8 | Akwa | December 2022 / January 2023 / February 2023 While reading this at the computer, try doing four seated knee lifts (R,L,R,L), and you’ll probably notice the body rocks side-to-side. Now imagine that someone has super-glued your foot to the floor, then try to lift it. It won’t come up, but continue trying harder (without letting the body lean). What you’ve done, by imagining the foot is stuck, is activate deep tissue trunk/core muscles (synergists and stabilizers) - you can probably feel it in your abdominals. Next, imagine slowly overcoming the super-glue as you lift your leg. I call this the Heavy Concept. If we imagine that the arm or leg is too heavy to lift, we almost always have precise and proper muscle recruitment. Reverse Heavy simply returns to anatomical position while imagining the limb is too light. Lowering the knee from a knee lift is an example. First, hold your knee up and then imagine surgical tubing keeping it up (the middle of the tubing is under the knee, and the two ends are attached to the ceiling.) Now, imagine you can’t put your knee back down, but you’re trying; this activates deep tissue trunk and gluteal muscles. The Heavy Concept puts the focus back on the synergistic and stabilizing muscles and takes it away from the prime mover. This concept expands the treatment capabilities for clinicians and trainers. Those focusing on weight shifts and loads will especially benefit. I call the concept Heavy and Reverse Heavy because my clients understand it. I know they wouldn’t understand if I called it what it is: A muscle re-education program. So, call it something they can relate to if the terms Heavy and Reverse Heavy don’t work. Helpful Hints: • Reps. I’ve found that most clients can’t stay focused on Heavy for more than six repetitions. Their minds start to wander, and they lose precise muscle recruitment. • Breath. Please keep clients from holding their breath during the effort. That can lead to a few potentially dan- gerous issues—cue to ‘exhale’ as they make the Heavy or Reverse Heavy effort. • Equipment. Simply adding weight or tubing to make the exercise heavy doesn’t work; at least, it hasn’t worked for me. Clients continue to move from the outside in instead of the inside out. It’s the ‘thought’ of Heavy (or Reverse Heavy) that gets us to move correctly. Clients with poor cognitive skills may not be able to participate or benefit. Slow Motion I was jogging in the pool one day and found that the slower I moved, the harder it was for balance and stabilization. So, I switched to a walk, progressively moving slower and slower, which was incredibly hard for balance. However, it also made me more aware of how I was moving – proprioceptive input increased dramatically. Best of all, it showed me my compensatory patterns for falls. I immediately added it as a progression to the BackHab program. Have clients move slowly and then progressively slower and slower. It seems we can’t get to “super-slow” in one transi- tion. You’ll see how they compensate and be able to re-teach balance compensation. • They’ll lift their shoulders and hunch forward – that won’t help balance. • They’ll put their arms out to the side or forward – recipro- cal arms are best for balance. • They’ll look down – another thing we don’t want for balance. • They’ll swing their arms around to compensate – that cer- tainly won’t help on land. • They’ll lift the foot up to step over the water resistance – that’s not it. Like on land, the heel should barely clear the pool bottom during the swing phase. • They decrease step length and increase step width. Chal- lenge them when they do that. • They might slide their feet instead of using a normal swing phase. Cue to adjust. We’d like to see ankle wobble because that will help on land. We’d also like to see core muscles engage. Try it your- self, and you’ll feel all of this. Just keep going slower and slower. The core muscles grow stronger with Slow Motion. The ten- sion in a muscle is related to the number of motor units firing and to the impulse frequency conveyed to the motor neu- rons. Physiologically, using a slower speed protocol requires the activation of more muscle fibers and an increase in the frequency of firing to maintain the necessary force. This pro- vides stimulation for muscle strength development. The initial strength development involves neurological adap- tations (stimulation of muscle fibers through increased firing and recruitment) followed by muscle hypertrophy. In mus- cle hypertrophy, an increase in protein synthesis results in a multiplication of myofibrils within muscle fibers leading to an enlargement of the cross-sectional area of the muscle. There is also a corresponding increase in actin and myo- sin filaments, which subsequently increases the capacity for cross-bridge formation. When the clients decrease the exercise pacing, they can per- form slow, controlled movements. These controlled move- ments produce a higher quality of work with less resistance. As a result, it’s much safer and produces better innerva- tions and improved outcomes. The most common outcome is improved balance skills. Proprioceptive input and core engagement also upgrade. Stop/Start I knew and taught Newton’s first principle of inertia, but until I started using the Stop/Start progressions in BackHab I did not see how effective it could be for balance and core. Cli- ents had been leaning forward while walking because of the water resistance, and simply momentum kept them going. It was discouraging.
