0:00 This is Brent coming at you with another one of our collaboration videos, to bring 0:04 you a progression of the single leg excursion, or the single leg balance and 0:10 excursion. I think I mentioned it previously as the single leg balance and 0:14 excursion of death, which makes a progression of this seem even more 0:18 sadistic. I'm going to have my friend Rob come out and help me demonstrate, he is 0:22 responsible for this sadistic progression. I want you guys to know PT 0:26 for many years, certified orthopedic manual therapist, and faculty himself 0:30 for the Maitland workshops, he decided to add resistance to this exercise. So, how 0:36 you are going to get this started is you need something to resist you 0:39 laterally. Alright the idea is to stimulate activity of your gluteus 0:44 medius, so when you're setting up this resistance you want to make sure so that 0:48 somebody can in fact stand on a single leg and maintain a neutral pelvis. 0:54 Alright so just a real quick test before we go through all the postural cues, he 0:59 can in fact maintain a neutral pelvis, I can feel his gluteus medius firing 1:03 against the resistance we have pulling him that way. All right so let's go ahead 1:08 and start over and get the setup. I'm going to make sure his upper 1:11 body posture is good, head back, chin tucked, shoulders down and back. 1:16 I'm going to go ahead and have him bring his feet together, make sure they're 1:18 pointing forward. Now I know usually our kinetic chain checkpoints are hip width, 1:22 but he's about to stand on one leg. Now the big cues for this exercise 1:28 are not something we always pay attention to I think, but are extremely 1:33 important in this particular progression. I want to make sure that he can press 1:38 the first MTP, that's the ball behind his big toe, into the floor while maintaining 1:46 the arch in his foot, that's his medial longitudinal arch, that's the inside arch 1:52 of your foot. So can you press that big toe in but still maintain the arch of 1:57 your foot, good. This whole exercise is going to be predicated on the fact that 2:02 he can maintain single leg balance while maintaining that arch, squeezing his 2:08 glute medius, he can squeeze his cheeks like he's got a dollar bill 2:12 between them, and then draw his TVA, there you go. Now go 2:18 ahead and lift this foot off the ground, and we can see that already this is a 2:23 hard exercise you really don't even have to go any further. This alone just the 2:27 challenge of that resistance, maintaining that arch, keeping your glute medius 2:33 firing drawing in your TVA, this is very very challenging, but we're going to go 2:39 ahead and progress it anyway, because at some point you're going to want to 2:41 progress, and it's kind of fun to abuse Rob. So what you are going to do is 2:46 you can go ahead and start doing your excursions. Now your excursions are going 2:49 to be through sagittal, frontal, transverse, just as we've done before. 2:51 Make sure you limit excursion, make sure you limit distance to as far as they can 2:57 reach while maintaining the arch in their foot, that's it that's all you get; 3:02 this isn't about reach as far as you can until your whole body collapses. The 3:08 first thing somebody's going to want to do is go flat foot on you, and then reach 3:12 really far, but that's that's already cheating it's already compensating. So 3:15 make sure you keep a very very watchful eye, on the medial arch of that 3:20 foot. Let's go a little frontal plane good. Now when I go frontal plane 3:25 I do like to do a little abduction with extension, so he's going out and just a 3:31 couple inches back for me. What I'm trying to promote is gluteus medius 3:35 activation on the side, not TFL, a lot of people like to go abduction and flexion 3:40 which is gearing up the TFL which is a short overactive structure in a lot of 3:43 our postural dysfunction. The transverse plane stuff, now I like to teach this as 3:50 the intention to move in the transverse plane, that is this leg is going to move 3:55 in the transverse plane where he tries to keep his pelvis facing forward, his 3:59 ASIS should be facing that way. Very, very challenging progression. You can see Rob 4:06 is wearing out, this isn't actually our first take either so poor Rob is getting 4:10 beaten down today, but you see these progressions, you see how you can add 4:16 this resistance. One thing that Rob also brought up which I thought was 4:21 awesome is he uses this in his practice, as a way to start integrating the 4:26 gluteus medius back into our gait pattern. So once you have this resistance, once 4:33 you know this person can balance on a single leg, you can actually have them 4:38 work on stance phase with their right leg, while working through their 4:42 swing phase on the left side. So they can go from a toe-off position, 4:49 you're not actually doing toe off, but toe off position, and then we actually 4:53 talked about you could go to heel strike. He likes to go back sometimes to 4:58 just almost like an excursion activity, and just do a toe touch. I think either 5:03 way would be acceptable depending on what functional impairment you're 5:07 working on within their gait pattern, but but you do a few reps of that after 5:12 you've done all this wonderful balance work to kind of set up that gluteus 5:16 medius firing, to try to set up better mechanics in the foot, and I think you 5:20 guys are going to see some huge improvements in the way people not only 5:24 walk, but this would be a great warm-up activity for running. All of your 5:28 athletes out there who have that lower leg dysfunction. I hope you enjoy 5:31 that exercise. Rob once again thank you for all of the tips. I really appreciate 5:36 you coming out today. We'll talk with you soon.
