You may very well have a myofascial trigger point affecting the right QL. Research on trigger points shows that when active, they 1) make a muscle hyperirritable 2) easily fatigued 3) shorten the muscle. All of these could explain your observations of that muscles’ performance.

Should you perform the exercise on both sides? Definitely, since the research on the lumbar FCE suggests that one of the ratios of endurance values which bests predicts back pain is side-to-side imbalances of >5% (if memory serves, since I’m at home at present).

Your assessment of the right shoulder sounds mostly right. Typical presentation is tight internal rotators, inhibited external rotators and depressors.

As to the distance between the ribs and pelvis while doing the side bridge, that’s parsing it too fine. Address the chronic QL shortening with 30 sec stretch every 4 hrs for several weeks to show the muscle full length. Get a myofascial release specialist (DC, LMT, PT, Rolfer, etc) to help deactivate trigger point there. Then show the muscles these exercises and others like the Farmers Walk and Single Arm Kettlebell Carry to integrate the muscle into functional activities. It will find it’s way home from there.

You may want to check out the FMS screen to help you with these things too, Ema. As a trainer, you can learn how to use it on yourself and on clients. Check out http://www.functionalmovement.com for more info. Good Luck!

I can do the side bridge on both sides, also advanced level (one would hope so as I am a personal trainer), though I find it tougher (some QL discomfort, burning sensation and shoulder a bit “wobblier”) on the right if I hold it for say 30 or 45 seconds (I won’t be doing this anymore after reading your article, thanks).

1) How come? Could this be due to muscle ischaemia/hypoxia affecting the right QL?

2) Do I even need to do this exercise at all (on the right side anyway)? I will try the repeated 10 second bouts and see if that makes things better.

3) Is the slight lack of right shoulder stability/discomfort likely due to underactive serratus anterior and tight pec minor and overactive infraspinatus?

4) When doing this exercise on the left side, there is no pain or discomfort, just a feeling of being slightly less strong (but again, I could hold this for over 1m 30s, as I had to do for an assessment once). I am aware of the distance between ribs and hips being longer. Hard for my brain to tell what the optimal “distance” (and degree of muscule activation/strength) is. Any suggestions?
(not all the venues where I work have mirrors)

Thank you very much.

Ema.

For painful wrists with the Bird dog, have the client do them on their fists if they have wrist problems. Good luck!

Slightly more germane to this site which is geared toward extension-biased, discogenic LBP, some research from the McKenzie camp has begun to indicate that in this population of LBP, extension based exercises are superior to “strengthening” exercises. It is my clinical experience that a combination of McKenzie based therapy during acute/subacute phase, and stabilization per McGill’s work is superior in the long term. This clinical approach with the clinician’s personal experience, informed by the best available evidence is Sackett’s definition of evidence based medicine as found on the home page of http://www.fixyourownback.com.

In Stu’s defense from your statements, he is a reluctant but very good clinician whom I have seen at work on high level athletes. I am not familiar with Leyderman’s work but in the reading of what I have found, he seems well informed. As I pointed out before, his slant in his articles has been to argue that the notion of attempting to isolate specific muscles (as has been the trend with isolation of TrA per Hodges work) is misinformed at best, harmful at worst. Those same sentiments are foremost in McGill’s approach and indeed, Leyderman uses McGill’s work and his grad students (Cholewicki, Kavcic, etc) to make his points. I have emailed him to encourage him to lean on his students to investigate this topic of comparison of exercise methods directly in a prospective fashion. Much of the comparison research that we are talking about are retrospective reviews of the literature and make it difficult to make hard and fast clinical decisions with them. Too many apples and oranges in the same basket.

Time will tell if any of these are superior and for who.

Dr. Eyal Lederman (he’s a D.O.) has a beef with specific “core” exercises that place higher value on one exercise or one muscle group. McGill does too has extensively pointed out the flaws in this approach, and is cited extensively in Lederman’s article to refute that approach. Much of FixYourOwnBack.com is modeled on the research of Stuart Mcgill. I think the problem here is the misinterpretation of the purpose of the ENTIRE site here (promote exercise for pain relief and overall health, help to provide the ground swell for better research to dial in various types of back pain that respond to specific types of exercise) vs. this one video. This one video highlights 3 exercises that each build ENDURANCE in all of the core muscles, but each exercise has higher MVC of one particular aspect of the core. For higher levels of rehab, the next steps in McGill’s approach after building endurance, are improving strength, power, and agility of the muscles through complex movements. We are watching the same movie Mark, we just walked in at different points. For the majority of viewers here, these 3 exercises will be easily accessible, improve endurance of key muscles that research has determined are frequently low in endurance in chronic back pain, and reduce their frequency and severity of future back pain. Beyond this are the green fields of training (as opposed to rehab), to improve performance in work and play goals. And yes, you are precisely right, ALL muscles of the core, AND those that integrate with the core need to be used in coordinated fashion to achieve those goals. Cheers!