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Core Training on Bravo

A standing plank protocol using the Cybex Bravo to aid in a post-therapy shoulder strengthening program

A subject increased maximum abdominal plank time 155% following a five week, post-therapy shoulder strength training program including the Cybex Bravo to perform a standing plank.  The standing plank elicits similar muscle activation compared to a traditional plank, without the requirement of having to support all of one’s body weight.

Author

Chad Bohls, MS, ATC
Fischer Sports Physical Therapy and Conditioning
Phoenix, AZ

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Introduction

The plank is a common core strengthening exercise that is also demanding of the upper-body musculature.  As a result, this exercise may be difficult to incorporate into a shoulder strengthening program following rehabilitation for a glenohumeral dislocation.  This case study focused on utilizing the Cybex Bravo Functional Trainer to examine the effects of a standing plank exercise protocol on the strength development of a subject rehabilitating an injured shoulder.

Background

The subject was a 57 year-old businessman who is also a recreational golfer.  He arrived at physical therapy with a right glenohumeral dislocation, which he suffered after slipping on wet pavement and falling into a parked car.  Prior to enrolling in this program, the subject performed 18 weeks of physical therapy for his injury. Other than this incident, he’s had no prior history of significant shoulder pain or injury.  After being discharged, the subject transitioned to a post-therapy strength training program.

Although the patient had a good prognosis for golf and other activities of daily living, he had limitations with closed kinetic chain exercises, such as upper extremity step ups and pushups.  His limitation seemed to be an overall strength deficit in his upper extremity and core.  Both of these areas were deemed to be essential to his successful participation in golfing activities.  Specifically, the subject could not perform the plank exercise on his elbows and toes without pain in his right shoulder.  Therefore, the Cybex Bravo was utilized to perform a standing plank; this exercise requires similar muscle effort compared to the traditional plank, without the requirement of supporting one’s body weight.  The aim of this case study was to examine the effects of this training program on core and shoulder strength development.

Procedures

After obtaining written consent, the post-rehabilitative program ensued.  The program consisted of a continuation of the shoulder protocol previously completed, and was combined with a new exercise on the Cybex Bravo Functional Trainer which simulated a closed kinetic chain plank exercise.  This particular exercise was chosen to re-create the torque loading through the spine normally achieved in a plank, but the subject did not have to support his full body weight, allowing for a progressive and systematic increase in loading.

The complete protocol is described below and includes the Cybex Bravo Functional Trainer.  The program was performed 3 times per week for 4 weeks, totaling 12 sessions.  The first session was used for testing and establishing exercise workloads.  All exercises were performed during each treatment session, but the order was varied in order to avoid effects due to sequencing.  Progression or load increases were made when the subject was able to complete the desired sets and repetitions with proper form and minimal fatigue.  Initial load increases were made at the third treatment session, and subsequent increases were done in the fourth, fifth, and tenth treatment sessions (table 1).  The active warm up included Row Machine x 5 minutes and single arm Body Blade x 3 sets of 30 seconds.  A general summary of the program is as follows:

1.  Cybex Bravo Functional Trainer Standing Planks @ 60 lbs (SP): 3x30 seconds

2.  Total-Gym Pull-ups (PU): 3 x 8 reps

3.  Cybex Bravo Glenohumeral Extension/Adduction (BEA): 3 x 12 reps each

4.  Upper Body Step Ups on 6 inch box (SU): 3 x 10 reps

5.  Cybex Bravo Overhead Single Arm Elbow Extension (OEE): 3 x 15 reps

6.  Bicep Curl Press Combo (BCP): 3 x 10 reps

7.  Counter Height Pushups 4 feet (CHPU): 3 x 10 reps

8.  Wall Stability Ball: Up/Down, Circles CW CCW, Side/Side (WSB): 3 x 10 reps each

Table 1. Subject’s strength training program progressionPicture1

The primary outcome measure was a traditional prone plank exercise, performed on elbows and toes until fatigue.  Fatigue was identified as the point at which the subject broke proper form (favoring the right involved shoulder), creating a significant left side lean and/or loss of a neutral spine position.

Results

Prior to beginning the study, the subject was measured for time to failure while performing a bilateral upper extremity plank.  The subject was able to perform the plank for 47 seconds until failure, as identified by visual observation.  At the point of failure, the subject reported significant shoulder pain that had progressed throughout the exercise.

At the completion of the study, the subject was re-evaluated while performing the same plank protocol.  The subject was able to hold the floor plank for 2 minutes without shoulder pain, an increase of 155%.

Discussion

The subject reported that the primary reason for stopping was core fatigue, evidenced by increased tension in his lower back.  The subject appeared to have an equal weight distribution on the upper extremities throughout the exercise.  It seems likely that, as a result of this program, both shoulder and core strength improved.  The Bravo standing plank was a new exercise added to protocol after the subject had been discharged from physical therapy, which led to the conclusion that it was an important contributing factor to the subject’s strength increases.

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