Monday Memo 1/29/18

The Monday Memo

January 29, 2018                                                                           PITT DPT STUDENTS

Hollowing vs. Bracing: Building the Proper Foundation for Spine Stability


Abdominal hollowing and abdominal bracing are two techniques commonly used in the outpatient physical therapy setting to treat both acute and chronic low back pain patients whose symptoms are a result of some degree of spinal instability, or an inability to use their musculature properly to maintain their spine within the “neutral zone.” The mutual goal of these exercises is to teach the patient to reactivate certain muscles of their core with the purpose of increasing stiffness of the spine, enabling it to more effectively withstand potentially compromising loads and positions that can result in further pain and injury. Though both exercises are used to treat the same activation deficits of the spinal stabilization musculature, recent evidence has emerged calling into question the effectiveness of the abdominal hollowing technique in achieving this goal, and even suggests a potentially deleterious effect of the exercise in certain scenarios.


The abdominal hollowing exercise, which involves a selective drawing in of the transversus abdominis (TA) muscle to create a “hollowing out” effect in the abdominal region, gained in initial popularity due to evidence that found delayed and diminished EMG activity of the TA in certain patients with low back pain. This research failed, however, to examine the other surrounding musculature of the core, and more recent evidence has found that similar activation deficits were found in additional muscles of the abdominal cavity, suggesting that this delayed and diminished muscle activation is not unique to the TA, but rather pervades the surrounding deep abdominal musculature in certain low back pain patients. Abdominal bracing; which involves a submaximal co-contraction of these affected muscles such as the internal and external obliques, quadratus lumborum, rectus abdominus, transversus abdominis, lattisimus dorsi, and erector spinae, among others; might potentially be better suited to address the widespread activation deficits seen in these patients.


Additional research that examined the forces on the spine under varying loads and positions concluded that holding an isometric TA contraction decreased the potential energy of the spine and caused it to fail at lower loads. This evidence runs contrary to the belief that this isolated contraction increases spinal stability and refutes the clinical reasoning behind maintaining this type of contraction during various exercises such as squats. This reasoning was further called into question by a study that compared a stabilization exercise program involving isometric TA holds in conjunction with various exercises such as bridges and bird dogs with a similar program encouraging participants to employ their natural spinal stabilizing mechanisms throughout their exercises. The trial found that there were similar improvements between groups on pain outcomes, but the general, non-hollowing exercise group had greater improvements in self-reported disability scores. The study suggests that encouraging the body to employ its natural stabilizing mechanism by synchronously activating its abdominal cavity musculature may be more effective than isolating specific core muscles at achieving spinal stability.


Synchronous contraction of muscles about a joint increases the stiffness of that joint more effectively than contraction of a single muscle crossing the same joint. This principle is especially important when attempting to increase stiffness and ultimately stability of the spine and can be achieved by training the totality of the core musculature to synchronously contract with the abdominal bracing exercise to ultimately enable the patient to maintain this stiffness throughout their daily activities. An appropriate level of stiffness required for safe performance of most non-athletic activities only requires the core muscles to contract at 25% of their maximum voluntary contraction level. The principle of stiffness can and should be extrapolated to high level athletes as well in order to optimize safe and effective performance. A powerlifter, for example, must maintain a very high degree of co-contraction during a squat or deadlift in order to keep his or her spine in a neutral position when under heavy loads. This minimizes the risk for injury to the spine and maximizes performance by providing a solid foundation upon which the more distal joints can operate. Rapid contraction and relaxation of the abdominal brace is also important for athletes requiring more ballistic bursts of speed, such as baseball pitchers, golfers, mixed martial artists, and hockey players. It is essential for these athletes to be able to adequately activate their core musculature synchronously in order to accomplish the explosive movements required by their sports. A mastery of the abdominal brace technique may be particularly useful for returning these patients to their previous level of sport participation and skill.


To optimally teach safe and effective movement to our patients, we must replicate in the clinic those motor patterns that are demanded for performance in the real-world setting. This involves synchronous and synergistic activation of all muscles responsible for accomplishing a task, not isolated activity of muscles such as the transversus abdominis, which, when selectively contracted, has been shown to decrease potential energy and load tolerance of the spine. The healthy body activates its core muscles synchronously to prepare for and withstand movement and load on the spine. It is important to encourage that synchrony with the bracing technique to achieve optimal spine stability and performance.


-Brooks Kenderdine, SPT Class of 2019






McGill, S., PhD. (2010). Core Training: Evidence Translating to Better Performance and Injury Prevention(Vol. 32, Rep. No. 3). Lippencott Williams & Wilkins.


McGill, S. (2017). Ultimate back fitness and performance. Gravenhurst, Ontario: Backfitpro Inc.


