Gaze stability exercises

Demonstrated above, a standing dynamic hug with serratus anterior press can help to biomechanically prevent common overuse injuries. Photography supplied by the author.

There is a growing understanding of how certain levels of daily physical activity can positively affect cardiovascular, musculoskeletal, respiratory, and endocrine function, as well as improve mental health. This is why many people across the country have joined the movement to become physically fit and stay healthy. Currently, the American College of Sports Medicine and the American Heart Association both recommend at least 30 minutes of moderate intensity physical activity 5 days a week or? vigorously intense cardio 20 minutes a day for 3 days a week, which should be coupled with eight to 10 strength-training exercises twice a week. Many working Americans have difficulty fitting this type of workout routine into their busy schedules. Instead, their competitive drive and desire to stay physically fit result in longer, more intense workout sessions during the weekend. This group of working Americans has become known as the weekend warriors. The weekend warrior is a colloquial term to describe people who compress their weekly exercise into 1 to 2 days of long, vigorous physical activity.1 For example, they will engage in hours of racquetball, pickup basketball games, biking, flag football, hiking, and other recreational activities. This pattern of exercise generates sufficient energy to satisfy current physical activity recommendation (>1,000 kcal/week), but over one to two sessions a week, instead of the recommended 5 days.2 Kruger et al found that weekend warriors, through their infrequent bouts of activity, spend an estimated median energy expenditure of 1,079 MET.min.wk in one to two times a week. This is higher than the average 525 MET.min.wk needed to meet the physical activity recommendation for health (30 minutes of moderate intensity on 5 days).1

From a public health perspective, weekend warriors are of particular interest. They reap health benefits from being physically active, but may be at a higher risk for overuse injuries.1 Common injuries incurred by the weekend warrior can range from cervical herniated discs, impingement/rotator cuff tears of the shoulder, and low back pain to patellofemoral pain, ACL and meniscal tears of the knee, muscle strains/tendinitis, and ankle sprains. Unfortunately, with lack of time as a barrier to exercise, infrequent bouts of activity may not be sufficient to maintain the adequate strength and flexibility that is required to prevent injury. As the body is engaged in intense activity for a long period, muscles resist high forces expending a significant amount of energy. Decreased strength and flexibility result in early fatigue and inability to withstand the dynamic forces applied during vigorous workouts, resulting in muscle strains and ligament sprains. A comprehensive wellness maintenance plan focused on muscle flexibility and strength is one way to prevent overuse injuries.

The wellness plan explained below is designed to incorporate a brief 1-day moderate to high intensity routine targeting muscles that aid in preventing common injuries. Along with an emphasis on proper sitting posture, this approach can further strengthen the muscles needed by the weekend warrior to prevent injury.

Gaze stability exercises

Demonstrated above is how to optimize posture through the performance of resistance exercise.

Maintaining the ideal sitting posture is very important not only for the weekend warrior, but for any person whose job requires them to sit for long periods of time. Poor posture while sitting at a desk, typing, or looking downward to write many e-mails on a Blackberry may result in rounded shoulders and forward head posture. Rounded shoulder posture can lead to downward rotation of the scapulae, decreasing the subacromial space and increasing the probability of shoulder impingement or rotator cuff tears. Forward-head posture can cause excessive flexion of the lower cervical vertebrae leading to progressive shortening of the anterior neck and suboccipital neck musculature, resulting in increased muscular stress throughout the entire craniocervical region and localized painful muscle spasms or trigger points, headaches, and ultimately cervical spine herniated discs causing upper extremity pain and radiculopathy.3

One can optimize posture by maintaining a lumbar lordosis, retracted scapulae, and neutral head position. Performing the face pull backward lunge and back extension alternating “T and Y” exercises (described in Resistance Training section) will strengthen the appropriate muscles that maintain this correct sitting posture.


The often neglected warm-up component will help increase blood flow to the muscles in preparation for physical activity. A cold, stiff muscle is not prepared for rapid movements and not able to readily move joints in an appropriate manner. In addition, if stiff muscles are lengthened too quickly during intense activity, injury will result. The weekend warrior’s prevention program will start with 10 to 20 minutes of warm-up activity. The warm-up phase should incorporate large muscle groups, including activities such as jogging or biking, allowing the participant to increase core temperature and metabolic rate.4 One should then perform 3 to 5 minutes of stretching activities. Stretching is important to restore range of motion and maintain the optimal length-tension relationship of a muscle. Performing dynamic stretches incorporating whole body movements and rhythmically contracting muscle groups through functional ranges of motion (ROM) will continue to elevate core body temperature, enhance motor unit excitability, improve kinesthetic awareness, and maximize ROM.5 Dynamic stretching may include skipping, hopping, jumping, side squatting, and rotational motions of the extremities such as arm and leg swings.5 Ideally, static stretching should occur upon completion of the physical activity if a muscle or muscle group feels tight.


Resistance training plays a vital role in allowing one to maintain an injury-free, competitive body. When putting together an effective workout plan, one must apply the principles of overload, periodization, and specificity to enhance physical development and positively affect recreational sports performance.

