Muscle imbalances are

ubiquitous / due to sitting

The Core as a Punctum
Fixum in Sport: A Key to
Making Movement
Patterns More Efficient
Craig Liebenson, D.C.
Craigliebenson.com
craigliebensondc@gmail.com

Working out should improve Most gym exercises tighten us

them - right? • “Think of working out in
the gym. All the
movements are about
folding inwards.
Between curls,
crunches and squats
we’re always tightening
and closing ourselves
up.”
Laird Hamilton

1
 Scissors Over Time Failure Tolerance
Drops w/ Repetitive Strain
• Oblique diaphragm
• Failure of oblique
abdominal muscle
slings Failure Tolerance
• T/L overload
• Hyperlordosis Load Margin of Safety
• Lower Cross Failure
Syndrome (Janda)
Derived from:
McGill S, Lower Back Disorders:
Evidence-Based Prevention and
Rehabilitation.
2002, Human Kinetics, Champlain, IL

Time

Derived from:

Back Injury Recovery

McGill S, Lower Back Disorders:
Evidence-Based Prevention and
Rehabilitation.
2002, Human Kinetics,
Champlain, IL
• …is usually a result of “a history of excessive
loading which gradually, but progressively, • Breaks/Periodization/Soft Tissue work
reduces the tissue failure tolerance.” “re-sets” Injury Threshold
McGill SM. ACSM Resourse Manual - 3rd Ed. 1998. Williams & Wilkins,
Baltimore Failure Tolerance

Load
Margin of Safety

Time

2
 Agonist-Antagonist
Dysfunction “Weak Link”
Muscle response pattern to sudden
trunk loading in LBP individuals 1. Upright Posture 2. Core/Respiration 3. 1 Leg Stance
• Delayed activation
• Over-activation
• Delayed relaxation

Radebold A, Cholewick J, Panjabi M, Patel T. Spine

2000;25:947-954.

Horizontal Axis
I) The Diaphragm & the Core of Diaphragm (Kapandji)

3
 Conclusion: Patients with chronic LBP
appear to have both abnormal position and
a steeper slope of the diaphragm. JOSPT
2012:42:352-362.

Diaphragm Test -
To Cue or Not to Cue
p553-555 (ROS)
NO ! • “During movement pattern testing, minimal verbal
• Most common faulty movement cues should be used which test an individual’s
pattern habitual way of performing a movement. If the cues
• Vertical chest breathing are too “leading” then the test will be of the subjects
predominates over horizontal ability to learn how to perform the movement
correctly, rather than how they are habitually
• Scalene overactivity performing it.”
• “graded on how they chose to perform rather than
how they could perform the tasks given feedback or
coaching”
• “the hallmark of the SFMA design is the use simple
basic movements to expose natural reactions and
responses by the patient.”

4
 Who is More Athletic?

“The irony is that

what enhances
performance prevents
injury”

IAP Test II) Punctum Fixum

ROS - p555-557 for Punctum Mobilum -
• Bring the chest The Key to Tri-Planer
passively into the Movement
caudal, expiratory
position
• Then the support is
removed from under
the patient’s legs
• The patients holds this
position actively

5
Ball & Socket Joints Require a Fixed Core

Developmental Movement

Whole Body Tri-Planer

Function Jan Zelezny/ Barbora Spotakova

6
 1. Kolar Arm Lifting Test
- p557,558 ROS
Initial position
Patient supine, or standing errects
He/she lifts both arms slowly
L/S stability w/ good lower rib
stability
• Maintain co-contraction of deep
muscles
• Hold exhalation position of ant-inf
ribs during normal respiration
L Hamilton “Once you start being conscious of the
repetitive motions that we all just accept… you realize
how little we do to counteract those motions.”
Lower crossed syndrome)
Vleeming’s Active SLR
“The Core Screen”
Test
• Supine have patient perform SLR
20 cm up & note if there is:
– Pain
– Significant trunk rotation
• If the test is negative add
resistance/ √ strength _/5
7
Abdominal bracing increases lumbar Abdominal bracing reduces lumbar
axial rotation stiffness during the axial rotation during the Active
Active Straight Leg Raise test Straight Leg Raise test

Liebenson, C., Karpowicz, A., Brown, S., Howarth, S., McGill, S.M.
(2009) The active straight leg raise test and lumbar spine stability. Physical
Medicine and Rehabilitation.1(6): 530-535

Overhead Arm Reach Baby Get-Up

• Overhead Reach

8
 What is the Goal of
Get-Up to Sitting to Bear Human Development?

Wall Bug (Kolar) Foam Challenges

Marching Bicycle Kicks

9
 FRONT PLANKS WITH
Stir the Pot
SAW (2/1)
Perform on toes
– Perform in a plank on your toes
– Start w/ chest against the ball
& then push off the ball before
“stirring the pot”
– Start w/ wide stance &
progress by narrowing your
base of support

Vele’s Forward Anti-Rotation

Inclination Pallof Press
Don’t forget the feet!

10
 Cable Chop Plank Rolls

A Roll Not a Twist 2. Punctum Fixum - S-T

• Be sure shoulder blade does not stick out

11
 Start on All 4’s CORRECTION
- hands under shoulders
- knees under hips

• Push off the floor w/ your hands

• until your shoulder blades are flat against
your back
• & your head glides up
• AVOID ROUNDING YOUR BACK!

Bird Dog -
opposite arm/leg reach

NO 
Don’t forget the
hands!
YES 

12
 1” Punch Dying Bug

Bird Dog &

3. Posterior Chain
Anti-Rotation Dysfunction

13
 1 Leg Box Squat
RDL
• Sit on box w/ 1 foot
elevated
• Squat up and down barely
touching the box each time

Troubleshooting
• Find the height you can
squat to on 1 leg
• It may be easier if you
stand on a bench so that
your raised leg stays off the
floor easier
• Avoid trunk flexion
2LDL 1LDL

Functional Reach 1 Leg Squat

a. Supported TRX

14
 Reactive Ham Curl - Singles
• Gray Cook-
"The best
resistance is the
one that causes
the problem to
correct itself
without verbal or
visual
feedback."

Medial Knee
4. Frontal Plane
Collapse

15
Frontal Plane Stability

16
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