Part 3: Programming for Power Training

Part 3: Programming for Power

Part 2 of the Power Training Series ended with us defining muscle power in the context of our patients’ everyday lives, as well as why training for muscle power gets ignored.

Now that we’ve established some fundamentals of muscle power and why we need to train for it, we’ll show a concrete example of a power exercise being applied in a rehab setting.

Fixing Movement Patterns with Power Exercises

Limitations in movement patterns can be brought on by a lot of reasons, such as:

  • Poor motor control
  • Impaired hip hinge
  • Breathing dysfunction
  • Poor posture
  • Poor pelvic tilt/positioning
  • Tight muscles

Thus, the first order of business would be resetting the patient’s mobility. This could be done through use of hands-on techniques such as joint mobilizations, ART, Graston, etc. Then, we would attempt to reinforce that new pattern with home exercises, kinesiology taping, and adapting lifestyle/behavior.

Is that the end of the treatment guidelines? Have we ruled out other possible causes of dysfunction before handing our patients a strap and having them go home and pull on their arms or legs for several minutes at a time?  Most likely not.

Once we’ve improved mobility and alleviated pain, the patient is ready to go to the next step, where they’re loaded and patterned in upright positions and postures. What should we do for this part of the treatment? The answer may be power training to engrain these new movement patterns and form more “reflexive” recruitment of the core muscles when they need it.

The chop and lift is a great place to start with power training.

Power Exercise 1: The Chop & Lift

The chop and lift provides a combination of diagonal and rotational movement patterns that people will come across each day in real life.  Combining upper extremity patterns with postural positions of development can be a powerful corrective training technique to promote local muscle activity and to treat imbalances.

By adapting the position, resistance, and velocity, it can be applied to all sorts of patients and diagnoses, including:

  • Trendelenburg dysfunction
  • Valgus collapse
  • Diminished arch control
  • Decreased scapular stability
  • Altered firing of the upper trapezius
  • Impaired thoracic range of motion

Here’s a video on how to perform the chop and lift.  Note how we can vary positions/speed as the patient progresses:

 

  • Start with patient kneeling on the floor.  One of my favorite cues is to pretend that the patient is "in cement" from the waist down.  
  • Assess the position.  Make sure patient is stable.  This can be challenged by narrowing base of support, going to half kneeling, or having the patient perform the exercise in an isometric "lunge" position
  • Patient brings resistance across their body while keeping core stable and breathing out.  As patient progresses you can add isometric holds, eccentric training, or power/speed training

Be sure to watch out for compensation of the foot and ankle, hip drop, not crossing midline, breathe holding, hyperextension of the thoracic spine and loss of balance.  These can all be cues that the patient is not ready for prescribed exercise or position may be too advanced.  If you are not sure compare to the other side!

We’ve had great success with using the chop and lift to initiate movement training and therex progression on a wide variety of complex musculoskeletal diagnoses in our patients.  Perhaps you’ll find this another useful tool to add to your arsenal.

Be sure to join us for the last part of our discussion, where we’ll wrap up the series with 2 great power exercises for the lower body.  Until then, Happy Rehabbing!

References

  1. Voight, Michael, et al. "The Chop and Lift Reconsidered: Integrating Neuromuscular Principles into Orthopedic and Sports Rehabilitation." North American Journal of Sports Physical Therapy 3.3 (2008): 151-58.