WHAT I LOVE UNILATERAL MOVEMENTS FOR PHYSICAL THERAPY
Unilateral training has gained popularity as accessory movements in strength and conditioning and movement programs. Unilateral training simply means that you are biased towards loading one side of the body opposed to traditional bilateral training like squats, deadlifts, and bench press do. Moving one side of the body at a time, creates a hugely advantageous scenario leading to increases in proprioception, balance, motor recruitment, firing patterns, muscle activation and efficiency.
Pain and Contra-Lateral Effects
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. If we are working with someone that is just overly irritable and sensitive to loading one side due to acute injury or pain; we can train the opposite side and negate the unloading effects to the involved injured or painful side. There are contra-lateral responses with training that actually positively affect the untrained side such as hypertrophy, circulation, strength, and power output. Not to mention the added benefit of getting the movement and training effect without disrupting the healing process on the injured or painful side.
The body is also really good at compensating or reducing load from a painful tissue. For example during a double leg squat if you are having anterior knee pain on the right side; your body can shift towards the left side or make the movement more hip dominant. Since we don’t want to overprotect an injury we can force load thru painful or problematic tissues thru more direct unilateral loading strategies.
Unilateral training offers some natural reduction on the injury risk spectrum. If you think double leg or double arm movements are inherently safer hear me out. Since unilateral movements require less load this automatically makes it injury reducing. All injuries in some form of fashion occur because of a body region’s capacity to manage that load was exceeded. So by reducing load we fall into decreased risk.
Most movements are heavily dominated by the sagittal plane of motion. Which involves flexion and extension. Unless you play baseball, softball, golf, or tennis; chances are that you neglect rotational training in your prescriptions. Specificity is important with your training and sport related performance; however for total movement health and variability; everyone can benefit from training anti-rotation and rotational capacity.
One sided training creates more core stability demand and requirements. Spine stabilization is mandatory so that your extremities can produce the maximal amount of force safely. Every single pain and/or injury rehab will address lumbopelvic stabilization in some form or fashion.
Co-contraction of muscle groups. Due to the overall balance demand increase with unilateral lower body training this increases the stability requirements. Take a unilateral RDL movement that primarily is working the hamstrings and glutes; we also get the added benefit of working on foot control, hip stability, spine stabilization, and stability in the shoulder blade and rib cage.
Assess and Treat
Unilateral movements can be used as both an assessment and a treatment. We can assess side to side movement quality and find any possible relevant contributions or missing links from your capacity by comparing two sides. If we take a 3 rep max rear foot elevated split squat and on the left side you can do 185 pounds and on the right right side you can only do 135 pounds; we have problems. We can also treat what that assessment revealed with the same exact movement and manipulating variables like load, tempo, position, and volume.
Tall athletes have long femurs. Having long femurs is generally not ideal for being a really good back squatter. Squats are a fundamental pattern to training, hip and knee extension, spinal stability, and a host of other things. Using unilateral variations of the squat such as the split squat, rear foot elevated squat, or lunge variations can allow us to train most effectively with the same benefits of a traditional squat.
Back Pain and Hip Impingement
By introducing some variability in the pelvis and hips we can work around and offset load that may be causing added hip discomfort or low back pain with traditional bilateral movements like the squat and deadlift. It’s much harder to stabilize the head of the femur in the acetabulum on two sides simultaneously as opposed to one side at a time.
We can manipulate rib cage position and further help with scapular upward rotation, elevation, and tilting by addressing one side at a time with movements like landmines presses, unilateral DB overhead movements, and various closed chain plank/pushup positions.
First of all, no one is built symmetrically. Our movement patterns and even our limb lengths will vary between opposing sides of our body. If we try to train symmetrically all the time with bilateral exercises, eventually, we will further develop our muscular imbalances and inhibit our performance and athletic development.
The majority of bilateral training occurs in the sagittal plane – up and down, forward and back. There is relatively little demand on resisting or creating motion related to rotation or side bending due to the symmetrical nature of the loading. Muscles like our obliques and glute medius don’t necessarily get trained to a high degree. In contrast, since a muscle like the glute medius doesn’t have a primary function that is sagittal in nature, it will be under trained with primarily sagittal movements. Whereas when we do unilateral movements, these different muscles and motions do get trained – at least to a greater degree. When we are on one foot, using one arm, or any other derivative of such, we have to resist our shoulders and pelvis moving and rotating around the axis points. This helps to check off these other things that would possibly otherwise get neglected.
This isn’t a LEARN trying to tell you not to do bilateral training-there is no replacement for squats, deadlifts, presses and all the other options. From a rehab and physical therapy standpoint we use unilateral movements OFTEN in our assessments and treatments.