more detailed review and additional research regarding these relationships is discussed in the course: <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">Intrinsic Stabilization Subsystem (ISS)</a>.
The TVA contracts prior to planned activity, bilaterally regardless of the direction of limb motion, and activity increases with changes in <a id="posture" data-tip="1658" target="_blank" href="/glossary-term/posture" class="glossary">posture</a> including increased <a id="center-of-mass-gravity" data-tip="1187" target="_blank" href="/glossary-term/center-of-mass-gravity" class="glossary">center of gravity</a> height, increased respiration, and speed of locomotion (1-5). The stabilizing function of the TVA likely occurs by two primary mechanisms. First, increased TVA activity increases <a id="tension" data-tip="1229" target="_blank" href="/glossary-term/tension" class="glossary">tension</a> of the <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> and middle layers of the thoracolumbar fascia (TLF), resulting in increased stiffness of the lumbar spine and <a id="force-closure" data-tip="1448" target="_blank" href="/glossary-term/force-closure" class="glossary">force closure</a> of the sacroiliac joint (SIJ) (6-12). Second, TVA contraction (along with the other muscles of the ISS) decreases the intra-abdominal volume and increases intra-abdominal pressure, which increases the rigidity of the spine, resists lumbar flexion forces, and may result in decompression forces (13-15). In studies by Morris et al. and Hodges et al., asymmetrical firing of the TVA was demonstrated with greater resistance and speed, and synergy was demonstrated between the TVA, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">obliques</a>, and lumbar multifidus muscles (16-19). This implies that the TVA contracts bilaterally and relatively equally at lower intensities, and as larger forces are generated by the limbs (either due to increased weight or velocity), activity of the TVA on the more stressed side increases, and additional muscles are recruited to match the additional load. These studies demonstrate that the TVA and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> may be recruited in synergy, prior to motion, to aid in the stabilization of the lumbar spine and pelvis in asymptomatic individuals.
In 1996, Hodges et al. published a pivotal study that demonstrated the TVA fired prior to the initiation of arm swing in asymptomatic individuals but fired after the initiation of arm swing in individuals with low back pain (20). Hodges et al. would follow-up this study with research demonstrating that the same pattern also occurred during leg movement, various speeds of arm movement, and demonstrated the same altered recruitment pattern could be replicated by injection-induced low back pain (21-24). Further, they would show that low back pain results in not only decreased recruitment of intrinsic muscles (TVA, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">obliques</a>, and lumbar multifidus) but increased reliance on &#x201C;global muscles&#x201D; (25). Studies have shown a decrease in TVA recruitment and multifidus atrophy post episodes of low back pain and injury (30, 31). More recent research has demonstrated that altered recruitment patterns increase the likelihood of low back pain/injury in the following year, that unresolved altered recruitment patterns result in worse outcomes a year post-physical therapy, changes in TVA recruitment patterns correlate strongly with a disability index, and that even adductor/groin injury/pain may result in altered TVA recruitment strategies (26-29). These studies suggest that alterations in the recruitment of the TVA and <a href="https://brookbushinstitute.com/courses/intrinsic-stabilization-subsystem" target="_blank" rel="noopener">ISS</a> may result from, or increase the risk of low back pain and injury, and may be an issue that warrants attention during therapeutic intervention.
Studies have also shown that 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>) and exercises like quadrupeds (described below) are effective for stabilizing the lumbar spine and SIJ, decreasing low back pain induced atrophy of the TVA and multifidus, and may reduce the number and severity of future episodes of low back pain (12, 30, 31 -34). Additionally, quadrupeds and quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> have demonstrated efficacy for increasing activity, recruitment, and hypertrophy of all muscles of the <a href="https://brookbushinstitute.com/article/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. <a href="https://brookbushinstitute.com/courses/gluteus-medius-activation-progression" target="_blank" rel="noopener">Gluteus Medius Activation</a>) should precede more <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> techniques like quadrupeds. Note, quadrupeds may be used as either a &quot;transverse abdominis activation&quot; or &quot;core integration&quot; within the Brookbush Institute Templates. This was not intended to complicate <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> intervention order, as it simply implies that this exercise should likely be performed after more isolated <a id="activation-technique" data-tip="1531" target="_blank" href="/glossary-term/activation-technique" class="glossary">activation techniques</a>, but prior to other core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a> techniques. It should also be noted that the research below demonstrates that even when quadrupeds and quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> are performed alone, they are effective for increasing activity, recruitment, and hypertrophy of core musculature.
<img src="https://www.datocms-assets.com/25800/1649281673-intrinsic-stabilization-subsystem.jpg" width="251" height="273" title="The instrinsic stabilization subsystem which includes the transverse abdominis, multifidus, deep pelvic floor muscles, and diaphram" alt="Intrinsic Stabilization Subsystem">

