Y

Professional PT
Clinical Corner
Issue 3

Inside this issue:

Student Symposium 1
A Simple Test for
Glute Activity

2,3

Editors Note

Subtalar Sling Taping Technique

In The Mind
Of.Our Patients!

A Slippery Slope

Thought of the
Month

Clinical Spotlight

To Stretch or Not

Technique
9
Peek/Clinical Gems
Points of Interest:
Rob Panariello received
the Lynn Wallace award
from the Sports PT section of the APTA for clinical education and clinical
excellence at the Combined Sections meeting
(CSM) in Indianapolis,
and he will also be presenting at the NFL Combine Medical conference
in Indianapolis, Indiana
Febuary16, 2015

March 2015

Student Symposium: A huge success!!

Professional Physical Therapy
held our 3rd annual clinical
education symposium on Saturday February 21, 2015 at
our Garden City facility. The
symposium is another way to
show our continued commitment to education and clinical
excellence. This free event for
the students is an excellent
forum for us to share
knowledge with our future
clinicians and show our continued commitment to education.

symposium started with opening remarks by our chief clinical officer Rob Panariello
highlighting the importance of
paying it forward and mentoring our young clinicians.
Excellent talks were also presented by:
Tim Stump MS PT ATC
Glenn Bitran MPT, COMT,
Adam Discepolo DPT

Students asked about the

company benefits and specifically, our clinical education
program. The student program, MedBridge, our goal to
mentor our young clinicians
and the development of a residency program were discussed.
The symposium was a huge
success and core to our future
growth!

Adrian Datu PT, DPT, OCS,

CSCS, Cert. MDT

This year was the best attendDean Maddalone PTA, CSCS

ed symposium to date with
104 students representing 17 The feedback from the students was excellent. Our HR
different schools.
department was well repreStudents arrived at 12:00 and
sented with an information
started off with a pizza/soft
booth set up which was very
drinks meet and greet. The
busy during the breaks.

Coming soon: Education

quick tips on video

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2014

YPage 2

Professional PT Clinical Corner

A Simple Test for Glute Activity:

The gluteal muscles

are a significant
contributor to proper
posture, physical
esthetics, the
rehabilitation of low
back, hip, and knee
pathology.

In recent years the gluteal

muscle group has received
much notoriety in the physical rehabilitation, fitness, and
sports performance industries. The gluteal muscle
group includes the gluteus
maximus (one of the most
powerful muscles in the
body), medius, and minimus,
which together make up the
buttock. There is also documentation from those who
consider the small tensor fasciae latae part of this muscle
group as well.
The gluteal muscles are a
significant contributor to
proper posture, physical esthetics, the rehabilitation of
low back, hip, and knee pathology, as well as optimal
athletic performance to name
a few. This muscle group also
contributes to the high force
application into the ground
surface area for favorable
body propulsion, deceleration
from high velocities and landings, and change of direction
abilities. The gluteal muscle
group also safeguards the
preservation of the athletes
posture and contributes to
the appropriate vertical hip
height during high velocity
activities. This commentary
will discuss a gluteal testing
technique that is both easy
and accurate to utilize with
both your patients and athletes.

Rob Panariello MS PT ATC

conversations is the contribution of the gluteal muscles for

the maintenance of proper
hip height during sprinting
and other high velocity athletic activities. This vertical
hip height lesson was imparted upon me years ago by
distinguished sprint coach
Charlie Francis at the time
Charlie, Al Vermeil and I were
all hired by an NFL football
team and worked together as
consultants with their football
players during the off-season.
This lesson was also reinforced during recent sprint
training discussions with
Charlies protg and my
good friend S&C Coach Derek
Hansen.
The gluteus maximus is
known as a strong extensor
of the hip, however one must
not forget that the hamstring
muscle group plays a dynamic role in hip extension function as well. During high velocity activities the athletes
optimal hip height (posture)
must be maintained. Weak
muscles will result in a decrease in hip height thus effecting the position of the
stance foot at the time of
ground contact. This decrease
in

The Gluteal Muscle Group

Many dialogs regarding the
gluteal muscle group may
include activation, force
production, and function to
name a few. One aspect of
athletic performance not often discussed during these

hip height signifies a diminished distance from the hip to

the ground surface area, resulting in a foot contact fur-

For internal use only. Not intended for external sharing or distribution.

