The Bird Dog rehab exercise is neurologically incorrect. Know what you are asking your client to do, and why..

Runners, athletes . . . Even in your drills, do it correctly !
Is this Bird Dog standing up? No, look more closely.

Photo #1: pull that right swing leg outwards with your abductors/external rotators. Do not let the knee drift inwards, it will lead to that foot targeting the midline. Plus, because of the neurologic links, it will encourage the left arm to cross the mid line (see yesterdays FB blog post). The upper limb movement can shape lower limb movement. An aggressively narrow cross over gait is undesirable in many aspects, it might be more economical, but it has a wallet full of potential liabilities.
IF you train your machine in a lazy manner, it is not unlikely it will perform as such. Get that knee under the shoulder, not under your head.

Aside from that, this is a good drill. It is neurologically correct. Note that:
- the right arm is in extension and the left hip is in extension
- the left arm is in flexion and the left knee is in flexion.
This is neurologically correct cross crawling.

* VERY important point:
the Bird Dog exercise is not neurologically correct for the reason of training the proper crossed patterning from a neuro perspective. Note that in the 2nd photo, the bird dog, the same left arm is in flexion, but his left leg is in EXTENSION ! If you want to use the bird dog to teach core engagement, that is one thing, but do not think you are coordinating normal gait patterns or the proper crossed response. This is why we do not use the Bird Dog with our patients, it goes against training fundamental gait patterns.
When we crawl, we use the following pattern:
- the right arm is in extension and the left hip is in extension
- the left arm is in flexion and the left knee is in flexion.

This is neurologically correct cross crawling. Don't believe us ? Get on the floor and crawl like an infant, it is no where near the bird dog exercise, in crawling the coupled crossed extension and flexion responses are NOT conflicting. So, just because the Bird Dog "sort of looks like crawling" do not get it confused with crawling, because it is not. It is a mere balance exercise, some use it for the core stability, but it is one based on UN-fundamental neurologic patterning we use every day.......something called gait, and running, things we do in our sports. So understand what message you are sending to the CNS.
We are not saying the Bird Dog does not have value, not at all, but if you are not thinking about what it actually is doing, you might be driving patterns you do not want.

Right arch pain, can you see a possible reason in this video?

Do you see a possible reason for right foot pain? There is something not kosher to be seen. It doesnt mean it is valid, or the cause, or that it is primary or secondary, but it should be something that cues up a clinical exam focus to rule in/rule out.
Answer below (don;'t read further, test yourself)
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the right hallux does not fully extend. And we know that hallux dorisflexion at the 1st MTP joint engages the windlass, and helps to plantarflex the 1st MET and raise the arch and prepare the foot for loading and for forefoot transition. If the hallux doesn't extend sufficiently (like in a hallux rigidus, painful turf toe etc) then we can have some loading issues. Just something to think about. In this case, it was the cause and answer. But might not always be such.

Who’s driving the compensation, anyway?

We often look at folks gait and see a pelvic drift or lean to the weak side and think “I should help them strengthen their gluteus medius”, which is often needed, but we need to think of what is driving that compensation.

Take a look at this gent that presented to the office with low back pain and watch his gait. 

Some things we hope you see are:

• lean to the right during right stance phase
• increased arm swing on the left
• increased progression angle of the foot on the left
• increased arm abduction on the left, adduction on the right
• increased finger flexion on the left
• slight head tilt to the left
• tibial varum
• crossover gait

Perhaps you are thinking, in the same order as above:

• weak glute medius on left or QL on right or compensating for LLD on L
• using L arm to try and help propel himself forward
• increased balance requirements on the left so the “kickstand” foot
• moving center of gravity the left
• increased flexor tone to try and compensate for a weakness
• moving center of gravity to the left, the brain needs to help keep the eyes parallel to the horizon
• tibial varum and perhaps a more supinated foot posture, or increased forefoot pronation requirements
• crossover

..or maybe you are thinking of something else?