<h4>Muscle Activity in Healthy Individuals</h4>
Several studies have described <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> electromyographic (EMG) activity during quadrupeds. Stevens et al. demonstrated that healthy participants performing the quadruped opposite arm/leg raise exhibited significant increases in activity of the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> multifidus, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal 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>, the <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external obliques</a>, and relatively small increases in <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a> and <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity (35). Bae et al. investigated the effects of weight shift on <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during quadrupeds with one leg extended, demonstrating that cueing a decrease in weight shift significantly increased <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity and <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity (36). And, Queiroz et al. compared pelvic positions during quadrupeds, demonstrating that a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> pelvic tilt with lumbar flexion significantly increased <a href="https://brookbushinstitute.com/courses/external-obliques" target="_blank" rel="noopener">external oblique</a> and <a href="https://brookbushinstitute.com/courses/gluteus-maximus" target="_blank" rel="noopener">gluteus maximus</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, an <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> pelvic tilt with lumbar extension significantly increased multifidus <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and a neutral pelvis and spine resulted in the lowest over-all <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity. Note, <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity was similar in all positions (37). These recruitment patterns match what may be expected based on the moment arms, directions of rotational <a id="torque" data-tip="1294" target="_blank" href="/glossary-term/torque" class="glossary">torque</a>, and joint actions described in the variations of quadrupeds investigated in these studies. Quadrupeds effectively recruit and challenge trunk stabilizers and rotators, reducing weight shift may increase trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and altered pelvic position (<a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> or <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tilt) 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.
<h4>Progressions</h4>
Additional studies compare various quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>. Pirouzi et al. demonstrated that <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity of the transversus abdominis, <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a>, and multifidus increased when progressing from quadruped with arm raise, to opposite arm/leg raise, to leg raise (38). Lee et al. demonstrated that <a href="https://brookbushinstitute.com/courses/rectus-abdominis-pyramidalis" target="_blank" rel="noopener">rectus abdominis</a> activity significantly increased during quadrupeds when hip flexion angle decreased from 90&#xB0; to 80&#xB0; to 70&#xB0; (feet further from hands) (39). Further, Masaki et al. compared multifidus activity during quadrupeds demonstrated that raising an <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> extremity resulted in more activity than a <a id="contralateral" data-tip="1549" target="_blank" href="/glossary-term/contralateral" class="glossary">contralateral</a> extremity, that raising a lower extremity resulted in more activity than raising an upper extremity, that the addition of abduction to a raise resulted in more activity than flexion/extension, and that the addition of resistance also resulted in more activity (40). These studies suggest that quadrupeds may be progressed from arm raise to opposite arm/leg raise, to leg raise, to increasing abduction angle, to the addition of external load, to potentially a decrease in hip flexion angle.
<h4>Effect on Upper Extremity</h4>
Additional studies have demonstrated that quadrupeds may have a significant effect on <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> and <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity. Kim et al. demonstrated an increase in <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> and <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a>&#xA0;muscle activity during a quadruped with leg raise, particularly for the <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> and <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a>&#xA0;on the same side as the leg raised (41). Similarly, Nam et al. demonstrated that <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> leg lift during a quadruped (with protraction) resulted in a significant increase in <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity on the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> side and an increase in the <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> to <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a>&#xA0;activity ratio (42). And, the study by Bae et al. mentioned above, demonstrated that cueing a reduction in weight shift during quadruped with leg raise significantly increased <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity (36). These studies suggest that quadrupeds may be beneficial for improving scapular stabilization, especially when performed with protraction, and further leg raise on the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> side may further increase <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity and improve the <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> to <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a>&#xA0;activity ratio.