January 29, 2018 |

The Monday Memo: 1/22/18

The Monday Memo

January 16, 2017                                                                           PITT DPT STUDENTS

Student Spotlight


Student: Christopher Drager, Class of 2019

Q: Hey Chris. Tell us a little bit about yourself to get started: Where did you grow up? Where and what did you study for your undergraduate education?


A: I grew up ten miles south of Pittsburgh in Jefferson Hills, PA. After graduating from Thomas Jefferson High School, I chose to attend Virginia Tech to play football and study Human Nutrition, Foods, and Exercise.


Q: What got you interested in the field of physical therapy?


A: I’ve participated in team sports my entire life. Competing with and against different players was the most exhilarating activity for me. During a 7th grade football game, I tore my ACL and was restricted from athletic participation for three years. That period really challenged me physically, mentally, and emotionally because I was unable to do what I loved the most. In order to return to sports and really gain a competitive edge, I began reading a lot about physical fitness and nutritional advice and it was that information that got me back on the playing fields and eventually earning a college scholarship. Now that my playing days are over, I chose to use the PT profession to help others break down barriers and accomplish their goals.


Q: What else are you involved in outside of school?

A: For the past six years, I have helped coach high school football at my alma mater, Thomas Jefferson High School.


Q: Awesome! Did you have a successful 2017 season?


A: Yes, we went 11-2 and defeated Montour at Heinz Field for the 4A WPIAL Championship, making it the third consecutive championship season.



Q: That’s amazing, Chris. Congratulations! What was your favorite memory from this past season?


A: By far, my favorite memory was destroying Belle Vernon in the WPIAL semifinals round. After losing to the Leopards in the regular season, we were afforded another opportunity to play them in the playoffs. After a great week of preparation, we held the Leps to one first down, beat them 27-0, and removed their hopes of playing at Heinz Field for the WPIAL title.

Q: What is your favorite thing about coaching a team of youth athletes?

A: I enjoy the camaraderie and competition. Coaching requires you to spend a lot of time with a lot of people. Working together and developing strategies and striving to excel for a cause that’s bigger than the individual…that’s what I enjoy the most.


Q: What are your career goals or next steps after your graduate?

A: Over the last few years, I haven’t had many quality options in terms of career choices. Ideally, after graduation I’d love to work as a physical therapist and strength and conditioning coach within the Navy athletics program, but now that the future is showing many different avenues and holds many quality opportunities, I’m just going to savor the moment and take one step at a time.

Q: Anything else you would like to share?

A: I’m grateful Pitt afforded me an opportunity to pursue a new profession. Physical therapy school is giving me the skills to help others (and myself) perform better and be healthier. PT is a rewarding and potentially lucrative profession and I’m glad I’ve chosen to travel down this path!

Thanks again to Chris Drager!

January 22, 2018 |

Monday Memo 1/16/18

The Monday Memo

January 16, 2017                                                                           PITT DPT STUDENTS

Mindfulness in Physical Therapy

As current physical therapy students, we all wrote an essay in order to get into school that detailed what the APTA vision statement for the Physical Therapy Profession meant to us as individuals. As we all still remember that vision statement is as follows “transforming society by optimizing movement to improve the human experience.” When first looking at that statement I am sure what jumps out to us all is “optimizing movement”, where we as future physical therapists will help society by improving an individual’s function so that they can partake in their daily life. What we may miss is that wellness too can help a person improve their human experience. In fact, per the APTA, one of the roles of a physical therapist is to “Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.” Within the physical therapy realm there has been a shift to not only incorporate physical activity but also wellness into treatment. There are many ways in which a physical therapist may incorporate wellness into their treatment of a patient. Rebecca Meehan at the last APTA meeting pointed out that Yoga is one of the many ways that a bridge can be formed between traditional physical therapy and wellness.


Yoga when broken down means “to yoke” or “to join”. Where individuals concentrate on joining the mind, body, and spirit. There are many different types of yoga which include but are not limited to Vinyasa Yoga, Hatha Yoga, Pranayama, Bikram, Medical Therapeutic Yoga (MTY), and the list goes on. Meehan explained that MTY, unlike the other forms of yoga, takes existing evidence based practice while also streamlining clinical assessment and management to improve patient satisfaction and outcomes with specific yoga prescription. In this sense MTY encompasses all components of the biopsychosocial model that we all have come to learn in our studies as physical therapy studies. Yoga also incorporates mediation and mindfulness, where meditation is finding the peace within and mindfulness is a type of mediation where one focuses on being present and being actively aware of what you are doing. The breath that is incorporated in yoga helps to achieve this state of meditation and mindfulness.


There are many ways that yoga can benefit patients which includes and is not limited to improved balance, improved strength, improved mobility, improved mood, improved fatigue levels, and improved quality of life. Many of these improvements are the very impairments that bring patients to physical therapy in the first place, so it seems like a no brainer that yoga is a great tool to incorporate into treatment. Now you may be asking how do I incorporate yoga into my treatment? To be clear, MTY is a specific license you must obtain. This does not mean, however, that just because you don’t have a MTY license that you still can’t incorporate aspects of yoga into your treatment. For example, you may choose to work on breathing with your patient, an essential component to any exercise. You also may elect to incorporate some balancing poses for that elderly patient who is at an increased risk for falls or a warrior 1 pose for the patient working on lower extremity strength, core strength, and balance.


