0:04 This is Brent of the Brookbush 0:05 Institute and in this video we're going over 0:07 a very commonly used exercise for lumbar 0:10 mobilization- the open book. We're also 0:13 going to discuss how it could be used 0:14 for thoracic and sacroiliac joint 0:17 mobility and maybe a great active 0:19 stretch for the pectoralis major, 0:21 pectoralis minor, posterior deltoid, and 0:23 potentially even the piriformis. I'm 0:25 going to have my friend, Melissa, come out and 0:26 she's going to help me demonstrate. Now, I 0:29 think you guys will quickly find that 0:30 setup is the most complicated portion of 0:32 this exercise, and it's going to take 0:35 some time for you to teach, and remind, 0:39 and reinforce your patients and clients 0:41 to be able to do this with good form. Go 0:43 ahead and lay on your side. This is where 0:45 we're going to start. I'm going to go 0:47 through these form cues from bottom up 0:49 here. So, we're going to start by 0:50 straightening out the bottom leg, so her 0:53 bottom leg becomes kind of this pivot 0:55 point. It should be in line with her 0:59 torso and her head, so we should see a 1:01 nice straight line from the top of her 1:03 head through her spine, through her hip, 1:06 knee, and ankle. She's then going to take 1:09 the foot of her top leg and put it 1:12 behind that bottom knee. We're then going 1:15 to use some sort of space, or foam roll, or 1:18 Hypersphere- something about this size to 1:21 get the top knee level with her hip. That 1:26 is, with her pelvis in a position that is 1:30 kind of perfectly vertical here. Now 1:33 she's going to take this bottom hand, and 1:34 this bottom hand is going to be 1:36 responsible for maintaining her knee 1:40 position. Alright, so she's going to 1:42 hook the bottom of that leg and keep it up 1:44 in flexion, which is going to keep us a 1:46 little bit posteriorly tilted which is 1:48 going to help us with the lumbar 1:49 mobility portion of this. She's then 1:52 going to take this hand, and I want her 1:54 to really tuck it behind her head. So, 1:56 she's going to wrap those fingers all the 1:57 way behind her occiput, maybe grab her 2:01 ponytail with her web space here. Alright, 2:04 so all the way around. I don't want to 2:05 see any cheating with with fingers 2:08 barely touching the head. 2:10 This is the setup. This is how we get 2:13 started. Now, the fun part is to see how much 2:16 mobility Melissa actually has. She's 2:19 going to start by trying to put this 2:20 elbow down on the floor. This isn't so 2:25 easy for a lot of people. This takes a 2:27 lot of extensibility of her posterior 2:29 deltoids, of her scapular muscles, and 2:32 even some mobility of her thoracic spine, 2:34 rib cage, and lumbar spine. But then, the 2:38 really hard part for most people is 2:40 trying to lay this arm flat down on the 2:45 floor. Melissa, here, has pretty good 2:48 mobility, but you can see she still has 2:52 about an inch to go there. So, if she 2:55 starts again, we're going to hold for two 2:58 and then open up, hold for two, and I try 3:04 to get my patients doing 10 to 20 reps 3:06 with those two second holds. Don't let 3:08 them rush through. I think you guys are 3:10 going to find that a lot of your 3:11 patients get stuck. They end up right 3:13 about here- that's as far as they can get. 3:15 You want them putting a little bit of 3:17 effort here, holding that position, making 3:19 sure they are trying to put an effort to 3:21 go further. And then have them go back. 3:24 Same thing on this side. Put some effort 3:26 forth. Now, let's think through some of 3:29 our kinesiology and where this may 3:31 benefit our patients from a mobility 3:33 perspective outside of just the lumbar 3:35 spine. As I mentioned, when Melissa comes 3:38 this way, that is a lot of horizontal 3:41 adduction which is going to require a 3:44 ton of mobility from her posterior delt. 3:46 She's also protracting and upwardly 3:49 rotating her scapula, which means she's 3:52 going to need some extensibility from 3:54 potentially her lower traps here as she 3:58 protracts her mid traps, as she protracts 4:00 her rhomboids, as she 4:02 upwardly rotates and protracts. All of 4:05 that's going to help as an active 4:07 stretch here. Go ahead and open up. And 4:10 then if she gets into this position, we 4:12 see a ton of horizontal abduction, 4:15 abduction, and external rotation of the 4:17 shoulder, which is basically pectoralis 4:20 major stretching. 