Several studies have compared the effects of incorporating quadrupeds into a training program. Kim et al. (2019) demonstrated that several sets of deadbugs, deadbugs on a foam <a id="roll" data-tip="1602" target="_blank" href="/glossary-term/roll" class="glossary">roll</a>, or quadrupeds, each variation incorporating the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> and slow <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> hip/knee extension, had an immediate and significant effect on pelvic rotation in asymptomatic individuals with assessed reductions in pelvic rotation (60). Lee et al. compared 5-weeks of either multiple repetitions of 10-second holds of the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> while maintaining a pressure of 50 mm Hg on a cuff placed under the lumbar spine in a <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> position, to a protocol of lumbar stabilization exercises including curl-ups, <a href="https://brookbushinstitute.com/courses/plank-progression" target="_blank" rel="noopener">side-planks</a>, and quadruped opposite arm/leg raise. Both groups demonstrated similar increases in transverse abdominis thickness and increases in the amount of time that single-leg sitting on a <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> ball could be maintained (61). These studies suggest that quadrupeds with <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a>, along with various other core stabilization exercises, may have both immediate and long-term efficacy for increasing pelvic position, transverse abdominis thickness, and <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>.
Two additional studies suggest that quadrupeds may have a positive impact on movement quality. Kim et al. (2013) compared standard training for adolescent female basketball players with and without 8-weeks of <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> quadrupeds and <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> <a href="https://brookbushinstitute.com/courses/bridge-progression" target="_blank" rel="noopener">bridges</a> targeting the non-dominant side, demonstrating that the addition of these <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> exercises significantly improved right to left activation and reduced recruitment asymmetries, and also improved the amount of forward displacement resulting from sudden unexpected perturbation (reactivity) (62). Bagherian et al. compared college athletes in off-season training with and without the addition of 8-weeks (3x&apos;s/week) of core <a id="stability-training" data-tip="1172" target="_blank" href="/glossary-term/stability-training" class="glossary">stability training</a> (including quadrupeds), demonstrating significant improvement in Functional Movement Screen (<a id="fibromyalgia" data-tip="1137" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">FMS</a>), <a id="lateral" data-tip="1567" target="_blank" href="/glossary-term/lateral" class="glossary">lateral</a> step-down, and Y-balance <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a> scores with the largest improvements made by those with the worst initial scores (63). These studies suggest that <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> quadrupeds may be effective for reducing the right to left asymmetries, and that core <a id="stability-training" data-tip="1172" target="_blank" href="/glossary-term/stability-training" class="glossary">stability training</a> including quadrupeds may improve <a id="fibromyalgia" data-tip="1137" target="_blank" href="/glossary-term/fibromyalgia" class="glossary">FMS</a> movement quality scores, <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a>, or reactive recruitment of trunk musculature.
Additional studies demonstrate that adding quadrupeds to core or strength training programs may be beneficial for sports performance; however, the results suggest outcomes may be <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a>. Imai et al. compared the outcomes of soccer players performing a variety of performance-related tests, following the addition of 12 weeks (3x&apos;s week) of either conventional trunk exercises or stabilization trunk exercises (including quadrupeds). The stabilization trunk exercise group demonstrated significantly better scores on the <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> and <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> components of the Star Excursion <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (SEBT), and within-group changes suggested stabilization exercise may have a larger effect on &quot;Cooper&apos;s test&quot; (aerobic <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a>) and rebound jumps. Both groups improved on vertical jump tests, and neither group significantly improved in the 50m step <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">Test</a> (64). Lust et al. compared training for baseball athletes with and without the addition of core exercise (including quadrupeds), demonstrating no significant change in throwing <a id="accuracy" data-tip="1218" target="_blank" href="/glossary-term/accuracy" class="glossary">accuracy</a> or proprioception; however, some significant differences were noted in tests <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> to core endurance (65). These studies suggest that core training, including quadrupeds, may be an appropriate intervention for improving <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">Balance</a> and activities requiring <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a>, but these exercises are unlikely to have an effect on high-velocity activities.

