PT on the Net Research

F.I.S.T Part 9: Integrated Hip-Core-Shoulder Exercises in the Frontal Plane

This article will cover integrated hip-core-shoulder movement patterns within the frontal (lateral) plane. When I think of the many benefits of the exercises in this series, my mind first thinks of how we are teaching the body to work as an integrated functional unit in all three planes of movement. An underlying goal has been directed toward increasing the core’s ability to reduce force, produce force, and dynamically stabilize during integrated full body movement patterns. It would be awesome to see the 29 muscles that attach to the lumbo-pelvic hip complex (core) all working together during functional activities. Our goal is certainly not to isolate these muscles, but to teach them to work as a unit with the rest of the body, much like how they must operate during life’s activities.

Many traditional upper body strength programs are directed towards developing strength of the prime movers, or large superficial muscles, without concern for stabilizer function. The exercises in this article series have a secondary goal, which is to improve stabilizer function within the shoulder complex and to integrate natural shoulder and scapular reactions. All of the movement patterns incorporating the shoulder complex are intended to restore balance and improve posture. As you know, many individuals exhibit more of a rounded shoulder appearance with forward head posture. The exercises in this series are perfect for restoring balance to the system as well as helping individuals in fighting against imbalance and the effects of gravity.

Along the same lines, many traditional lower body strength programs are directed solely towards developing strength of the prime movers. Lower body strength training, much like traditional core training, is geared towards isolating muscles as opposed to training movement patterns. Many lower body programs are dominated with machine training such as seated knee extensions, seated or prone leg curls, leg presses, seated abductor/adductor exercises, and seated heel raise’s. This type of training coupled with prolonged sitting on the job, creates a reaction within the body where the pelvis, lumbar spine, and lower extremities are disassociated from one another and don’t work together as a unit efficiently. Therefore, another goal for exercises in this series, is teaching the hip-knee-ankle-foot to properly function along with the trunk and pelvis through various squatting and lunging patterns.

In this article, the lower body will be required to perform lateral shifting and partial to full range side lunging in one direction and transfer this pattern in the opposite direction. This movement will be executed while in a wide-based, square stance with the feet remaining in contact with the ground. All of the exercises start with a one dumbbell reach pattern toward the opposite leg while shifting the weight laterally and performing the modified side lunge pattern. The side lunge and reach pattern also requires hip hinging and trunk flexion with mild rotation during the deceleration phase (refer to Figures 1-3). Of course the opposite reaction of hip and back extension with mild rotation will be seen during the acceleration phase (refer to Figures 5-10).

As we age and become more sedentary, it’s not surprising that our bodies move poorly from side-to-side, as seen when lunging and reaching in either direction. Athletes such as speed skaters, basketball players, baseball infielders, and others have finely tuned movement systems when operating in the lateral plane. Developing well- coordinated hip-knee-ankle loading in each direction with proper spinal stabilization is essential to developing a strong and stable core. Additionally, we can significantly reduce the chances of our clients suffering a low back injury by training their movement system to function correctly in the frontal plane.

The side lunge and reach pattern must be reviewed first to set the foundation for all movements which start with this loading pattern. We will focus on the deceleration or loading pattern, which creates a real life reaction that mimics reaching laterally to pick up an object or lowering an object towards the floor.

When teaching the modified side lunge and reach pattern, have the client place the feet outside shoulders width in a square stance. With no weights in the hands, instruct them to shift their weight toward one leg while flexing the knee and hip (side lunging). They should hinge from the hips while simultaneously pushing the buttocks back and reaching toward their kneecap with the opposite hand. Note that the kneecap is positioned over the mid foot and aligned with the second and third toes. The trailing leg should be straightened with the foot remaining flat on the ground. This will induce a functional stretch upon the adductors. At this point the client should feel that 80% of the weight load is shifted toward the lunging leg side. The lumbar spine should remain in a neutral position with a natural arch maintained while drawing in the abdominal wall. The rib cage should remain expanded with the chest up during this modified lunge and reach pattern. The eyes should look down toward the floor as if reaching toward an object at knee height (refer to Figure 1).