ther anterior to the bodys

center of mass than desired.
Due to this change in foot
contact position some significant consequences may transpire. These changes include, but are not limited to
the following:
1. Increased ground contact
times (increased amortization) resulting in less elastic
energy available for force
output.
2. Decreased flight time and
distance covered
3.An greater amount of energy is required to maintain the
body above the center of
mass
4. A pawing vs. a
punching of the ground surface area ensues. This results
in a greater pull through by
the lower extremity to propel
the body forward. This adjustment requires the hamstring muscle group to make
a greater contribution as a
knee flexor, thus repetitive
strides over time set the table
for possible hamstring injury.
A Simple Test for the
Glutes
The gluteal testing procedure
requires a standard treatment
table with a plyobox the
height of approximately 12
inches lower than the table
height placed at the end of
the table. The athlete lays
supine at the end of the table
with their knees flexed to 90
degrees. Their feet are positioned flat upon the plyobox.
(Figure 1).

Professional Physical Therapy 2015

Page 3

Issue 2

A Simple Test for Glute Activity

When instructed, the athlete performs a bilateral lower extremity

bridge (raises their hips) for a specific number of prescribed repetitions and reports if they feel the
muscle activity in the gluteal or
hamstring muscle groups (Figure
2a).

(continued from previous page)

string muscles ability to produce

force. The active insufficiency concept of a muscle transpires when a

The test is repeated performing a

single leg bridge with each lower
extremity The athlete once again
reports if the muscle activity is felt
in the gluteal or the hamstring
muscle groups. If the test performance is felt in the hamstring muscle group the gluteal muscles are
assumed to be performing suboptimally and require additional
training.

two joint (bi-articular) muscle is

shortened at one end while a muscle contraction is initiated at the
second joint. Due to the close
The length-tension position of a
proximately of the muscle attachmuscle fiber will affect the ability of
ments, the muscle is placed at a
the muscle fiber to produce force.
low point on the length tension
The gluteal test described is foundcurve resulting in a diminished caed upon the principal of active
pacity to produce force. Therefore
insufficiency which based on the
bi-articular muscles placed in a pobody positioning of this test, will
sition of active insufficiency will
have a specific effect on the hamconsequently produce a weaker
The Active Insufficiency of a
Muscle Group

muscle contraction.
The hamstrings are a bi-articular
muscle group with attachments at
both the hip (pelvis) and the knee.
At the initiation of testing, the hip
joint is positioned in an extended
position while the knees are simultaneously flexed to 90 degrees resulting in a hamstring position of
active insufficiency. This shortened
position the hamstrings results in a
decreased ability to produce ideal
tension (force), thus the emphasis
of the hip extension performance is
now placed upon the gluteal muscles. During the test performance if
a significant exercise performance
contribution were felt in the hamstring muscle group, due to the
limited ability for this muscle group
to produce force, the tester would
conclude the gluteal muscles were
not performing optimally.
This test is an effective component
of the evaluation process of both
the patients we rehabilitate as well
as the athletes we train at our facilities. Hopefully it will be a consideration as a component of your
evaluation as well.

Note form the editor:

Hope everyone is staying warm!
Dont worry the nice weather is coming soon, so they say. I hope you
enjoy this months newsletter . Please
feel free to reach out with ideas,
questions, comments..whatever.
Dont be afraid to submit an article,
otherwise you will have to read my
stuff month after month after month
:)

It does not matter how slowly

you go as long as you do not
stop.
Confucius

Enjoy!

Robert Shapiro

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Page 4

Issue 2

The Ankle Joint: Subtalar Sling Taping Technique :

According to the American Orthopedic Foot and Ankle Society, a lateral
ankle sprain is the most common
cause of lost playing time and disability among athletes. In order to
decrease the incident of this injury
the athlete must not only demonstrate the proper ankle/leg dynamic
and static strength but also the appropriate external support to the
ankle. This includes ankle taping
techniques or bracing when engaging in physical activities like basketball, football, etc. The Subtalar
Sling ,which could be applied either
medially or laterally, is a taping
technique introduced by Dr. Gary
Wilkerson from the University of
Tennessee 1991. Wilkerson compared the biomechanical effect of
standard taping versus the subtalar
method of taping and concluded that
subtalar sling ankle taping procedure provided greater restriction to
motions associated with ankle instability than the more widely used
standard procedures.
This technique must be applied in
addition to the regular taping technique in order to maximize joint sta-

bility. The following materials and

application method is required for
the technique:
Materials: High-strength semielastic tape (Elastikon)

Axel Melendez, ATC

talus in relation to the leg.