Comparing Exercise Outcomes

Research Review (Pathology)

Individuals with a history of low back pain exhibit altered <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during quadrupeds when compared to asymptomatic controls. Masaki et al. demonstrated that young participants with a history of low back pain performing quadrupeds with opposite arm/leg raise exhibited an increase in the lumbar lordotic curve, more <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, but similar lumbar multifidus activity as asymptomatic participants (66). Conversely, Shah et al. demonstrated that when quadrupeds were performed with an increased lumbar lordosis, patients with chronic low back pain exhibited more multifidus activity and asymptomatic participants did not (67). Additionally, Marshall et al. demonstrated that low back pain patients exhibited lower <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">erector spinae</a> activity during quadrupeds when compared to asymptomatic controls and that the addition of abdominal bracing resulted in inconsistent changes in <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity (68). Yoon et al. demonstrated that low back pain patients exhibited significantly higher <a href="https://brookbushinstitute.com/courses/multifidus" target="_blank" rel="noopener">lumbar extensor</a> activity than asymptomatic controls when performing quadrupeds with opposite arm/leg raise, but similar <a href="https://brookbushinstitute.com/courses/multifidus" target="_blank" rel="noopener">lumbar extensor</a> activity during leg raise only, or arm raise only variations. Further, low back pain patients performing the opposite arm/leg raise variations also exhibited higher local to global <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity ratios. Last, performing the quadruped with leg raise only resulted in higher levels of <a href="https://brookbushinstitute.com/courses/internal-obliques" target="_blank" rel="noopener">internal oblique</a> activity, the highest local to global <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity ratios, and similar <a href="https://brookbushinstitute.com/courses/multifidus" target="_blank" rel="noopener">lumbar extensor</a> activity as asymptomatic individuals. This study suggests that the variation of quadruped used in previously mentioned studies may explain the contradictory findings regarding lumbar extensor activity and that quadrupeds with <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> leg raise may be an ideal <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> for low back pain patients (69). In summary, these studies suggest that low back pain patients performing quadrupeds exhibit higher levels of <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">thoracic extensor</a>, <a href="https://brookbushinstitute.com/courses/latissimus-dorsi" target="_blank" rel="noopener">latissimus dorsi</a>, and potentially <a href="https://brookbushinstitute.com/courses/erector-spinae" target="_blank" rel="noopener">lumbar erector</a> activity, &quot;abdominal bracing&quot; is likely an unreliable intervention for improving recruitment; however, quadrupeds with leg raise may be an ideal <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progression</a> for low back patients attempting to optimize local to global <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity ratios.

For low back patients, quadrupeds with <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> may be ideal for targeting the TVA and normalizing trunk <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> recruitment. Gorbet et al. demonstrated that quadrupeds with <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> resulted in similar TVA activity in both asymptomatic individuals and those with low back pain (70). Desai et al. demonstrated that low back pain patients exhibited altered recruitment patterns during the <a href="https://brookbushinstitute.com/video/side-plank" target="_blank" rel="noopener">side-plank</a> and modified push-up, but similar recruitment during quadrupeds. Further, the addition of <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments only increased activity and did not alter or normalize recruitment patterns (71). As mentioned above, Yoon et al. (68) demonstrated that quadrupeds with leg raise improved local to global activity ratios. Also mentioned above, Marshall et al. (69) demonstrated that abdominal bracing did not result in <a id="reliability" data-tip="1795" target="_blank" href="/glossary-term/reliability" class="glossary">reliable</a> improvements in recruitment. An RCT by Selkow et al. compared the recruitment timing of the TVA during upper extremity motion in low back pain patients and asymptomatic participants, following a control procedure or 4 weeks (2x&apos;s week) of an exercise program including deadbugs, side-planks, and quadrupeds. Both low back pain patients and asymptomatic controls exhibited significant improvements in TVA activation timing following the exercise program, with the largest changes seen in those individuals with the greatest delay in onset timing (72). These studies suggest that quadrupeds may aid in selectively recruiting the TVA, improve local to global <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity ratios, and improve onset timing, whereas other core exercises, abdominal bracing, and <a id="stability" data-tip="1194" target="_blank" href="/glossary-term/stability" class="glossary">unstable</a> environments are likely to increase <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity without normalizing recruitment patterns.