If proper synergy occurs, there should be shared eccentric loading between the hips, thighs, and back. Many individuals will display trunk dominance during this movement pattern. They will exhibit limited hip and knee flexion with poor gluteal loading, or in other words they do not get their buttocks back and fail to anteriorly tilt the pelvis. Individuals who exhibit more of a tail tucked position in their normal standing posture will typically have trouble loading the hip without rounding lower and upper back. This posture will overload the hamstrings, back extensors, posterior ligaments, and lumbar discs (refer to Figure 4).

If the pattern is faulty as explained, I typically have the client hold this end range position and adjust their posture. Again, I emphasize the client to lift the rib cage and restore their lumbar curvature while keeping tension within the abdominal wall as to not let the belly push outward toward the floor. I often have to place my fingers at their mid lumbar spine and have them sense the desired position with this tactile awareness. They should sense the connection of bending more at the knee and hip while also hinging a bit more to accomplish this position. This is especially important if working with a post-rehab disc patient, as trunk and lumbar flexion are to be limited. Of course, this awareness is very important for all individuals as we teach them to position their lumbo-pelvic-hip complex in the most advantageous and stable position. Progressing to a lower reach position (refer to Figures 2-3) is most applicable for individuals with optimal flexibility, strength, and coordination, or possibly for a specific sport or activity requirement.

Side Lunge & Reach Toward Opposite Leg

Figure 1. Knee reach Figure 2. Mid-shin reach
Figure 3. Lower shin reach Figure 4. Improper reach (tail tucked position with trunk dominance)

Now that we have covered the loading phase, we need to look at the transfer phase to the opposite hip with the concentric shoulder action. The shoulder complex will be required to perform single arm patterns while shifting the weight or transferring the load to the opposite hip. The three frontal plane shoulder patterns covered are the bent arm lateral raise with external rotation (goal post), long lever lateral raise with external rotation, and hammer curl to lateral press.

Developing frontal plane strength and stability within the shoulder girdle has tremendous benefits. I personally like to use the frontal plane patterns along with exercises in the two previous articles for individuals with rounded shoulders and a forward head posture. They are used instead of traditional overhead pressing and front shoulder raises, as these movements feed into the anterior dominant imbalance that already exists. We are trying to create a one-arm reaction which mimics lifting an object laterally or grabbing an object off a shelf. We are also creating strength and stability within the shoulder girdle where it is highly susceptible to injury, especially in a contact or tackling sport. This particularly relates to the long lever lateral raise and hammer curl to lateral press.

The other reaction we are trying to create through the bent arm lateral raise with external rotation is improved functional strength of the shoulder abductors, scapular abductors, and external rotators. This is a key movement used to restore posterior balance to the shoulder complex, especially for throwing and striking athletes or those with a rounded shoulder appearance.

Frontal Plane Shoulder Patterns

Figures 5-6. Bent arm lateral raise w/ ext. rotation. (goal post)
Figures 7-8. Long lever lateral raise w/ ext. rotation.
Figures 9-10. Hammer curl to lateral press

During the concentric shoulder actions, it is important that we reverse the loading pattern and shift only in a lateral direction. The shoulders and upper torso should remain square, without rotation, during this transfer phase. The exerciser should be cued to push off the floor with the inside ball of the foot and release the heel which promotes straightening the leg and loading the opposite side hip and thigh musculature. The exerciser should focus on slightly flexing the opposite knee and hip while simultaneously performing the shoulder action. Also, we want to cue the exerciser to finish in a slight hinged position, which will keep the pelvis slightly anterior while maintaining a natural lumbar curve. The exerciser should focus on feeling that their buttocks receives load during this transfer. Many individuals will exhibit a tucked tail position and a vertical trunk position as they fail to load the opposite side hip. Accompanying this action, we will often see that the abdominal wall is pushed outward and the lumbar spine has an exaggerated curvature. This represents a weak position of the lumbo-pelvic hip complex, where the lumbar spine receives far too much negative loading without help from the powerful hips to buffer the transfer of load.

Figure 11. Improper loading transfer during bent arm abduction w/ ext. rot. (goal post)

If this position is noted, have the client perform the desired shoulder movement pattern again without weight load. Make sure to again stress releasing the heel of the trailing leg and have the client focus on slightly bending the knee and hip while transferring laterally. Having the client emphasize hinging slightly forward at the hips during this transfer phase is usually very helpful to create a good loading reaction. We must tie the movement together by controlling the core during the concentric shoulder action. We need to emphasize drawing in and bracing the abdominal wall as we shift laterally.