To close, wellness is an important aspect of physical therapy. Yoga is a great way that wellness can be incorporated but it is not the only way. Many tools out there can be used to join physical therapy and wellness and it is just a matter of taking the time to do so. If we as physical therapists are mindful, we can serve as the ones to help patients practice health and wellness.





*If you are interested in partaking in some yoga classes, the Pitt Marquette team hosts monthly Sunday classes at the UMPC Rooney Sports Complex. Stay tuned on the Pitt DPT website for upcoming classes!

January 16, 2018 |

Monday Memo 1/8/18

Movement Analysis


Human movement is amazing as there is always more to it than meets the eye. For instance, a squat is more than just a squat. It’s the ability to coordinate:


🔹Total Body Stabilization


🔸Hip Movement


🔹Knee Movement


🔸Ankle Movement


🔹Breathing & Abdominal Pressure


🔸External Load Management


The above list isn’t comprehensive, but it serves it purpose. It shows us that movement is composed of smaller parts, or base components, that work together to create the final product. When we analyze dysfunctional movement, it’s important that we identify in which component the dysfunction shows up. When we do this effectively, we’re provided insight into where we need to intervene or, at the very least, what to break down for further evaluation.


This concept really shines in the motor control phase of rehabilitation, as it can be applied to everything from the most simple to the most complicated movement pattern. Breaking a movement down into separate components allows us to utilize drills that work on specific areas of dysfunction. With intelligent programming, a training effect should take place, and we can re-test and shift our focus towards integration.

Take a look at the video below for one example:


  1. Single-Leg Rockback

🔹 We can use this drill to improve our backside mechanics. The rock helps us load the posterior hip on our “support leg” while moving into deep hip & knee flexion, ankle dorsiflexion, and toe extension. At the same time, the opposite leg should be cued into active triple extension (hip/knee extension & ankle plantarflexion) to ingrain propulsion mechanics and aid in tensioning the system. Taking away the rear toe support by adding in the leg lift takes away some external stability & fully loads the support leg.

  1. Transitional Kneeling Drill

🔸 This drill helps us improve our frontside mechanics and mainly focuses on the swing phase. We want to encourage as much pure hip flexion as possible, avoiding compensatory hip abduction, rotation, or contralateral trunk lean that allows for circumduction in the swing phase. Once the leg has completed the swing phase and is acting in support, we can modulate our foot placement and anterior lean to increase or decrease the hip extension stretch we receive on the rear support leg.



The bottom line is that movement is nuanced. It’s complicated. But it can always be broken down into simpler, easier to digest, components.


  • Charlie Badawy SPT, CSCS, USAW


January 8, 2018 |

Monday Memo 1/1/2018

A Place To Play


Growing up, the playground was the place to be. This is where memories were made, friendships were created, champions were born, and competition wove its way into our innocent lives. I think that most people have some sort of positive memory associated with playing as a child and I believe that it is very important for creating a positive association with exercise, movement, and physical activity. This is why I believe it is important for everyone to be given the chance to participate in play. Recently, I came across and article of NFL quarterback, Drew Brees, in partnership with his foundation, creating an all-inclusive playground in New Orleans. I have never heard of all-inclusive playgrounds before this, so I looked into them a little further after reading the article, and what I found brought me tremendous joy as a student of physical therapy.


Essentially all-inclusive playgrounds aim to provide a safe, inclusive, and entertaining environment for children of all motor and sensory ability levels. A few of the companies that provide the equipment for these playgrounds have certain standards and considerations that help shape their goals for their products. Miracle Recreation uses four, “Must Haves,” when designing their equipment:


  1. Accessibility – There needs to be an ADA approved route to the playground
  2. Equal Opportunity – All children should be able to participate in ground level AND elevated play
  3. Variety – Offering a variety of play experiences can help children incorporate all senses.
  4. Integration – The play area should feel like a cohesive community where sensory rich play opportunities are included among the activity


Other organizations such as inclusive by Playcore Inc. have a set of seven principles that they strive to achieve:


  1. Be Fair
  2. Be Included
  3. Be Smart
  4. Be Independent
  5. Be Safe
  6. Be Active
  7. Be Comfortable


A more in-depth explanation of their principles can be found on their website. One such playground can even be found here in the Pittsburgh area in Upper St. Clair’s, “The Clubhouse.” I encourage anyone who is interested to look further into these playgrounds, and support your local area in trying to increase the number of these facilities. Everyone should be included and everyone deserves to play.


-Jim Tersak, SPT, CSCS


January 1, 2018 |