Several studies have investigated the efficacy of stabilization exercise, including quadrupeds, for the treatment of low back pain. Nelson-Wong et al. demonstrated that patients with low back pain, exacerbated by standing, exhibited decreased pain and normalized <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity after 4-weeks of lumbar stabilization exercises (including quadrupeds) (73). Marshal et al. demonstrated that low back pain patients exhibited a significant decrease in pain, disability, and <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity during the passive portion of the flexion/relaxation response following a 12-week exercise intervention (including quadrupeds) (74). Note, this study likely demonstrates a reduction in &quot;guarding/spasm&quot; during forward bending. Sung et al. demonstrated that 4-weeks (3x&apos;s/week) of trunk stabilization exercise (including quadrupeds) resulted in significant improvements in disability and pain, but did not significantly improve lumbar extensor endurance (75). Akodu et al. (2015) demonstrated that 4-weeks (2x&apos;s week) of a core stabilization exercise program (including quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>) improved pain, function, quality of life, and psychological health (76). And, another study by Akodu et al. (2018) demonstrated that chronic low back pain patients, following 8-weeks of stabilization exercise (including quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>), exhibited significant improvements in pain-related disability, sleep quality, depression level, and anxiety level (77). These studies demonstrate that 4 - 12 weeks of trunk stabilization exercise (including quadrupeds) may improve outcomes for low back pain patients, including normalized <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity and a decrease in guarding during forward bending, decreased pain and pain-related disability, and improvements in sleep quality, depression level, and anxiety level.
<a id="randomized-control-trial" data-tip="1406" target="_blank" href="/glossary-term/randomized-control-trial" class="glossary">Randomized controlled</a> trials (RCT) have also been published investigating the efficacy of stabilization exercise (including quadrupeds) for the treatment of low back pain. An RCT by Rydeard et al. compared a 4-week program of Pilates-based therapeutic exercises (including quadruped variations on specialized equipment) to standard physician and medical care for chronic low back pain. Results demonstrated that the Pilates-based therapeutic exercise resulted in larger improvements in pain and disability at 3-, 6-, and 12-month follow-ups (78). An RCT by Kumar et al. (2011) compared a program of various quadruped <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> to prone-lying for an equivalent amount of time, demonstrating that the exercise program resulted in significant improvements in <a id="arthrokinematics" data-tip="1861" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">joint play</a> and pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a> after the 1st and 2nd sessions (79). As mentioned above, an RCT by Selkow et al. compared the recruitment timing of the TVA during upper extremity motion in low back pain patients and asymptomatic participants, followed by 4-weeks (2x&apos;s week) of an exercise program including deadbugs, side-planks, and quadrupeds or 4-weeks of a continuation of normal activity. The exercise protocol improved TVA activation timing for low back pain patients and asymptomatic participants, with the largest changes seen in those individuals with the greatest delay in onset timing (72). An RCT by Hicks et al. investigated the potential for a clinical prediction rule (CPR) that may improve outcomes by determining which low back patients are most likely to improve following a stabilization exercise program. The highest positive likelihood ratio was achieved when patients exhibited 3 or 4 of the following variables: age less than 40, positive straight-leg raise <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, positive <a id="prone" data-tip="1561" target="_blank" href="/glossary-term/prone" class="glossary">prone</a> <a id="stability" data-tip="1193" target="_blank" href="/glossary-term/stability" class="glossary">instability</a> <a id="assessment" data-tip="1482" target="_blank" href="/glossary-term/assessment" class="glossary">test</a>, aberrant motions, lumbar <a id="hypermobility" data-tip="1677" target="_blank" href="/glossary-term/hypermobility" class="glossary">hypermobility</a>, and fear-avoidance beliefs (80). These RCTs demonstrate the efficacy of trunk stabilization programs (including quadrupeds) for improving <a id="arthrokinematics" data-tip="1861" target="_blank" href="/glossary-term/arthrokinematics" class="glossary">joint play</a>, pain pressure <a id="sensitivity" data-tip="1226" target="_blank" href="/glossary-term/sensitivity" class="glossary">sensitivity</a>, global pain and disability for low back pain patients, and TVA activation timing for both symptomatic and asymptomatic individuals exhibiting a delay in activation timing.
<img src="https://www.datocms-assets.com/25800/1649282054-quadruped-in-class.jpg" title="Example of a quadruped using a ball for added stability and control" alt="Quadrupeds with ball">