References:

Wilkerson, GB: Biomechanical and

neuromuscular effects of ankle tapApplication: Patient/subject posiing and bracing. J Athl Train 37:
tioned on a table with the foot hang436-445, 2002
ing off in a 90* of foot dorsiflexion
Wilkerson, GB: Comparative Biome(neutral)
chanical effects of the standard
Starting off from the base of the
method of ankle taping and a taping
4th & 5th tarsometatarsal heads
method designed to enhance sub apply 1or 2 strips oriented on a talar stability. Am J Sports Med. 19:
588-595, 1991
45* angle in the sagittal plane
towards the lateral malleolus &
wrapped around the lower leg.

Axel Melendez ATC currently

serves as the Sports Medicine Coordinator for Professionals New Jersey
Make sure the tape spans all
joints between the forefoot & leg offices.
(4th & 5th tarsometatarsal
joints, transverse tarsal joint,
subtalar joint and talocrural
joint).
A vertical component resists
frontal plane motion of foot, A-P
component resist anterior translation of talus (anterior drawer).
Most of the restraint will be in
inversion of lateral border of the
foot and internal rotation of the

Step by step:

For internal use only. Not intended for external sharing or distribution.

Professional Physical

Professional PT Clinical Corner

Page 5

In The Mind Of.Our Patients!

It may sound funny but not many
patients come to physical therapy
because they want to. Often their
MD refers them because theyve
been injured or had surgery or maybe a spouse or parent make them
go to physical therapy. Bottom line
is, our patients are usually in pain
are often irritable and come to us
because they need physical therapy.
Thats an important concept for us
to understand as clinicians, administrative personnel, aides and executives. In 2015, Professional is embarking on a companywide initiative
to improve customer service and
make it a cornerstone of our care.
Being empathetic to our patients is
where it all begins.
Empathy is the ability to understand and share the feelings of another. For many of us in the health
professions, this comes naturally.
For some it is more challenging. In
order to truly give our patients a
great experience when they dont
necessarily want to be here, requires everyone to contribute.
In my 23 years as a therapist practicing in Westchester, Upper East
side and Upper Westside, Ive dealt
with plenty of cranky patients.
What I try to teach young clinicians,
aides and administrative staff is to
put yourself in your patients
shoes. It sounds simple and most
of us have heard about doing it but

Tim Roy PT CSCS

what would YOU be thinking if you

walked in to your office and how
would that experience play out?
Would you have a good experience?
What would need to change?

late? Should I be annoyed that

shes late and messing up my
schedule? What if it were you?
How would you react if your PT told
you Youre late. I cant do any
manual on you but you can do your
exercises ?
Common expectations and assumptions that we have about our patients will often bias us to what we
may say or do. Its important to be
mindful of using empathy as a starting point with our patients from the
moment they call us to ask those
first questions. Francis Peabody
said it best back in 1927 when he
addressed Harvard Medical Students: for the secret of the
care of the patient is in caring
for the patient.

Common misconceptions:
How many of us really know what
your own insurance benefits are or
even what your copay is? Yet we
often expect our patients to know
this.

Tim Roy is a Regional Clinical

Director in NYC and works out of
our West Side location.

Many 70-80 year olds did not grow

up growing to a gym or exercising
very much. Should we get frustrated when they still dont know what
to do after 4-5 visits?
What about the frazzled Mom who is
continually rushing to drive the kids
to their activities and then get herself to PT but keeps showing up

Random quiz questions (I had some extra room :) )

1. What is the function of the popliteus in closed chain movement?
2. What is the capsular pattern of the wrist joint?
3. What does a positive Babinski reflex? (great toe up or down?)
4. What spinal segment refers to the elbow and mimics lateral epicondylitis?
5. Who was this years Lynn Wallace award from the Sports PT Section OF THE APTA ?
Answers on next page

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Page 6

Issue 2

The Slippery Slope:

