Open Books – Rotational Mobilization for the Spine (active stretch for various muscles)

Open Books – Rotational Mobilization for the Spine (active stretch for various muscles)

March 27, 2020 22 By Kailee Schamberger


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. you Subtitles by the Amara.org community