In comparison to various interventions, stabilization exercises (including quadrupeds) have demonstrated <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> results. Salavati et al. compared the effects of 4-weeks (3x&apos;s/week) of stabilizations exercise (including quadrupeds) to conventional physiotherapy for chronic low back pain patients. Findings demonstrated that the stabilization exercise group exhibited significantly larger improvements in <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> and function, but improvements in pain were similar for both groups (81). Sung et al. compared 4-weeks of core stabilization exercises (including quadrupeds) to a lumbar flexibility program, demonstrating that only the stabilization exercise group had a significant decrease in disability. Note, neither group exhibited significant changes in lumbar extensor endurance time (82). Sundaram et al. demonstrated that low back pain patients exhibited larger improvements in pain and function following 4-weeks of core stabilization exercise (quadruped exercise, curl-ups, <a href="https://brookbushinstitute.com/courses/bridge-progression" target="_blank" rel="noopener">bridge</a>) when compared to Pilates exercise (hundred, side bend, swan rising) (83). An RCT by Rohini et al. compared 4-weeks (5x&apos;s/week) of extension exercises, stabilization exercises, and no-exercise controls for the treatment of lumbar disk herniation (as diagnosed by MRI), demonstrating that both intervention groups made significant improvements in pain and disability; however, the stabilization group also exhibited positive changes in motor control of the TVA (84). And, Ko et al. compared chronic low back pain patient outcomes following 12 weeks (3x&apos;s per week for 60 minutes) of a lumbar stabilization exercise program, a sling exercise program, and controls continuing daily activity, demonstrating that patients with chronic low back pain exhibited similar improvements in pain, lumbar flexion/extension strength, and range of motion following the stabilization exercise and sling exercise programs (85). These studies suggest that stabilization exercise (including quadrupeds) may result in similar outcomes for pain, but is likely <a id="superior" data-tip="1570" target="_blank" href="/glossary-term/superior" class="glossary">superior</a> for improving function (decreasing disability) when compared to conventional physiotherapy, flexibility programs, extension-based programs, and Pilates. Note, these studies compare these exercise modalities to one another; however, there may be an additional benefit to combining these programs (discussed below).
<h4>Adding Stabilization Exercise to an Existing Program:</h4>
Studies have also investigated whether additional benefits can be attained from adding stabilization exercise (including quadrupeds) to a therapeutic program. Jeong et al. demonstrated that the addition of gluteal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strengthening to a lumbar segmental stabilization program (including quadrupeds) improved disability scores, lumbar <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strength, and <a id="balance" data-tip="1190" target="_blank" href="/glossary-term/balance" class="glossary">balance</a> for individuals with chronic low back pain (86). An RCT by Javadian et al. demonstrated that the addition of core <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> exercise (including quadrupeds) to an 8-week general strengthening program resulted in significantly less <a id="anterior" data-tip="1566" target="_blank" href="/glossary-term/anterior" class="glossary">anterior</a> translation during forward bending when compared to general strengthening alone (87). An RCT by Kumar et al. (2017) investigated 3 weeks (5x&apos;s/week) of a progressive, <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> program including soft tissue, &quot;knee to chest exercise&quot; and stabilization exercise (including quadrupeds) and compared it to a conventional physical therapy program that included heat, E-stim and flexion exercises. The <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> exercise program resulted in significantly larger improvements in pain, quality of life, lumbar range of motion, and neurodynamic tests results (88). Last, a prospective RCT by Pillastrini et al. demonstrated that the addition of an extension based exercise program (including quadruped variations) to education via an ergonomics brochure significantly decreased the rate of development, and/or decreased the severity of neck and low back pain and disability, during a 2-month follow-up of nursery school teachers (89). In contrast to the comparisons made in the previous section, these studies suggest that replacing a program with stabilization exercise may be less beneficial than adding stabilization exercise to an effective program. In these studies, prevention and outcomes improved significantly when stabilization exercise was added to gluteal <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> strengthening, general strength training, <a id="integration" data-tip="1473" target="_blank" href="/glossary-term/integration" class="glossary">integrated</a> physical therapy program, and/or an educational brochure.