Ron Alzate PT

A few years ago, the discipline of

spinal manipulation piqued my curiosity and I started looking into continuing ed courses on it. I also did
some research and found that spinal
manipulation had some, albeit scarce
at the time, evidence supporting its
safety and efficacy in the treatment
of lower back pain. So were clear,
Im referring to high velocity, lowamplitude thrust manipulations.
A few years ago I took a course
with James Dunning - a very funny,
slightly abrasive and hilariously
opinionated PT with a heavy Irish
brogue. He is the founder of the
Spinal Manipulation Institute and is
based out of Birmingham, Alabama.
His 2-day course was a nononsense, highly practical review of
the literature and instruction in the
application of numerous manipulation
techniques. The stuff we learned
spanned the entire spinal column. It
was exciting and it was fun. Slowly
but surely, Mr. Dunning let his disdain for chiropractors be known. To
make a long story short, he was in
the middle of a legal battle with chiropractors and has since defended
his right and every other PTs in
Alabama in front of the Alabama
Supreme Court no less, to perform
spinal manipulations.
If you believe that chiropractors are
the only practitioners who should be
performing spinal manipulations,
then read no further. If it does not
concern you that PTs in several
states Alabama, Arkansas, Califor-

nia, Indiana, New York, Washington,

just to name a few have faced similar challenges to their state practice
acts, then move on to the next article. If you are not worried about restrictions being placed on your ability
to practice PT, then go right ahead
and dig your head a little further into
the sand. But if you are worried
about the slippery slope we might
find ourselves on if we do not meet

mobilization? Or personal trainers

decide that exercise prescription
should be solely their domain? Think
thats ridiculous? We probably
thought the same thing about spinal
manipulation 20 years ago. I highly
encourage you to read the articles
below. At the very least, educate
yourselves on whats going on in other parts of the country. It might just
be a matter of time before this fight
lands on your doorstep.
https://osteopractor.wordpress.com/
2015/02/06/spinal-manipulation-byphysical-therapists-recent-legislation
https://osteopractor.wordpress.com/
2015/02/20/supreme-court-ruling-infavor-of-alabama-physical-therapistin-spinal-manipulation-case)

these challenges head on, then we

have to start doing something about
it.
In his online publication
Osteopractic Physical Therapy Mr.
Dunning writes: It is perhaps most
important that physical therapists be
engaged in the legislative process,1
because Over the past fifteen years,
legislation has been introduced in
multiple states that would restrict
physical therapists from practicing
Ron Alzate is a Partner and Cliniand/or advertising spinal manipulacal Director of our Times Square
tion and limit such activity to chirofacility
practors alone or chiropractors, osteopaths and medical doctors. How
soon before massage therapists challenge our right to perform soft tissue

Quiz answers:
1.

unlocks the knee by medially rotating the tibia, externally rotating the femur

2. equal limitation of wrist flex/extension

3. great toe extension (UPWARD) with fanning out of the other toes
4. C6
5. see announcements on page 1 :)

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Professional PT Clinical Corner

Page 7

Thoughts of the month:

For the past 24 years I have spent
hours upon hours trying to learn and
grow as a manual therapist. Early in
my physical therapy education I remember watching one of my professors perform soft tissue and joint mobilization techniques on one of my
classmates and I thought wow, how
do I make my hands do that. I went
to my professor asked that very
question and I remember her response to this day and share it with
my students (or anyone else who will
listen). She said, when you first begin
to perform any hands on technique
your hands are like cement and as
you make a conscious effort to improve the cement chips away and you

Clinician Spotlight:

Robert Shapiro MA PT COMT

develop knowing hands. I have never

forgotten that advice.
Today there is a big push for evidence based practice, although I do
understand the importance, I hope
we, as manual therapists, dont forget about the importance of practicing our art and listen to what our
hands tell us. Experts say it takes
10,000 hours of meaningful practice
to become an expert in any discipline.
Next time you palpate a structure or
perform a technique make sure you
are doing it with purpose and
thought, your hands can give you
amazing information when you listen
to them!