The overload principle is based on the concept that one’s body must adapt to demands imposed upon it. Literature has demonstrated that strength improvements are a result of neurological adaptation and muscle hypertrophy. During the first 3 to 4 weeks of resistance training, strength gains are primarily due to neurological adaptations.6 Hypertrophy of muscle fibers is observed approximately 8 to 12 weeks after the initiation of a training program.6 Our bodies will respond and adapt in a specific manner based on the exercises performed. Thus, the physiological stress or loading of the muscles must be progressively increased over time for progress to occur.6 In order to achieve neurological overload and adaption, four factors should be considered in designing a resistance program. These factors include: load (resistance), repetitions, sets, rest, and frequency. Periodization is the process of implementing overload factors in a systematic process over time.6 Periodization prevents overtraining and injuries and is divided into specific volume and intensity categories to achieve targeted goals. These goals consist of muscle endurance, muscle hypertrophy, strength, and power.

The more closely resistance exercises simulate the actions of a specific sport or activity, the greater transfer carryover of strength and power to motor performance in that sport or activity.6

This recommended resistance-training plan consists of a high intensity workout, with nonstop multijoint resistance activities targeted at strengthening key muscle groups, in an attempt to biomechanically prevent common overuse injuries. Supplementing these exercises with one’s routine exercise regimen can achieve a comprehensive strength training program.

Face Pull Backward Lunge—In standing, initiate exercise with arms abducted to 90° and perform middle trapezius row followed by shoulder external rotation (ER). Lunge backwards while maintaining a shoulder ER isometric hold. In the lunge position, eccentrically control shoulder internal rotation. Return to starting position. Continue exercise, alternating legs with lunge. This lift is important for the overhead or throwing recreational athlete, especially for anyone who has sustained shoulder injury such as anterior instability, a labral tear, or rotator cuff impingement/tear. This exercise targets the strength of rotator cuff muscles, which play a role in maintaining the humeral head position in the glenoid fossa.

Standing Dynamic Hug with Serratus Anterior Press—In standing, arms are abducted to 90° and elbows flexed to 45°. Start with a chest fly movement by horizontally adducting the arms. Protract scapulae while extending elbows and flexing the shoulders. This exercise strengthens the pectoralis major, the serratus anterior, and the anterior deltoid muscles. Most importantly, the serratus anterior muscle is targeted. Lack of strength or muscular endurance of the serratus allows the scapula to rest in a downwardly rotated position, causing scapular winging and abnormal scapulohumeral rhythm, which may result in injury.7 This is commonly seen in people who suffer from glenohumeral instability, shoulder impingement, and other shoulder conditions.7

Ts and Ys Back Extension—Lie prone on a physioball with your hips centered over the ball. Extend your back, keeping your neck in a neutral chin tuck position. Perform alternating horizontal shoulder abduction, Ts, and shoulder scaption, Ys. Maintaining an erect position strengthens the erector spinae muscles, while shoulder movement targets the middle and lower trapezius muscles, helping to stabilize and downwardly rotate the scapula.

Hamstring Physioball Curl—Initiate by digging your heels into the physioball. Perform bridge by elevating buttocks off the surface. Hold this position and perform a hamstring curl by flexing your knees to 90°. Maintain bridge position while continually performing curls. Targeting core muscles will decrease the likelihood of low back pain, while strengthening hamstrings will increase dynamic stability in the knee.

Squat with Overhead Dumbbell Press—Start in squat position holding dumbbells in a neutral wrist position. Extend legs while simultaneously performing a supinating biceps curl and bringing the weights to mouth level. Initiate overhead press by horizontally abducting arms and extending elbows overhead.

Single-Leg Squat with Scaption Raise—Stand with one leg on box or elevated surface. Perform a single-leg squat bending your knee to 45° to 60° and maintain proper knee position while performing shoulder scaption to 90°. Cue patient to maintain knee in sagittal plane with knee directly over the foot. Research has shown that performing this exercise provides great dynamic control of the trunk, hip, and femur over the planted leg,8 by engaging gluteus maximus, hip abductor, and hip external rotator muscles. Decreased hip abductor and external rotation musculature control will lead to femoral internal rotation, hip adduction, and genu valgum, which may play a role in lateral patellar tracking in patellofemoral pain and a potential increased risk for noncontact ACL injuries.8 Performing shoulder elevation in the scapular plane increases the difficulty of this exercise and strengthens the deltoid muscle in the most commonly used range of motion of the shoulder.

Prone Plank—Prop your body up on to your forearms and toes while maintaining a neutral spine alignment. Progress exercise by placing feet on dynamic surfaces. Targeting the core will help with body control and spinal stabilization during dynamic activities.

The weekend warrior is susceptible to overuse injury because there is little time to maintain one’s muscle strength and flexibility. The described exercises target key muscles that may help prevent injury and provide a great high burning calorie workout. It is prudent for individuals to engage in such a workout as these multijoint lifts are a great method of circuit training, which will allow the individual to remain active with less chance of injury.

Matt Berliner, PT, is an adjunct professor at the School of Health and Rehabilitation Sciences at the University of Pittsburgh Medical Center Center for Sports Medicine. For more information, contact .

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