A few additional studies have demonstrated that quadrupeds may be effective as part of a treatment plan for conditions other than low back pain. As mentioned above, the RCT by Pillastrini et al. demonstrated that the addition of a program including quadrupeds to patient education may aid in the prevention and reduction of neck pain and disability (89). Im et al. demonstrated that a scapular stabilization exercise protocol including quadruped arm raise, performed for 4-weeks (30 min., 3x&apos;s/week) resulted in significant improvements in cervical pain and disability, <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> and <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and craniovertebral angle (90). Aoyama et al. investigated the effects of adding <a href="https://brookbushinstitute.com/courses/plank-progression" target="_blank" rel="noopener">planks</a> and quadrupeds (trunk stabilization) to a protocol of hip abduction, hip extension, and pelvic tilts (standard care) for the treatment of femoral acetabular impingement syndrome (FAI). The finding demonstrated that when compared to the standard care protocol, the trunk stabilization group demonstrated significant improvements in hip range of motion and strength at 4-weeks and significant improvements in pain and function at 8 weeks (91). Ehsani et al. compared general strengthening to <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> stabilization exercises (including quadrupeds) for the treatment of postpartum lumbopelvic pain in women after pregnancy. Ultrasound imaging demonstrated significant changes in TVA and pelvic floor <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> thickness and activation following <a id="specificity" data-tip="1224" target="_blank" href="/glossary-term/specificity" class="glossary">specific</a> intervention; however, significant differences in pain relief were not demonstrated (92). A larger participant pool and longer-term follow-up may be recommended to determine if muscular changes resulted in better carry-over and outcomes during long-term follow-up. These studies suggest that the addition of quadrupeds to a treatment plan should also be considered for neck pain and disability, hip pain and dysfunction, and perhaps post-partum pelvic pain.