The truth of the matter is that what is driving the largest part of his compensation is in fact a disc herniation, but not for what you may be thinking. The herniation is on the LEFT SIDE and at L3-L4. Take a look at the MRI Image. Yes, there is also a small herniation that L5-S1 but it DOES NOT occlude the foarmen nor hit the individual nerve roots and is on the LEFT (which you are hopefully thinking would cause left sided weakness)

Hmmm...

So what is driving his compensation is actually a LEFT SIDED quad/adductor weakness (the femoral and obturator nerves are from L2-4). Go back and watch the video again. Can you see it?

Someone needs to be driving the bus. Don’t be too quick to jump on it until you know who is driving it and where it is going. 

Who Rules -- The glutes or the quads? Well, it is complicated.

We have often talked about how important it is to be able to achieve terminal hip extension for an athlete, and arguably for everyone. This means one must have strength of the glutes into that terminal range so one can actually achieve the range of motion and access it functionally. If one does not, then extension movements may occur in the lumbar spine via some anterior pelvic tilt. However, one must not dismiss that upright posture needs sufficient quadriceps strength as well -- meaning, hip extension and knee extension get us to an upright posture and make locomotion possible. If we make the hip flexors or quadriceps tight, due to weakness of the lower abdominals or glutes,  we get anterior pelvic posturing and less hip extension (these are admittedly very rough principles, we all know it is far more complex that this).  What I am saying is that there is an interaction amongst groups of muscles, functional patterns of engagement, recruitment and whatnot. 

One must clearly realize how much knee and hip motions are coupled and work with and off of eachother.  If we bend over in a squatting type motion, we are in hip flexion and knee flexion. When we stand, hip and knee extension. These guys play off of eachother.  One must consider these issues when movements are more advanced and loading and loading rates are magnified, such as in squatting type lifting.  

A few weeks ago Bret Contreras in conjunction with Strength and Conditioning Research put out an article by Yamashita , yes, a 1988 article.  "EMG activities in mono- and bi-articular thigh muscles in combined hip and knee extension."  What this article looked at was what happened during isolated hip extension and isolated knee extension, and more importantly, what happened to the forces when both joints loaded simultaneously, paired in generating extension at the hip and knee, as in a squat. 

This article suggested that when hip and knee extension forces are generated in conjunction, the knee extensors are more activated than if the same force was generated in isolation. What this seemed to suggest is that during the extension phase of a squat, it is easy for the quad thigh muscles (rectus femoris, vastus medialis in this study) to to try and rule the movement, from an activation perspective -- the hip extensors (g. max and semimembranosus) take second seat.  We have talked many times about the dangers of this principle when we frequently say "the glutes should be in charge of the hip, not the quads, when the quads try to apply dominant control of the hip motion, trouble may ensue." Admittedly, this may not be entirely true and it is very loosely stated, but the principle has some sound value when it is approached from how we intend it to be heard, that many athletes do not have sufficient glute strength, hip extension range of motion, and poor control of pelvic neutral. So, they dump into the quads because as we see here in this study, they are very appropriately positioned to help synergistically drive the positioning for, and activity of, hip extension motor pattern production. Is this why we see small buttocks and large quadriceps in distance runners, and the opposite in sprinters ?  We think so, but we need to dive deeper into the research to prove or disprove it, but the principles seem to make sense.
This is why I like to initially drive my glute and hip extension work with my clients in a more knee flexed position, such as supine bridges.  I cannot say it better than Bret Contreras did when he reviewed this article,  

"So exercises that involve less knee extension (glute bridges, hip thrusts, deadlifts, pull throughs and back extensions) will tend to produce much greater hip muscle activation than those that involve more knee extension (squats, lunges, and leg presses), although there are always other factors involved of course!".  

If you are not following Bret's and Strength & Conditioning Research's work, you are missing out, They are thorough and insightful, they do their homework, learn from them.
We clearly need to dive into some newer research on this topic, we will see if we can squeeze out the time. 

