The side plank/bridge (Figure 1a and 1b) is a core stability exercise widely used to prevent and treat back pain. This exercise is often limited in its use and application secondary to the high forces placed through the glenohumeral joint. By creating a larger surface area for the forces to be distributed throughout the shoulder using the reverse side plank/bridge, individuals may be more comfortable while increasing the time in the position. Increasing the holding time in this position may also create more therapeutic levels.
The traditional side plank/bridge is performed by propping up on the ipsilateral elbow to the side that is on the mat, then raising the hips up off of the mat extending either to the knees or to the lateral aspect of the ipsilateral foot (Figure 1a and 1b). The side plank/bridge is widely used in the prevention and treatment of back pain by increasing the core stability. This exercise has been shown to have moderate to high electromyography for a large group of core muscles, including the quadratus lumborum, transversus abdominis, external obliques, multifidi, longissimus thoracis, and gluteus medius (1,2,8). This exercise is typically performed in an isometric manner, for a set duration, to improve the endurance of the core musculature. Endurance of the core musculature and isometric capacity is often associated with recreational or conditioning activities, such as jogging (3), or activities of daily living, such as standing (4). It may also be useful during the beginning phases of lumbopelvic stability training for power sports. In fact, research indicates that the side plank/bridge had a moderate correlation with dynamic movements such as a diagonal chopping motion, which are more commonly seen in power sports such as baseball and tennis (7).
McGill et al. (5) established normal holding times for the side plank/bridge compared with an individual's prone isometric back extension times in the Biering-Sorensen test position. However, it was discovered that the side plank/bridge time was much less than the Biering-Sorensen test position (5). The Biering-Sorensen test position showed the most benefit/prevention occurred when the position was held for longer periods (approximately 180 seconds) (6). McGill et al. (5) found that men were able to hold the side plank/bridge for approximately 65% (94–97 seconds) of back extension time and women for 39% (72–77 seconds) of the time for their prone isometric back extension. In another study, Marshall et al. (4) showed that men with a side plank/bridge time less than 83 seconds and women with less than 64 seconds were at a greater risk of developing back pain with standing.
Unfortunately, many individuals are limited in holding the side plank/bridge for the necessary time to reduce the risk of back pain because of pain and or fatigue in the shoulder or prior shoulder injury. By using a reverse side plank/bridge, individuals may be able to increase the duration of training for this exercise, thus potentially improving the endurance of the core musculature while alleviating or reducing shoulder pain and fatigue.
To remove the shoulder pain/fatigue that is seen with the traditional side plank/bridge, we have begun to incorporate a reverse side plank/bridge. To perform this exercise, the individual begins in a side-lying position. Based on the individual's comfort, place 1–2 pillows under the head and shoulder. The legs/feet should be placed on top of a 6–8 inch step/box to recreate a similar height as that of the humerus in the traditional side plank/bridge. If needed, a couple of pillows may be placed under the legs to increase the individual's level of comfort. The box can be moved either proximally or distally to increase/decrease the difficulty of this exercise (Figure 2a and 2b). Moving the support distally will increase the difficulty by increasing the distance from the shoulder (fulcrum/axis); in addition, the moment arm is lengthened and increases the torque required for the muscles to stabilize the torso. The number and duration of each set are determined based on the individuals training goals (prevention versus rehabilitation) and previous activity level.
Those engaged in preventive/general training should start with 10 repetitions, with each repetition being held for 10 seconds. A work to rest ratio of 1:1 may be used initially. The endurance training effect of this exercise can be enhanced by increasing the amount of time the isometric action is held or by reducing the rest periods between sets or repetitions. As the individual becomes better trained, gradually increase the amount of time each repetition is held and decrease the total number of repetitions, with an ultimate goal of increasing the total duration spent in the reverse side plank/bridge position to 180 seconds over 1–3 sets (either 3 sets of 60 seconds or 1 set of 180 seconds). The goal of holding this position isometrically for 180 seconds is based on the Biering-Sorensen test time (6) for decreased risk of pain and the maximum side plank time found by Palmer et al. (7). In the clinic, individuals are able to progress well over an appropriate period based on the individual's level of fitness and motivation. A patient or client who is rehabilitating from a back injury, or an episode of back pain, may initially perform repetitions without holding the isometric position at the end range of this movement, then progress to adding hold times as strength and endurance improve.
If an individual has shoulder pathology, such as subacromial bursitis, that prevents any pressure from being placed through the tip of the shoulder. A prone pillow may be used to create a “doughnut” and disperse the pressure around the shoulder without placing pressure on the acromion (Figure 3).
By removing the limiting factors of shoulder pain and fatigue in our clinic, we have seen substantial increases in the time that individuals are able to hold the reverse side plank/bridge position. Some individuals have reverse side plank/bridge times that are similar to their prone isometric back extension times. These times are much greater than the 65% and 39% of back extension times established by McGill et al. (5), which may further enhance core musculature endurance and reach preventative/therapeutic levels.
Although exercises such as the side plank are traditionally used to increase the stability and endurance of the core musculature, this exercise is not tolerated well by all patients/clients. Removing specific limiting factors, such as shoulder pain and fatigue often experienced during the traditional side plank exercise, allows individuals to increase their isometric holding times to more preventative/therapeutic levels. The reverse side plank/bridge may be an alternative exercise option to reduce the incidence of shoulder pain experienced during the traditional side plank. As a result, it may be an effective exercise for increasing the duration that an individual is able to hold an isometric action of the torso. By increasing the time under load for the muscles of the lumbopelvic hip area, the strength, endurance, and stability of the core may be improved. This may lead to possible reductions of back injuries and be used to effectively train those individuals who are experiencing back pain.
1. Ekstrom RA, Donatelli RA, Carp KC. Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther 37: 754–762, 2007.
2. Ekstrom RA, Osborn RW, Hauer PL. Surface electromyographic analysis of the low back muscles during rehabilitation exercises. J Orthop Sports Phys Ther 38: 736–745, 2008.
3. Hart J, Kerrigan C, Fritz J, Ingersoll C. Jogging kinematics after lumbar paraspinal muscle fatigue. J Athletic Train 44: 475–481, 2009.
4. Marshall PW, Patel H, Callaghan JP. Gluteus medius strength, endurance, and co-activation in the development of low back pain during prolonged standing. Hum Mov Sci 30: 63–73, 2011.
5. McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch Phys Med Rehabil 80: 941–944, 1999.
6. Moreau CE, Green BN, Johnson CD, Moreau SR. Isometric back extension endurance tests: A review of the literature. J Manipulative Physiol Ther 24: 110–122, 2001.
7. Palmer T, Uhl T. Interday reliability of peak muscular power outputs on an isotonic dynamometer and assessment of active trunk control using the chop and lift tests. J Athletic Train 46: 150–159, 2011.
8. Willardson JM, Behm DG, Huang SY, Rehg MD, Kattenbraker MS, Fontana FE. A comparison of trunk muscle activation: Ab circle vs. traditional modalities. J Strength Cond Res 24: 3415–3421, 2010.