<ul>
 <li>Progressions: Quadrupeds may be progressed from arm raise, to opposite arm/leg raise, to leg raise, to increasing abduction angle, to the addition of external load, to potentially a decrease in hip flexion angle.</li>
 <li>Scapula and Shoulder Stabilization: Quadruped with leg raise, especially the <a id="ipsilateral" data-tip="1550" target="_blank" href="/glossary-term/ipsilateral" class="glossary">ipsilateral</a> leg, and/or the addition of open- or closed-chain PNF patterns may increase <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> activity, improve the <a href="https://brookbushinstitute.com/courses/serratus-anterior" target="_blank" rel="noopener">serratus anterior</a> to <a href="https://brookbushinstitute.com/courses/trapezius-muscle" target="_blank" rel="noopener">upper trapezius</a> activation ratio, and increase <a href="https://brookbushinstitute.com/courses/deltoids" target="_blank" rel="noopener">posterior and middle deltoid</a> activity.</li>
 <li>Incorporating External Devices: Electronic devices may have the potential to optimize <a id="posture" data-tip="1660" target="_blank" href="/glossary-term/posture" class="glossary">form</a> and recruitment, the addition of a BodyBlade or Flexi-bar may increase trunk and shoulder girdle <a id="muscle-cell" data-tip="1781" target="_blank" href="/glossary-term/muscle-cell" class="glossary">muscle</a> activity, and the addition of resistance to arm and leg raises may provide additional challenge.</li>
</ul>
<img src="https://www.datocms-assets.com/25800/1649282220-resisted-quadruped-crawl-w-resistance.png" title="A quadruped progression using a sled to add additional resistance" alt="Quadruped with resistance (dragging a sled)">
<h3>Isolated Activation Progression:</h3>
<ol>
 <li>Quadruped</li>
 <li>Quadruped arm raise</li>
 <li>Quadruped opposite arm/leg raise</li>
 <li>Quadruped leg raise</li>
 <li>Dynamic Quadruped
 <ul>
 <li>Sagittal</li>
 <li>Frontal</li>
 <li>Transverse</li>
 <li>Resisted
 <ul>
 <li>Alternate Progressions: Gamification (&quot;Simon Says&quot;)</li>
 <li>Alternate Progression: Gali-peds</li>
 <li>Alternate Progression: Quadruped with Glute Activation</li>
 <li>Alternate Progression: Quadruped with Ball Resisted Cervical Retraction</li>
 <li>Alternate Progression: Hardest Quadruped <a id="exercise-progression" data-tip="1184" target="_blank" href="/glossary-term/exercise-progression" class="glossary">Progression</a> Ever</li>
 </ul>
 </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/or 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 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>
<h4>Notes on Form:</h4>
The exercises below differ from many of the other exercises recommended for activation and core <a id="integration" data-tip="1472" target="_blank" href="/glossary-term/integration" class="glossary">integration</a>. Although resistance is commonly used to progress exercise, the <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a> below challenge one&apos;s ability to maintain <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> during increasingly less stable <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>. During all <a id="exercise-progression" data-tip="1182" target="_blank" href="/glossary-term/exercise-progression" class="glossary">progressions</a>, the goal is to maintain 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>), maintain the spine and pelvic position, and challenge <a id="stability" data-tip="1191" target="_blank" href="/glossary-term/stability" class="glossary">stability</a> and endurance
<ul>
 <li>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>) - a light contraction of the TVA, achieved by gently pulling the lower abdominal region away from one&apos;s waistband. This should have minimal impact on breathing, should not be confused with a &quot;vacuum pose&quot; (maximal contraction of the TVA resulting in a &quot;vacuum pose&quot;, and is not a <a href="https://brookbushinstitute.com/courses/rectus-abdominis" target="_blank" rel="noopener">rectus abdominis</a> contraction. Contracting the <a href="https://brookbushinstitute.com/courses/rectus-abdominis" target="_blank" rel="noopener">rectus abdominis</a> generally results in a <a id="posterior" data-tip="1565" target="_blank" href="/glossary-term/posterior" class="glossary">posterior</a> tilt of the pelvis, flexion of the lumbar spine, or flexion of the thoracic spine. If these movements are noted while performing the exercises below, re-establish <a id="optimal" data-tip="1571" target="_blank" href="/glossary-term/optimal" class="glossary">optimal</a> pelvic and lumbar spine position and attempt the <a id="drawing-in" data-tip="1588" target="_blank" href="/glossary-term/drawing-in" class="glossary">ADIM</a> again.</li>
</ul>

Videos

Transverse Abdominis Isolated Activation (Quadrupeds)

Gali-Peds (Quadrupeds with Stability Ball)

Quadruped Crawl (Dynamic Quadruped)

Additional Quadruped Crawl Progressions

Transverse Abdominis and Deep Cervical Flexor (DCF) Activation

Transverse Abdominis and Gluteus Maximus Activation Progression

Hardest Quadruped Progression Ever

<h3>Reactive Activation Progression:</h3>
<ol>
 <li>Crunch and Catch &#x2013; Chest Pass on Floor</li>
 <li>Crunch and Catch &#x2013; Soccer Throw on Floor</li>
 <li>Crunch and Catch &#x2013; <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> &#x201C;Baseball throw&#x201D; on Floor</li>
 <li>Crunch and Catch &#x2013; Chest Pass on Bosu</li>
 <li>Crunch and Catch &#x2013; Soccer Throw on Bosu</li>
 <li>Crunch and Catch &#x2013; <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> &#x201C;Baseball throw&#x201D; on Bosu</li>
 <li>Crunch and Catch &#x2013; Chest Pass on Ball</li>
 <li>Crunch and Catch &#x2013; Soccer Throw on Ball</li>
 <li>Crunch and Catch &#x2013; <a id="unilateral" data-tip="1551" target="_blank" href="/glossary-term/unilateral" class="glossary">unilateral</a> &#x201C;Baseball throw on Ball</li>
</ol>

Transverse Abdominis Reactive Activations

Crunch and Catch

Crunch and Catch Progressions

Bibliography

© 2016, 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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