- Dr. Shawn Allen, the other "gait guy"

Here is an embedded code for the beautiful slide that accompanied Strength and Conditioning Research's summary of the study. If you cannot find it above in this post, goto their Facebook page and scroll to Sept 22nd, 2016. You will find it beautifully laid out there.  Beautiful job S&CR!

<iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2FStrengthandConditioningResearch%2Fposts%2F982124818565207%3A0&width=500" width="500" height="731" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowTransparency="true"></iframe>

Yamashita  1988. Eur J Appl Physiol Occup Physiol. 1988;58(3):274-7. EMG activities in mono- and bi-articular thigh muscles in combined hip and knee extension.
https://www.ncbi.nlm.nih.gov/pubmed/3220066
 

Low back pain and quadriceps compensation. A study.

“Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.“- Hart et al.

Recently I discussed a paper (link below) about how soleus  motoneuron pool excitability increased following lumbar paraspinal fatigue and how it may indicate a postural response to preserve lower extremity function.
Today I bring you an article of a similar sort.  This paper discusses the plausibility that a relationship exists between lumbar paraspinal muscle fatigue and quadriceps muscle activation and the subsequent changes in hip and knee function when running fatigue ensued. 

"Reduced external knee flexion, knee adduction, knee internal rotation and hip external rotation moments and increased external knee extension moments resulted from repetitive lumbar paraspinal fatiguing exercise. Persons with a self-reported history of LBP had larger knee flexion moments than controls during jogging. Neuromuscular changes in the lower extremity occur while resisting knee and hip joint moments following isolated lumbar paraspinal exercise. Persons with a history of LBP seem to rely more heavily on quadriceps activity while jogging.”- Hart et al.

Whether this or any study was perfectly performed or has validity does not matter in my discussion here today. What does matter pertaining to my dialogue here today is understanding and respecting the value of the clinical examination (and not depending on a gait analysis to determine your corrective exercise prescription and treatment). When an area fatigues and cannot stabilize itself adequately, compensation must occur to adapt. Protective postural control strategies must be attempted and deployed to stay safely upright during locomotion. The system must adapt or pain or injury may ensue, sometimes this may take months or years and the cause is not clear until clinical examination is performed. Your exam must include mobility and stability assessments, motor pattern evaluation, and certainly skill, coordination, ENDURANCE and strength assessments if you are to get a clear picture of what is driving your clients compensation and pain. 

So, if your client comes in with knee, hip or ankle pain and a history of low back pain, you might want to pull out these articles and bash them and other similar ones into your brain. Remember what I mentioned when i reviewed the soleus article ? I mentioned that the reduced ankle dorsiflexion range may be from a soleus muscle postural compensation reaction to low back pain. In today’s discussion, impairment of the hip ranges of motion or control of the knee (from quadriceps adaptive compensation) may also be related to low back pain, in this case, paraspinal fatigue.  

Sometimes the problem is from the bottom up, sometimes it is from the top down. It is what makes this game so challenging and mind numbing at times. If only it were as simple as, “you need to work on abdominal breathing”, or “you need to strengthen your core”.  If only it were that simple. 

Dr. Shawn Allen, one of the gait guys

References:
J Electromyogr Kinesiol. 2011 Jun;21(3):466-70. doi: 10.1016/j.jelekin.2011.02.002. Epub 2011 Mar 8.
Effects of paraspinal fatigue on lower extremity motoneuron excitability in individuals with a history of low back pain. Bunn EA1, Grindstaff TL, Hart JM, Hertel J, Ingersoll CD.

J Electromyogr Kinesiol. 2009 Dec;19(6):e458-64. doi: 10.1016/j.jelekin.2008.09.003. Epub 2008 Dec 16. Jogging gait kinetics following fatiguing lumbar paraspinal exercise.
Hart JM1, Kerrigan DC, Fritz JM, Saliba EN, Gansneder B, Ingersoll CD