b'CODING Update ComplianceLEGAL NUTRITIONCouncilANJC Leadership LEGAL EASE NUTRITION REHAB CouncilRELEVANT REHAB: Optimizing the By Dr. Donald C. DeFabio Curl-Up ExerciseChair, ANJC Physical Rehabilitation and Performance CouncilLEGAL Q&A CHIROASSIST EO, regardless of the breathing patterna correct respiratory pattern but also The curl-up exercise is a well-established exercise for the development of abdom- used. However, RA activity was notto ensure lumbar spine stabilization by Executive Directors Update inal strength and for rehabilitation of thesignificantly different in either position inincreasing intraabdominal pressure and lumbar spine. In fact, McGills variation ofKims study. RF activity was also greater inactivation of the core structures. The the curl-up is one of his Top 3 exercisesthe 90 degrees of hip flexion position. head, eyes, and spinal curves should all for low back rehab and return to function.Clinical Note: At 90 degrees of hipbe aligned with the pelvis and the hips Kim and Park examined the curl-upflexion there is less activation of thedown to the knees and feet, centering exercise with the hips in two positionsiliacus and iliopsoas and the pelvis is in aall joints in a stable position, involving all and with three variations of breathing tomuscular chains. Legislative Update determine to what degree these vari- passive posterior tilt, thus the RA will beDuring inhalation, expand the lower less engaged.INSURANCE Update INSURANCE Update ables affect the muscular activity of theAs mentioned above, the IO and EOportion of the abdominal region, the side rectus abdominus (RA) external obliqueand back parts of the abdomen, thora-TECHNIQUE Council were maximally activated at 90 degreescolumbar spine and lower ribs, keeping (EO) internal oblique (IO) and recuts femoris (RF) while performing a curl-up.of hip flexion. When combined withthe chest relaxed. During exhalation, the maximal expiration, muscular activityabdominals are actively contracted, and of the IO and EO was significantlythe diaphragm is kept in a horizontal elevated compared to the curl-up withposition and the chest again remains slow expiration and maximal inspiration.relaxed. The curl-up with maximal expiration also MedicareQ&AMedicare Update showed significantly higher perceivedClinical Note: With forced expiration the OUR HEALTH exertion score than the curl-up with slowdiaphragm is maximally contracted. This expiration. is an excellent and applicable method to A shortcoming of this study is thestrengthening the diaphragmproviding maximal inspiration and maximalcore stability and spinal stiffness with expiration samples were done whileactivity. the subjects were holding their breath.The application for your patients today Pre-bracing before any abdominalwould be to at least introduce curl-up exercise is essential to reinforce normalexercises with the hips at 90 degrees anticipatory recruitment patterns,of flexion. On top of that add maximal however breathing while exercising isexpiration until the patient can perform The curl-up exercise as defined by Kimimportant for sustained repetitions. Thecorrect abdominal breathing while was performed with the patient supine,ultimate goal would be to maintain deepperforming curl-ups. These techniques hands behind the head, and elevatingcore stabilization of the IO, EO andpromote co-contraction of the abdominal the upper body only until the inferiortransverse abdominus while breathingmuscles in the so-called bracing angle of the scapulae came off the floor.and exercising. technique, which provides trunk stiffness The hips were at either 90 degrees or 45Breathing does make a difference in coreand stability, allowing for more efficient degrees of flexion and anchored by thestabilization and low back rehabilitationenergy transfer between the upper and examiner.programs. Cavaggioni incorporatedlower body in life and in sport.The breathing patterns tested wereabdominal breathing with dynamicREFERENCES:stretches to analyze the effect it wouldKim SH, Park SE, Effect of Hip Position and Breathing slow inhalation while the curl-up wasPattern on Abdominal Muscle Activation DuringCurl-upperformed, maximal inspiration followedhave on abdominal strength. His studyVariations, J Exerc Rehabil. 2018 Jun; 14(3): 445450.by the curl-up, and maximal expirationfound that core stabilization exercisesCavaggioni L, Zannin E, IaiaFM, Alberti G,Effects of with abdominal breathing and globalDifferent Core Exercises on Respiratory Parameters and followed by the curl-up. During theAbdominal Strength, J Phys Ther Sci. 2015 Oct; 27(10): maximal inspiration and maximalstretching postures is more effective in32493253. expiration, the subjects held their breath.improving abdominal fitness and pulmo-Surface EMG activity of the RA, EO, IO,nary function than core stabilizationDonald DeFabio, DC, DACBSP, DABCO, and RF were measured in both 45 and 90exercises alone. in is private practice in Berkeley Heights degrees hip flexion. Cavaggioni mentions that whenand is the team chiropractic physician for a local university. He conducts Relevant The curl-up at 90 degrees hip flexionfocusing on diaphragmatic breathing,Rehab, and his exercise protocols can be provided better activation of the IO andit is important not only to re-establishfound on his YouTube Channel.14 I Fall 2019 www.anjc.info'