0:04 This is Brent of the Brookbush Institute, 0:05 and in this video we're bringing you 0:07 an interesting integrated exercise for 0:09 all of those with lower extremity and 0:11 lumbo pelvic hip complex dysfunction. 0:13 This is resisted walking. I'm going to 0:15 bring Melissa out, and we're going to torture 0:17 her a bit. This is a tough exercise. All 0:20 you guys need is something to wrap 0:22 around your waist. We're going to start 0:24 by setting up on the cable column. So, 0:27 I've seen a lot of creativity used here. 0:29 I think this was originally one of those 0:31 weight belts to attach weights to for 0:33 a resisted pull-up. I've used the 0:35 cuffs that go around elbows for hanging 0:38 leg raises. I've even used thick pull-up 0:41 assist bands hooked to a cable column, just 0:44 so that I can put something around the 0:46 hip joints, or around the pelvis just in 0:49 front of the ASIS here, and get it hooked 0:51 up to a cable column so I can create an 0:53 anterior to posterior force. Now, before we 0:57 start resisted walking, which sounds like, 0:59 "Oh, we're just going to walk and there's 1:01 going to be some resistance," which is all 1:03 well and good. But we don't want to 1:05 reinforce compensation patterns, we want 1:08 to improve patterns. When we do 1:10 integrated exercise, what we're trying to 1:12 integrate is the muscles we had 1:14 previously assessed as underactive. In 1:17 the lower extremity, that tends to be the 1:19 glute complex, the medial stabilizers of 1:22 the knee, and my inverters. Alright, so 1:27 here's what it's going to look like. 1:28 First things first, I'm going to have 1:31 Melissa get into a little bit of a 1:32 quarter squat position here, so we got a 1:34 little bend of the knee, and I want her 1:37 to drive through whichever leg is going 1:39 to end up in the back here, squeeze her 1:42 glute, lock her knee, and push off from the 1:45 ball of her foot. Let me see that. Boom, push. 1:48 Alright, like she's trying to take off, like 1:50 she's going to sprint. Let's see one 1:52 more step. Good. You can see nice 1:56 squeezed glute, right, her knee's locked, 1:58 and she's up on the ball of her foot. 2:00 Back nice and slow. Now, if you're on a 2:04 cable column, you're going to have to 2:05 keep this to like two steps 2:08 and then switch legs. An advantage 2:11 to the cable column is that eccentric 2:13 loading is also very difficult and maybe 2:16 beneficial unto itself. Let's see the 2:18 other leg. Good, nice and slow on the way 2:23 back. Whoo, nice and slow. Alright, so 2:29 let's talk about some cues that I use 2:32 often with this. So, the first 2:35 thing I want to make sure Melissa does 2:37 is that she doesn't do this. Just 2:42 walk. Right, I see this a lot with 2:45 resisted walking, which drives me nuts. 2:47 People hook their heal in and then 2:49 pull with their hamstring. Yeah, great 2:51 athletes, great movers don't pull, they 2:54 push. If she pulls, you can think about 2:58 how that might reinforce 2:59 synergistic dominance of her hamstrings 3:02 over her glute max. As opposed to pushing, 3:04 which is going to be her very first cue 3:08 to get that glute drive, so that she gets 3:12 a much more efficient movement pattern. 3:14 Just think of how much larger your 3:15 glutes are than your spindly little 3:17 hamstrings. Alright, so first things first, 3:21 lean forward a little bit and then push 3:26 by squeezing the glutes. Alright, so we 3:29 lean forward a little bit to load the 3:31 glutes and then push to squeeze the 3:34 glutes. If I couldn't get that to happen 3:37 what I could intentionally do is, maybe, 3:41 add back in, if I hadn't already, some 3:45 glute max activation exercises. Maybe 3:48 even add some bridges during her core 3:51 integration exercises, so that when she 3:54 got to this exercise in her movement 3:56 prep, or her warm-up or her rehab routine, 3:59 her glutes were ready to go. Now the next 4:03 thing we might see is she goes ahead and 4:05 steps forward, but this time she doesn't 4:08 walk out her knee. Well, maybe now what 4:11 I'm thinking is, okay we still have a lot 4:12 of synergistic dominance from the from 4:15 the hamstring and they don't want to let her 4:17 fully extend through the knee, or maybe 4:18 she's a little weak in her medial 4:19 stabilizers. I'm going to go ahead and 4:21 cue or to, "Ok, this time when you step 4:24 forward, I want you to lock your knee. You 4:26 have to squeeze your glute and lock your knee 4:28 out." Good. 4:29 And even if I have to do it one step at 4:31 a time