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This is Brent coming at you with another
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one of our collaboration videos, to bring
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you a progression of the single leg excursion, or the single leg balance and
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excursion. I think I mentioned it previously as the single leg balance and
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excursion of death, which makes a progression of this seem even more
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sadistic. I'm going to have my friend Rob come out and help me demonstrate, he is
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responsible for this sadistic progression. I want you guys to know PT
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for many years, certified orthopedic manual therapist, and faculty himself
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for the Maitland workshops, he decided to add resistance to this exercise. So, how
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you are going to get this started is you need something to resist you
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laterally. Alright the idea is to stimulate activity of your gluteus
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medius, so when you're setting up this resistance you want to make sure so that
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somebody can in fact stand on a single leg and maintain a neutral pelvis.
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Alright so just a real quick test before we go through all the postural cues, he
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can in fact maintain a neutral pelvis, I can feel his gluteus medius firing
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against the resistance we have pulling him that way. All right so let's go ahead
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and start over and get the setup. I'm going to make sure his upper
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body posture is good, head back, chin tucked, shoulders down and back.
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I'm going to go ahead and have him bring his feet together, make sure they're
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pointing forward. Now I know usually our kinetic chain checkpoints are hip width,
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but he's about to stand on one leg. Now the big cues for this exercise
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are not something we always pay attention to I think, but are extremely
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important in this particular progression. I want to make sure that he can press
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the first MTP, that's the ball behind his big toe, into the floor while maintaining
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the arch in his foot, that's his medial longitudinal arch, that's the inside arch
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of your foot. So can you press that big toe in but still maintain the arch of
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your foot, good. This whole exercise is going to be predicated on the fact that
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he can maintain single leg balance while maintaining that arch, squeezing his
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glute medius, he can squeeze his cheeks like he's got a dollar bill
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between them, and then draw his TVA, there you go. Now go
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ahead and lift this foot off the ground, and we can see that already this is a
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hard exercise you really don't even have to go any further. This alone just the
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challenge of that resistance, maintaining that arch, keeping your glute medius
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firing drawing in your TVA, this is very very challenging, but we're going to go
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ahead and progress it anyway, because at some point you're going to want to
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progress, and it's kind of fun to abuse Rob. So what you are going to do is
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you can go ahead and start doing your excursions. Now your excursions are going
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to be through sagittal, frontal, transverse, just as we've done before.
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Make sure you limit excursion, make sure you limit distance to as far as they can
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reach while maintaining the arch in their foot, that's it that's all you get;
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this isn't about reach as far as you can until your whole body collapses. The
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first thing somebody's going to want to do is go flat foot on you, and then reach
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really far, but that's that's already cheating it's already compensating. So
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make sure you keep a very very watchful eye, on the medial arch of that
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foot. Let's go a little frontal plane good. Now when I go frontal plane
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I do like to do a little abduction with extension, so he's going out and just a
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couple inches back for me. What I'm trying to promote is gluteus medius
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activation on the side, not TFL, a lot of people like to go abduction and flexion
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which is gearing up the TFL which is a short overactive structure in a lot of
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our postural dysfunction. The transverse plane stuff, now I like to teach this as
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the intention to move in the transverse plane, that is this leg is going to move
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in the transverse plane where he tries to keep his pelvis facing forward, his
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ASIS should be facing that way. Very, very challenging progression. You can see Rob
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is wearing out, this isn't actually our first take either so poor Rob is getting
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beaten down today, but you see these progressions, you see how you can add
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this resistance. One thing that Rob also brought up which I thought was
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awesome is he uses this in his practice, as a way to start integrating the
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gluteus medius back into our gait pattern. So once you have this resistance, once
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you know this person can balance on a single leg, you can actually have them
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work on stance phase with their right leg, while working through their
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swing phase on the left side. So they can go from a toe-off position,
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you're not actually doing toe off, but toe off position, and then we actually
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talked about you could go to heel strike. He likes to go back sometimes to
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just almost like an excursion activity, and just do a toe touch. I think either
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way would be acceptable depending on what functional impairment you're
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working on within their gait pattern, but but you do a few reps of that after
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you've done all this wonderful balance work to kind of set up that gluteus
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medius firing, to try to set up better mechanics in the foot, and I think you
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guys are going to see some huge improvements in the way people not only
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walk, but this would be a great warm-up activity for running. All of your
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athletes out there who have that lower leg dysfunction. I hope you enjoy
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that exercise. Rob once again thank you for all of the tips. I really appreciate