This is Brent of the Brookbush
Institute and in this video we're going over
a very commonly used exercise for lumbar
mobilization- the open book. We're also
going to discuss how it could be used
for thoracic and sacroiliac joint
mobility and maybe a great active
stretch for the pectoralis major,
pectoralis minor, posterior deltoid, and
potentially even the piriformis. I'm
going to have my friend, Melissa, come out and
she's going to help me demonstrate. Now, I
think you guys will quickly find that
setup is the most complicated portion of
this exercise, and it's going to take
some time for you to teach, and remind,
and reinforce your patients and clients
to be able to do this with good form. Go
ahead and lay on your side. This is where
we're going to start. I'm going to go
through these form cues from bottom up
here. So, we're going to start by
straightening out the bottom leg, so her
bottom leg becomes kind of this pivot
point. It should be in line with her
torso and her head, so we should see a
nice straight line from the top of her
head through her spine, through her hip,
knee, and ankle. She's then going to take
the foot of her top leg and put it
behind that bottom knee. We're then going
to use some sort of space, or foam roll, or
Hypersphere- something about this size to
get the top knee level with her hip. That
is, with her pelvis in a position that is
kind of perfectly vertical here. Now
she's going to take this bottom hand, and
this bottom hand is going to be
responsible for maintaining her knee
position. Alright, so she's going to
hook the bottom of that leg and keep it up
in flexion, which is going to keep us a
little bit posteriorly tilted which is
going to help us with the lumbar
mobility portion of this. She's then
going to take this hand, and I want her
to really tuck it behind her head. So,
she's going to wrap those fingers all the
way behind her occiput, maybe grab her
ponytail with her web space here. Alright,
so all the way around. I don't want to
see any cheating with with fingers
barely touching the head.
This is the setup. This is how we get
started. Now, the fun part is to see how much
mobility Melissa actually has. She's
going to start by trying to put this
elbow down on the floor. This isn't so
easy for a lot of people. This takes a
lot of extensibility of her posterior
deltoids, of her scapular muscles, and
even some mobility of her thoracic spine,
rib cage, and lumbar spine. But then, the
really hard part for most people is
trying to lay this arm flat down on the
floor. Melissa, here, has pretty good
mobility, but you can see she still has
about an inch to go there. So, if she
starts again, we're going to hold for two
and then open up, hold for two, and I try
to get my patients doing 10 to 20 reps
with those two second holds. Don't let
them rush through. I think you guys are
going to find that a lot of your
patients get stuck. They end up right
about here- that's as far as they can get.
You want them putting a little bit of
effort here, holding that position, making
sure they are trying to put an effort to
go further. And then have them go back.
Same thing on this side. Put some effort
forth. Now, let's think through some of
our kinesiology and where this may
benefit our patients from a mobility
perspective outside of just the lumbar
spine. As I mentioned, when Melissa comes
this way, that is a lot of horizontal
adduction which is going to require a
ton of mobility from her posterior delt.
She's also protracting and upwardly
rotating her scapula, which means she's
going to need some extensibility from
potentially her lower traps here as she
protracts her mid traps, as she protracts
her rhomboids, as she
upwardly rotates and protracts. All of
that's going to help as an active
stretch here. Go ahead and open up. And
then if she gets into this position, we
see a ton of horizontal abduction,
abduction, and external rotation of the
shoulder, which is basically pectoralis
major stretching.
Let's try that one more time. You guys
can see that she comes back, she also has
to upwardly rotate this way.
Upwardly rotate and posteriorly tip
her scapula, which is going to be a pec
minor active stretch. So, now we have
something that's great for both
posterior shoulder mobility as well as
pec mobility. Now, just the posterior
tipping thing- alright, the posterior
tipping of her scapula against her
rib cage is going to help to create a
posterior to anterior force on that rib
cage and mobilize those ribs. Your
ribs have a lot to do with thoracic
mobility, and we're adding that posterior
to anterior rib mobilization to thoracic
rotation. Now, something to keep in mind
is all of this is happening as an aside
to the main goal of this exercise, which
is generally lumbar mobility.
So this is all of the additional benefit
we get from an open book. But, let's talk
about this area right here, as this is
generally why we
use this exercise. This is the focus. As
she's going back and forth, she's causing
a ton of rotation at the spine, as
well as this position is slightly flexed and
this position is slightly extended. We
have her locked into a posterior tilt,
some flexion here, and I'm not allowing
her to get any adduction at the hip. In
this position, she can't internally and
externally rotate at the hip, so we know
that the motion is primarily coming from
her lumbar spine. As you go back
through here, you just can see that the
position she's put in here- go ahead and
open up- prevents her getting any
mobility from her hip or pelvis. Maybe we
get a little SI joint mobility as lumbar
rotation this way would actually force a
little posterior to anterior mobility on
the bottom SI joint, and anterior to
posterior mobility on
top SI joint. But, almost all that
rotation has to come from this lumbar
segment. If I want to get really,
really tricky, I can even put on
my physical therapy hat, remember how I
do lumbar manipulations or lumbar
physiological mobilizations for rotation,
and I could actually lock in what
segment I want to rotate by using- sorry
let me have you back in this position- by
using how high her knee is to get a
ligamentous lock from bottom up. If you
know how to do that, if you've taken
manual mobilization, manual manipulation,
lumbar spine courses, you know what I'm
talking about. I can do my little piano
grip on her lumbar spine, and let's say I
wanted her to focus more on- we'll call
it mid lumbar spine, although I'd love to
say that I could target L2 L3 segment,
we'll call it mid lumbar spine. We'll get
her right up to about here. I'll give her
some cue like, "Hey, I need you to grab all
the way up to second knuckle on that
hamstring." So, I'll give her some
cue that she can remember as far as
where to bring this leg, and now when she
opens up, she should feel that a little
higher in her lumbar spine. If I wanted a
little lower in her lumbar spine, of
course, I could go maybe, "Alright, I just
want your first knuckle on your
hamstring tendon here," which is her
biceps femoris tendon. If I wanted to get
up even higher, maybe I can get up into
that upper lumbar spine, maybe I go with
whole hand and really get her up high, and
again, have her do this exercise there. So
there you guys have it. We have a ton
going on in this exercise. It's primarily
a lumbar rotation mobilization, because
of the way we have the pelvis locked down,
but we have some sacroiliac joint
mobility. We also have a ton going on in the
upper body from
pectoralis major and minor, posterior
delt active stretching, and we have rib and
thoracic mobilization going on. This
becomes a very dynamic, very versatile
exercise to throw in somebody's
program. It's something I use all the
time in self-administered lumbar spine
home exercise programs. It also ends
up in a ton of my integrated warm-ups
for the athletes that I train, as well as
the recreational fitness member who we
know sits at a desk all day. All of
this stuff has a propensity towards
either restriction or overactivity. I
hope you guys enjoyed this video. I look
forward to seeing your questions in the
comments section. Feel free to post any
question you have.
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