Carrie Haubrich ATC

We a proud to announce that Carrie Haubrich, ATC in Huntington,

has been named the next Secretary of the New York State Athletic Trainers Association!
The following is Carries bio:
I have been practicing as a certified
athletic trainer for just over 12 years.
Upon graduation from Valparaiso University, I worked as a high school
athletic trainer, as well as a high
school science teacher in the northwest suburbs of Chicago. After 8
years, I moved into the clinical outreach setting working for a physical
therapy company. I was very fortunate to be able to have some great
opportunities within that organization
to grow and develop both my clinical
experience as well as moving into
more of the business end of the profession. I was a club sports manager
for the city of Chicago for 18 months,
where I learned a great deal about
business relationships and how to
provide quality health care to nontraditional athletes, including mara-

thon runners, MMA athletes, and

tion, but can help me to encourage
many more. I then was given the op- others to become more involved as
portunity to move into a management well.
role, which allowed me to marriage
my love for the athletic training profession with my passion for teaching.
I moved to New York this past July for
personal reasons, and have since
been working as an athletic trainer in
the clinical setting, where I have a
physical therapist teammate that I
work hand in hand with to treat patients. While I was still in Illinois, I
was starting to get interested in some
of the legislative and development
side of the athletic training profession, as my close colleague was the
IATA president elect, and now current
president. Upon coming to New York,
I have seen that there is a great deal
that can and needs to be done to help
protect our profession and continue to
move athletic trainers forward in the
health care arena. I would like to become a more active participant in the
progression of our profession, and
believe that being secretary will allow
me to not only increase my participa-

For internal use only. Not intended for external sharing or distribution.

Professional Physical Therapy 2015

Page 8

Y
Issue
2

To Stretch or Not To Stretch: That is the Question !

When stretching a muscle you
think is tight be careful that you are
not causing more instability. Let me
explain, when a person has pain
and dysfunction the bodies first reaction to try to protect and to give
that area stability. Stretching a
muscle that is trying to stabilize can
cause your patient more pain and
dysfunction.

as it is known, is based on a concept that it is the job of the Motor

Control Center (MCC) of the cerebellum to organize all body movements and patterns. This region
sends that information to the cerebral cortex which in turn sends info
the spinal cord and muscles. The
MCC can learn new routines (eg.
Dance moves) and can also create
new dysfunctional movement patWhen I come across a muscle that
terns due to trauma. When these
is tight the first question that goes
new dysfunctional movement patthrough my mind is why? What
terns are initiated the new inforother muscle is that muscle working
mation gets stored and the dysfuncover time to compensate? An example would be when examining
the levator scapulae of your patient
you notice that it is very tight and
painful and your first instinct is to
give your patient a levator stretch
to get rid of the tightness. But after
reading this article you may think
twice and say what if it is tight for
a good reason. What could that
reason be? First remember that the
levator is an elevator and downward
rotator of the scapula. What if the
latissimus dorsi (a scapula depressor amongst other things) on
the same side was overworked?
The levator is its antagonist and is
tional loop continues unless someworking over time to try to stabilize
thing is done to break the loop.
the scapula and the neck on that
Muscle testing is key to this concept
side (via its C1-4 attachments) . If
and is used to determine how muswe release the levator without adcles are related to each other. The
dressing the latissimus dorsi we
key to muscle testing for this techmay be setting our patients up for a
nique is that testing is done lightly
flare up of neck pain because we
initially since you are looking for the
took away the bodies attempt at
muscle to engage/respond, not the
stability. If you first released the
true strength of the muscle .
short latt the tone of the levator
may be normalized without even
In the above example, we test the
touching the levator. How do we
levator scapula and although it is
figure this out? In comes Neurotight to palpation it tests out weak
kinetic Therapy, a system devel(inhibited) , our job is to find a
oped by David Weinstock over the
muscle that may be shutting off
last 30 years is and becoming more the levator. This is done by searchpopular over the last 3 years. NKT, ing its antagonist, agonist , syner-

For internal use only. Not intended for external sharing or distribution.

