Are you Challenging Your Patients in all 3 Planes of Motion?
3 Planes of Motion: Sport is Three Dimensional
The athletic demands of any sport require the ability to create and control movement in all three planes of motion. A tennis player must be able to lunge to the side while controlling the rotational forces created through his trunk and arm. A runner needs the ability to maintain his/her pelvic height in the frontal plane while translating linearly in the sagittal plane to prevent dynamic knee valgus. Arguably the most important plane of motion for most sports is the transverse plane. Most injuries occur from a rotary force but when it comes to training and rehab, we often neglect incorporating rotary movements. There is an obvious disconnect between training and sport when it comes to transverse plane control. If athletic injuries occur from high velocity rotary forces, we need to implement transverse plane activities into our training sessions in order to teach the athlete how to control these forces.
Every Muscle Works in 3 Planes of Motion
Take the hamstring for example. Yes the hamstring is academically known as a hip extender and a knee flexor, but in reality it does much more than that. There are not many functional activities in which the hamstring acts concentrically to flex the knee. Instead, it often works eccentrically or as a dynamic stabilizer of rotational force. During the swing phase of gait, the hamstring is responsible for decelerating the lower leg. It more often works eccentrically as opposed to concentrically. Think of a baseball first baseman lunging to the side and bending forward to scoop up a ground ball. His hamstring must be able to simultaneously control his forward trunk flexion along with the rotary force of his pelvis rotating atop a fixed femur. This is the type of muscle action in multiple planes of motion that is not always addressed in a rehab setting. We need to get away from the traditional academic muscle actions and start thinking of muscles acting in a more functional manner.
A Weakness or Imbalance May Not Appear in Traditional Exercises
Without challenging your client or patient in all planes of motion, you may not notice subtle deficits in control. Your patient may be able to perform a standard sagittal plane lunge with perfect form and no loss of balance. However, when you begin to incorporate a posterior-lateral lunge with a pivot, they exhibit a lateral trunk lean to make up for a loss of control or proprioception of the lower limb.
Many of the exercises that I would consider to be “traditional” rehab exercises were developed for muscle isolation. They were devised based on muscle origin and insertion and the orientation of the muscle fibers. The goal of these traditional exercises is to isolate that particular muscle’s fibers. These exercises are great exercises and do have a place in the rehabilitation process. However, as discussed earlier, all muscles function in all three planes of motion. Therefore, when baseline strength has been developed, the exercises need to be tailored to challenge the muscles in multiple motion planes.
Perhaps my favorite example is standard shoulder external and internal rotation exercises. These are key exercises in the rehabilitation process of a shoulder athlete. However, once proper strength in the rotator cuff is developed, these exercises need to be progressed to appropriately mimic the functional demands that are going to be applied to the shoulder in everyday activity or sport. There aren’t many times throughout the day when the rotator cuff produces strict external rotation of the humerus with the elbow fixed to the patient’s side. Progressions need to include activities such as D1 and D2 diagonal patterns, external and internal rotation at the 90/90 position, rhythmic stabilization drills in an overhead position, and so on. More functional shoulder exercises with videos and descriptions will be included in later blog posts.
Where to Start
As with any rehab progression, the functional demands need to be gradually introduced in a safe manner. Full pain-free range of motion and good global strength are necessary prerequisites before introducing higher level dynamic activities. When it comes to order, I would argue that sagittal plane activities should be introduced first, then frontal, then transverse. This is because humans are naturally most comfortable performing in the sagittal plane. Our eyes are oriented in the sagittal plane and we can therefore function most easily in that direction. The volume of activity in each plane will depend on the nature of the sport. For example, a basketball player will require many frontal plane drills because of how his defensive position requires him to move. A wrestler may need to be challenged more in the transverse plane in order to withstand non-anticipatory rotational forces. Regardless of the patient or athlete you are working with, be sure to address all three planes of motion in order to optimize their recovery and minimize the chance of re-injury.
More images and videos of specific ways to incorporate triplanar exercises for your patients and athletes will appear in upcoming blog posts!