Limiting Rotational Movements

There is some current thought out on limiting or eliminating rotational movements from warm-up, specifically movements that involve the lumbar spine. Apparently the basic premise is that the function of the lumbar spine is to stabilize and limit ROM greater than 5 degrees. This comes from Gray Cooks and Shirley Sahrmann research and work. Sahrmann says "The ability to resist or to prevent rotation may in fact be more important than the ability to create it." I would like to know your opinion of this maybe you could blog it? This was sent to me by Michelle Hart-Miller. I thought rather than try to answer this myself that I would ask some of my colleagues who are more knowledgeable than me in this area to respond with their thoughts. (Remember Monday’s blog that you cannot be an expert in everything)

I, personally, DO the trunk rotational dynamic warmup exercises with my
athletes, but I agree that the primary function is to limit ROM greater
than 5 degrees. Why I do them and How? Why)I believe that if you do not
have each level of the spine ready to do up to 5 degrees of rotation, the
ones above and below will be asked to rotate more than 5 degrees and can
be injured. How)I believe that if you start with a very limited ROM in
the exercises and loosen up to a comfortable level of ROM. I believe that
these are to be done dynamically, meaning continuously moving/get in get
out, not static hold to stress the surrounding ligaments. They are not
for increasing ROM and should not be done aggressively enough to stimulate
ROM. These are VERY early in our warmup as they are NOT to be done as
aggressively as I have seen some trainers do, but they, in my opinion
should be done. Thats my opinion here at the Center.

Tom Bratcher, PT
Center for Athletic Peformance and Physical Therapy
Scottsdale, AZ

My first comment would be how they (Cook & Sahrmann) came to the 5 degree conclusion. It's nearly impossible to get a decent goniometric assessment of pure lumbar rotation without factoring in the thoracic spine. Gary Gray doesn't even bother- he uses the "total body functional profile", which is more practical.

The second thing is, if you look at the anatomic configuration of the facet joints of the back, it's clear to see they were designed to facilitate rotation.

A few observations from my point of view as an ATC with muscle energy and ART background.

1. The multifidus, transversus, & rotatores musculature of the lumbar spine in those with chronic back pain feels like mush. They have been proprioceptively "shut off". It's not just my opinion, it's well documented on MRI's. What shut them off?

2. Very rarely will I see someone with low back pain who doesn't have bi or ipsilateral deep hip rotator ( piriformis, gemelli, et al.), and adductor hypertonicity. If rotation can't take place in the hip, what do you think will take the hit?

3. Much has been made of iliopsoas TIGHTNESS, but I'd like to see more research done on WEAKNESS.

MET teaches you not to focus on the hypermobility, but rather to be a detective and seek out thehypomobility somewhere else in the kinetic chain that has contributed to it.

Joe Pryzulta. ATC & C.S.C.S.

A "bony" rotational stability (and for that matter frontal plane stability) is inherent and consistent with the design of the lumbar spine. That design changes as we move cranially towards the scapulae, arms and head to allow more freedom with rotation (sensible architecture with upper trunk rotation necessary to facilitate control of arms and head).

Worries or concerns about exceeding these natural limitations (with good training) in a healthy athlete are, in my opinion, unnecessary. I believe it might be more negligent to "avoid" or "protect" these motions than to incorporate them into the routine.

Even with the injured athlete we look to solve "rotational" motion/stability problems oftentimes first, as rotation is a(the) key component motion to restore function.

Also, I believe we are traveling a slippery slope with "isolation" and "cognitive" based training. Zeroing in on specific regions does not fit the complex neuroscience behind pure motion. I'm not saying that there is no place for isolated, cognitive training, but to expect that to carry over to an integrated, subconscious highly complex motion seems unlikely.

Jeff Woodrich,PT
Buffalo Rehab Group Physical Therapy,PC
& Athletic Training and Performance, LLC

I use rotational movement as part of dynamic warm up and training, but where the rotation comes from is what I think is the key point.
I believe that I see increasingly tight hips in my patients and the athletes I train. I especially see limited hip extension and internal rotation. My feeling is that the amount of sitting our society does is beginning to rob our hips of their potential mobility and strength and we are then demanding more of our spines. I also find it interesting that many of my patients and athletes have to be "taught" to unlock their feet when performing rotational movements. We have no idea how to move in the transverse plane or how to manage the demands of it. To avoid it completely, in my opinion, would be a mistake.
I tend to spend quite a bit of time trying to restore hip ROM and thereby theoretically decrease the demand on the spine. I then work to integrate the ROM into rotational movements beginning with the feet all the way through the top of the head and out to the hands.
I think that training rotation is essential, especially since so many of us don't manage the transverse plane well.

Thanks for stimulating the discussion.

All the best,

Bob Helfst, MS, PT, ATC, CSCS
Muncie, IN

First, I don't think you can generalize with any type of exercise. I think it depends on the individual and his or her needs/requirements.

Overall, I feel transverse plane motion is absolutely necessary in the lumbar region. Practically everything we do from daily activities to sport skills requires the abilty to rotate through the trunk.

Problems in the lumbar area are usually the result of deficits in others...hip tightness, poor scapulo-thoracic mechanics or even lack of proper ROM in the lower extremities.

The Lumbar spine is designed to work in three planes of motion to allow for proper (as Vern would say) loading and unloading of the entire body.

Limiting motion here would affect mechanics somewhere else. Find where the client/athlete is successful (which plane they are most successfull in) and start there. Then, tweak in the other two until function is restored.

A. Rod need more lumbar ROM than my grandma... but, she needs it for what she needs to do...ROM is dependant on what the user needs to do. Limiting motion to 5 degress? All I care about is are they able to get through their available ROM to allow for proper loading...so when they unload they are successful. I will move up and down the chain to make adjustments for strength and flexibility as necessary.

The body is a chain- link system. To limit one area is a mistake... that is not the way we were designed. If someone has pain in that area I have to decide what is the culprit and adjust from there.

Every client is an individual case.

John Perry P.T., C.S.C.S.

Obviously rotational exercises are not appropriate for people with lumbar instability. The exercises as well as the individual must be evaluated before prescribing them. Eliminating rotational exercises all together is far too extreme.

Jose Vazquez P.T., C.S.C.S.
Strength & Conditioning, Texas Rangers