Robert Shapiro MA PT COMT

gist or muscles that may be tight

(facilitated) . Searching is done
by palpating specific spot on the
suspected muscle (for example the
latissimus dorsi in this case) and
while maintaining light contact you
re-test the levator (initially weak).
This is called therapeutic localization and is based on the science
that touch stimulates mechanoreceptors within the skin and in turn
have connections to the muscles via
spinal pathways(cutaneomuscular
reflexes). If the levator now tests
strong you have found a pair (the
reflexive loop is completed), in other words muscles that are affecting
each other in function. If it does not
test strong keep searching. In this
case the key is to perform soft tissue release to the latissimus dorsi
followed immediately with light
strengthening (activating) the levator muscle. If the release was successful the levator should now test
normal on muscle testing (without
touching the latt). You have started
to re-train the MCC.
This relationship is not fixed with
one repetition and it is imperative
that the patient be given homework
to enable the body to integrate this
new efficient pattern. This patient
performs a soft tissue release to the
latissimus dorsi (90s secs) followed
by gentle strengthening of the levator (light shrugs 20 reps) The goal
of the exercise is to re-educate the
MCC and attain a normal pattern.
Homework is to be performed 2-3x
a day for one week to achieve motor reeducation.
This is a simplified example of the
importance of knowing what to release and what not to release.

Professional Physical Therapy 2015

Professional PT Clinical Corner

Page 9

Technique Peek : Whack a hip technique:

Robert Shapiro MA PT COMT

Use: Great for Lumbar, hip, foot pain Procedure

Dysfunction anteriorly displaced
femoral head.

is most likely neuroreflexive, effecting the type 3 joint receptors which

respond to quick movements by inhibiting muscles surrounding a joint.

Patient is positioned side lying with

their bottom leg straight and the top
hip is flexed to about 45 degrees.

Rationale for treatment: The theory is the femoral head is positioned

Therapist stands behind the patient
anteriorly in the acetabulum due to
and stabilizes the ASIS with their
some laxity in the labrum.
cephalad hand. The caudal hand applies a rapid (whacking ) force the
Assessment: if the following
posterior aspect of the trochanare positive you have found
ter. The vector of the force is in an
an anteriorly disp laced femoral
anterior direction vectored in a line
head
approx. 45 degrees in line with
1. Inability to maintain knee in the
where the ceiling meets the wall.
sagittal lane with passive hip
The key is to follow through with
flexion causing deviation into
your force grazing the trochanter
external rotation before hip flex- as depicted by the arrow in the phoion reaches 90 degrees
to.
2. limited hip IR at 90 of flexion
(blocked and painful)
3. weak hip ER tested at 90 degrees

From the work of Gail Molloy & Fred

Stoot , picture from NAIOMT
YouTube video

The goal is to spin the head of the

femur posteriorly in the acetabulum
and therefore reposition it into a neutral position. The mechanism responsible for the success of this technique

Clinical gems of the Month

To palpate the L5 spinous process
first find the PSIS and move your
fingers 45 degrees towards the
midline and you are on L5, to confirm that you are on L5 extend the
patients lumbar spine (side lying or
prone) and L5 is the last mobile
joint.

Re-test hip flex, IR and resisted

ER. If successful all three should be
improved.

Robert Shapiro MA PT COMT

The iliocostalis muscle tenderness is an "idiot light" for rib dysfunction signaling the therapist to
investigate further for potential
dysfunction.

Trigger points in the iliocostalis in

the region of L1 can refer to the
mid buttock
To test OA joint flex/ext 30 degrees axis through the ear.
When dealing with headaches
don't forget about the orbicularis
oculi due to its attachment to the
gala aponeurosis and occipitalis.
(See figure )

When you find an anteriorly rotated ilium look at the proximal

fibula head for dysfunction due to
the biceps femoris attachment to
Josh Cleland (2009) determined
the fibula head, sacrotuberous ligathat a reduced kyphosis at T3-T5
ment, and long dorsal SI ligament.
region was associated with a posiThe biceps femoris is facilitattive response to spinal manipulation
ed/over working attempting to
in patients with neck pain.
counter balance the anterior moFor internal use only. Not intended for external sharing or distribution.

tion of the ilium.

When treating a SIJ dysfunction
with an anteriorly rotated pelvis
remember to look for an anterior
talus on the same side
A positive Hoffman sign is elicited
by flicking of the middle finger
which elicits FLEXION of the thumb
w or w/o flexion of the fingers. (Hoffmann's sign, or heightened finger flexor reflexes suggest
an upper motor neuron lesion affecting the hands.)
Common deviations seen with
plank exercises: rounding of
thoracic spine due to over use of
rectus abdominis and underuse of
TA, hips too high: possibly due to
over activation of the quadriceps
due to multifidus weakness or hip
flexor tightness , trunk rotation
may be due to weakness up the
kinetic chain which can be sorted
out with muscle testing.
Professional Physical Therapy 2015