Next, we will cover the keys to performing the concentric shoulder actions. When performing the bent arm lateral raise w/ external rotation (refer to Figures 5-6), we need to keep the palm facing down during the first 70° of abduction while flaring the elbow in a bent arm fashion. Remember that this motion occurs while shifting laterally. At the same time the shoulder accomplishes 70° of abduction, the heel should start to release from the floor, and the shoulder should start to externally rotate. The knuckles should end facing up at the ceiling with the upper-lower arm forming a 90° angle and elbow parallel to shoulder. At the same time the goal post position is achieved, the same side hip should be fully loaded.

The client should be able to achieve the goal post position (90° of abduction and external rotation) if they have normal flexibility within the pectoralis major, internal rotators, and latissimus dorsi. They also must have normal extensibility or mobility within the thoracic spine.

If the client lacks normal range of motion, they will most likely compensate by overextending the lumbar spine and tucking the buttocks or tilting the pelvis posterior. We need to first make sure that the compensations are not due to poor neuromuscular control. If they do not respond to proper cueing, they need to stretch the tight musculature and mobilize their thoracic spine before starting their weight training session. They will most likely need to perform daily stretching and mobilization to restore balance and progressively improve range of motion (see Figures 12-14). This does NOT mean that they should not perform this exercise, but simply work through the range until they reach their tension barrier with proper positioning of the lumbo-pelvic-hip complex.

Stretching and Mobilization

Figure 12. Thoracic Mobilization
Figure 13. Lattisimus Dorsi Stretch Figure 14. Pectoralis Major & Internal Rotator Stretch

When performing the long lever lateral raise with external rotation, it is important to keep the arm moving close to the body. I instruct client’s to lead with the back of the hand while abducting the shoulder. Once the shoulder reaches approximately 45° of abduction with concurrent hip shifting, the pelvis should be in a neutral position and the heel should start to release from the floor. At this time, they should focus on externally rotating or in other words progressively turn the palm so that it faces forward. Simultaneously, the elbow should bend 10-15° and remain bent throughout the abduction movement. The elbow should finish at shoulders height with the hand ending level with the ear. Remember to keep the shoulders square during the movement.

When performing the hammer curl to lateral press, the client should be reminded that there are two actions performed with minimal transition time. First, they should focus on shifting the hips to a neutral position while simultaneously performing the hammer curl. At this point, the knuckle should be facing up with the thumb pointing at the anterior shoulder. Next, they will perform the lateral press while continuing the shift pattern and loading the opposite hip. The hip should be completely loaded as the end range of the lateral press is achieved. The hand should finish level with the ear, much like the long lever lateral raise with the palm facing forward, but the elbow is extended fully. This extended elbow position will maximally challenge the stability of the neck, shoulder, and core in the frontal plane. Remember to shift and press in a side-to-side manner while keeping the shoulders square.

Again I want to emphasize to load the patterns with sub-maximal weight while learning the exercises. I usually start with a weight that one can handle performing 15 repetitions. Using a lighter load in the initial learning phase allows for freeze frame teaching. Often times I have the exerciser hold the end range position for a couple seconds so that I can reposition them accordingly. If the load is too great during this learning phase, undue stress may be place on the cervical and shoulder stabilizers when using the freeze frame technique. The goal is to progressively increase load so that maximal shoulder fatigue can be achieved within a 10-15 repetition range.

Have fun being functional, and remember that attention to detail is what separates the mediocre from the magnificent!

For more information regarding Functional Integrated Strength Training, visit Mark’s Author Page or e-mail to him at


  1. Gray, Gary with Team Reaction, Total Body Functional Profile. Adrian, MI., 2001, Wynn Marketing Inc. & Gary Gray Physical Therapy Clinic Inc. 800-494-9555
  2. Gambetta, Vern, The Gambetta Method. Sarasota, FL. 1998, Gambetta Sports Training Systems Inc.
  3. Exercises 1-12. Cibrario, M., FIST 2 "The Next Level"-Core, Waukegan, IL., 2002,M.C. Training Inc. 847-562-1611