4:22 Let's try that one more time. You guys 4:25 can see that she comes back, she also has 4:27 to upwardly rotate this way. 4:31 Upwardly rotate and posteriorly tip 4:34 her scapula, which is going to be a pec 4:37 minor active stretch. So, now we have 4:40 something that's great for both 4:41 posterior shoulder mobility as well as 4:45 pec mobility. Now, just the posterior 4:50 tipping thing- alright, the posterior 4:52 tipping of her scapula against her 4:55 rib cage is going to help to create a 4:58 posterior to anterior force on that rib 5:00 cage and mobilize those ribs. Your 5:04 ribs have a lot to do with thoracic 5:06 mobility, and we're adding that posterior 5:09 to anterior rib mobilization to thoracic 5:13 rotation. Now, something to keep in mind 5:16 is all of this is happening as an aside 5:20 to the main goal of this exercise, which 5:23 is generally lumbar mobility. 5:27 So this is all of the additional benefit 5:29 we get from an open book. But, let's talk 5:31 about this area right here, as this is 5:33 generally why we 5:36 use this exercise. This is the focus. As 5:39 she's going back and forth, she's causing 5:42 a ton of rotation at the spine, as 5:44 well as this position is slightly flexed and 5:48 this position is slightly extended. We 5:52 have her locked into a posterior tilt, 5:55 some flexion here, and I'm not allowing 5:59 her to get any adduction at the hip. In 6:01 this position, she can't internally and 6:03 externally rotate at the hip, so we know 6:06 that the motion is primarily coming from 6:09 her lumbar spine. As you go back 6:13 through here, you just can see that the 6:15 position she's put in here- go ahead and 6:17 open up- prevents her getting any 6:19 mobility from her hip or pelvis. Maybe we 6:22 get a little SI joint mobility as lumbar 6:26 rotation this way would actually force a 6:28 little posterior to anterior mobility on 6:31 the bottom SI joint, and anterior to 6:34 posterior mobility on 6:35 top SI joint. But, almost all that 6:40 rotation has to come from this lumbar 6:45 segment. If I want to get really, 6:48 really tricky, I can even put on 6:52 my physical therapy hat, remember how I 6:55 do lumbar manipulations or lumbar 6:58 physiological mobilizations for rotation, 7:00 and I could actually lock in what 7:04 segment I want to rotate by using- sorry 7:09 let me have you back in this position- by 7:12 using how high her knee is to get a 7:15 ligamentous lock from bottom up. If you 7:18 know how to do that, if you've taken 7:20 manual mobilization, manual manipulation, 7:23 lumbar spine courses, you know what I'm 7:26 talking about. I can do my little piano 7:29 grip on her lumbar spine, and let's say I 7:31 wanted her to focus more on- we'll call 7:33 it mid lumbar spine, although I'd love to 7:35 say that I could target L2 L3 segment, 7:38 we'll call it mid lumbar spine. We'll get 7:42 her right up to about here. I'll give her 7:44 some cue like, "Hey, I need you to grab all 7:47 the way up to second knuckle on that 7:50 hamstring." So, I'll give her some 7:52 cue that she can remember as far as 7:54 where to bring this leg, and now when she 7:56 opens up, she should feel that a little 8:00 higher in her lumbar spine. If I wanted a 8:03 little lower in her lumbar spine, of 8:05 course, I could go maybe, "Alright, I just 8:07 want your first knuckle on your 8:09 hamstring tendon here," which is her 8:12 biceps femoris tendon. If I wanted to get 8:15 up even higher, maybe I can get up into 8:16 that upper lumbar spine, maybe I go with 8:19 whole hand and really get her up high, and 8:22 again, have her do this exercise there. So 8:26 there you guys have it. We have a ton 8:29 going on in this exercise. It's primarily 8:32 a lumbar rotation mobilization, because 8:37 of the way we have the pelvis locked down, 8:38 but we have some sacroiliac joint 8:41 mobility. We also have a ton going on in the 8:44 upper body from 8:45 pectoralis major and minor, posterior 8:48 delt active stretching, and we have rib and 8:51 thoracic mobilization going on. This 8:54 becomes a very dynamic, very versatile 8:59 exercise to throw in somebody's 9:01 program. It's something I use all the 9:03 time in self-administered lumbar spine 9:07 home exercise programs. It also ends 9:10 up in a ton of my integrated warm-ups 9:14 for the athletes that I train, as well as 9:17 the recreational fitness member who we 9:21 know sits at a desk all day. All of 9:24 this stuff has a propensity towards 9:26 either restriction or overactivity. I 9:29 hope you guys enjoyed this video. I look 9:31 forward to seeing your questions in the 9:33 comments section. Feel free to post any 9:35 question you have. 9:44 you
