Which of the thousands of stretching and strengthening exercises out there should you make a habit of doing every day? It’s important to know that very few targeted type exercises have ever been studied scientifically. Meanwhile, there just isn’t enough time in the day to do more than a handful of them.

I’m fairly active. I run, I lift (not weights, just factory stuff), I garden like a maniac and occasionally decide that I should re-side the house. Even before starting OESH, when I had my “sedentary” job as a Medical School Department Chair, I’d often run to and from work. Because of this, I’d never felt the need to do any additional types exercise, except for one, and more recently, a few.

For years, besides studying the effects of different types of shoes on gait (walking and running), I studied gait in a variety of populations with the goal to better understand what types of targeted stretching or strengthening exercises might be effective in maintaining or reversing some of the age-related declines in mobility and function. Essentially, I was funded by the National Institutes of Health to look for the “holy grail” exercises to keep us feeling young, healthy and injury free.

My research team and I evaluated all the hundreds of kinematic and kinetic variables that can be measured in a sophisticated 3-D motion analysis force plate instrumented gait laboratory. You might think that we found a lot of age-related differences, but actually, and rather surprisingly, we found just one. As we get older, we don’t extend the hip of our trailing leg as far backwards as we once used to. We found this in multiple studies (listed below) and in multiple populations where the reduction in hip extension was exaggerated even further in various disease populations as well as in frail elderly people who are at risk for falls.

That we consistently found just one difference out of so many parameters was pretty interesting and gave hope that we did indeed hit upon a “holy grail” discovery. A reduction in hip extension during walking, which we found to be associated with the pelvis tilting more forward, could be due to a loss in flexibility in our hips and/or due to poor posture, and weakness in our back and hip extensor muscles. Each of these potential explanations are associated with other things besides a decline in walking performance — low back pain, falls, and vertebral fractures, to name a few.

Our findings were substantial enough that the National Institutes of Health funded us to study the isolated effect of stretching the hip flexors. We showed with a randomized clinical controlled study that stretching the hip flexors twice a day with an isolated static stretch resulted in modest improvements in both healthy and elderly subjects. The fact that we found any difference, given the isolated, controlled nature of the studies, is significant. But the fact that they did not completely reverse the age-related changes leads us to believe that hip flexibility is not the only issue. The results imply that poor posture, and back and hip extensor weakness are also factors in our age-related decline in walking function.

Personally, I’ve been doing the same standard hip flexor stretch we used in our studies. Jay Dicharry, one of my research team members, included a schematic of it in some exercise recommendations to avoid the hazards of sitting, here. But gradually I’ve morphed the stretch into something that is similar in some ways to what some yogis would call a Crescent or Warrior Pose in Yoga.

More and more I’m recognizing that my usual physical activity isn’t enough to keep my back and hip extensors strong. And so I’ve adapted my lunge stretch into what is more of a combination stretching / strengthening maneuver. There are numerous ways to lunge and stretch the hip flexors but some I think are better than others. I’ve found that by not bending down all the way and by not bending my knees too much, I can simultaneously work my hip extensors and lower back. While exercising the hip extensors, It’s important that the quadriceps muscles are not overworked since it’s the hip extensors, not the quadriceps, that are the weak link. I think many lunges recommended by well-meaning trainers and coaches unnecessarily tax the knee joint, which is never a good thing.

A couple months ago, a friend of mine told me about Eric Goodman’s Foundation Training and showed me his book that describes a lunge stretch that turns out to be very similar to, if not exactly, what I’ve been doing for the last couple years. I think that his lunge stretch, adapted below by Women’s Adventure Magazine here, is terrific for simultaneously addressing all the things, in varying degrees – tight hip flexors, weak hip extensors, weak back muscles and poor posture – that would explain our research findings.

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The Foundation Training lunge stretch is just one of a number of targeted exercises aimed to strengthen the back muscles, hip extensors and entire posterior chain of muscles. Interestingly, Goodman developed the Foundation Training exercises as a means to deal with severe back pain that he had while he was a student in chiropractic school. From what I know, not just through my research, but my experience as a physical medicine and rehabilitation physician and my own personal experience, I think these exercises are spot on to help with lower back pain (although as with any exercise, I recommend you first consult with your physician). And they really do target our “holy grail” research findings.

I’ve begun doing more of the Foundation Training exercises besides the lunge stretch, including a kind of lunge variation, that Goodman calls “the Woodpecker” (shown below).

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I’m trying to make a conscious effort to fit them in when I can… in the factory, at home, and in the garden.

Meanwhile, I continue to do the lunge stretch twice a day, faithfully. As busy as I get, it’s hard for me to find an excuse to NOT do it, as it really and truly only takes a minute.

Research Studies:

Kerrigan DC, Todd MK, Della Croce, Lipsitz LA, Collins JJ. Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments. Archives of Physical Medicine and Rehabilitation 1998;79:317-22.
Kerrigan DC, Lee LW, Collins JJ, Riley PO, Lipsitz LA. Reduced hip extension during walking in healthy elderly and fallers versus young adults. Archives of Physical Medicine and Rehabilitation 2001;82:26-30.
Kerrigan DC, Xenopoulos-Oddsson A, Sullivan MJ, Lelas JL, Riley PO. Effect of a hip flexor-stretching program on gait in the elderly.  Archives of Physical Medicine and Rehabilitation 2003;84:1-6.
Laughton CA, Slavin M, Katdare K, Nolan L, Bean JF, Kerrigan DC, Phillips E, Lipsitz LA, Collins JJ. Aging, muscle activity, and balance control: physiologic changes associated with balance impairment. Gait and Posture 2003;18:101-108.
DiBenedetto M, Innes KE, Rodeheaver PF, Taylor AG, Boxer JA, Wright HJ, Kerrigan DC. Effect of a gentle Iyengar yoga program on gait in the elderly: an exploratory study. Archives of Physical Medicine and Rehabilitation 2005;86:1830-1837.
Lee LW, Evans J, Zavarei K, Lelas JL, Riley PO, Kerrigan DC. Reduced hip extension in the elderly: dynamic or postural? Archives of Physical Medicine and Rehabilitation 2005;86:1851-1854.
Franz JR, Paylo KW, Dicharry J, Riley PO, Kerrigan DC. Changes in the coordination of hip and pelvis kinematics with mode of locomotion. Gait and Posture 2009;29(3):494-498.
Riley PO, Franz J, Dicharry J, Kerrigan DC. Changes in hip joint muscle-tendon lengths with mode of locomotion. Gait and Posture 2010;31(2):279-283.
Watt JR, Jackson K, Franz JR, Dicharry J, Evans J, Kerrigan DC. Effect of a supervised hip flexor stretching program on gait in elderly individuals. PM&R 2011;3(4) 324-329.
Watt JR,Jackson K, Franz JR, Dicharry J. Evans J, Kerrigan DC. Effect of a supervised hip flexor stretching program on gait in frail elderly patients. PM&R 2011;3(4):330-335.

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