initially, okay step back, start 4:33 over again. Let's do it again. Even if I 4:35 have to do that to get her to 4:36 really learn how to step and lock out, 4:38 that's what I'm going to do. Again, if I 4:41 hadn't already put it in her program, I 4:44 could use something like a TKE, a 4:46 terminal knee extension exercise, 4:49 or tibial internal rotator activation, and 4:51 start working on those medial 4:52 stabilizers of the knee to get them 4:54 strong enough to get her to lock out. 4:56 Alright, the next thing I see a lot of is 4:59 somebody will push but leave their heel 5:02 on the floor. I see a lot of that. How 5:06 are you going to get a good step off, a 5:07 good bounce, if your heel-- you just 5:11 just left a joint out when you did 5:12 that. Right, you just left out your ankle. 5:14 I'm not going to move my ankle today. 5:15 That's not a good thing. We have a lot of 5:17 people who have ankle dysfunction. We 5:20 need to make sure they integrate their 5:22 ankle, and if you've been using tibialis 5:24 posterior activation, then all of these 5:27 cues will already be set up. This is one 5:30 of the reasons why I preach, "It's 5:32 important to fix the pieces before you 5:36 try to assemble the puzzle." In 5:38 other words, I believe you have to 5:40 activate individual muscles before you 5:43 try to integrate new movement patterns. 5:46 One of the reasons is because it sets up 5:49 all of our teaching cues. So, you remember 5:51 your tibialis posterior activation? Good. 5:54 So, toes up, push through the ball of your 5:56 foot. I want you to kind of, like- yeah, 5:58 press off. Good, oh good, and back a little 6:03 bit. She's getting more and more powerful. 6:05 She's pulling more and more on 6:06 the cable. This is really good. So you 6:10 guys can see how we're starting to integrate 6:12 all that in. And the last trick I'm going 6:14 to show you is you'll get those people 6:16 who collapse into their step. Right, they 6:19 try to take a step and they do this sort 6:21 of thing, also known as a positive 6:24 Trendelenburg sign. It's the collapse of 6:27 that pelvis, also known as gluteus 6:30 medias weakness. So, of course, I could 6:32 integrate back in gluteus medius 6:34 activation and see if that fixes the 6:35 problem. A little additional cue I can give 6:38 you is rather than have somebody step 6:40 straight out, 6:42 you could have them step out this way, 6:45 which is going to integrate a little bit 6:48 of abduction which is going to force 6:50 their gluteus medius to fire. So, let's 6:52 try that. Right, and the next step. So 6:56 this isn't quite the waltz step that we 6:58 see in sidestepping. We're not 7:00 quite doing this, we're just doing a 7:03 little bit of abduction, just a little 7:06 bit of a little of a wide shuffle or 7:10 wider shuffle than our normal walk to 7:13 make sure we're getting good gluteus 7:15 medius activation. And from here, let's 7:19 say I've set all of that up, then I can get 7:22 even more torturous. Now, I'm not going to 7:25 be able to show you how much I would do, 7:27 because of the width of this camera 7:30 angle. But what I really like to do is 7:33 take somebody off the cable column, use 7:36 something like a pull-up assist band, and we 7:40 end up setting up something that looks 7:42 like we're training for the Iditarod. 7:43 Maybe that's not a joke you want to use with 7:47 your patients, some people do not like to 7:49 be referred to as huskies. But, nonetheless, 7:53 I think if you guys wrap your wrists 7:56 around a band like this, 7:58 you've done a 7:59 good job cueing up to this point, you 8:01 guys can set up a pretty significant 8:04 distance. Okay, we're going to do 8:06 resisted walking for the next 50 feet. 8:08 Good, take another step. Good, take 8:13 another step. And now she gets that 8:16 nice, repetitive being able to work on it- 8:19 you can go ahead and relax. She can work on 8:22 one step after another after another 8:24 after another, rather than 8:27 the somewhat disjunct of having to take a 8:30 step and then come back. Right, so we can 8:33 progress from working on all of our cues 8:35 individually joint, joint by joint, segment by 8:38 segment, and then go, "Okay, let's really 8:41 try to get more transference out of this 8:42 exercise by having you do it 20 times in 8:46 a row, 40 times in a row, 50 times in a 8:49 row. Let's have you do this for a hundred 8:51 feet." Guys, I hope you enjoy this exercise. 8:54 I hope you have some fun with you 8:55 patients and clients. I look forward to 8:57 talking to you soon. 9:06
