Walking is one of those movements we all take for granted. We don’t regard this as an exercise, it is just something we all can do. But what happens if you have an accident, injury or suffer with some type of disease that affects your ability to walk correctly? What can you do about it? A severe loss of balance, strength, and confidence to do things that were previously easy and taken for granted can now completely change your quality of life. A stretching program will help to relieve some stiffness but will not be your answer for lack of strength. A strength program will help, but will not be your answer for lack of stability and movement efficiency. What do you do? To answer this is very difficult and will take more than just one secret exercise or a one size fits all approach. I have worked for many years helping people overcome all types of injury, and without a doubt helping someone to walk again would be right up there as the hardest physical problem to find a lasting solution to. In this article, I am going to share with you some of my most successful exercises, strategies, and methods for helping people learn to walk correctly, or in some cases getting out of the wheel chair and learning to walk again!
What Is Gait & Why Is It So Hard To Restore When There Is Dysfunction Present?
The human gait cycle is a very complicated, coordinated series of movements involving multiple joints and muscles all working together at once which is one big reason why so many rehabilitation programs fail when they use simple methods to improve it! You need exercises that target the neuromuscular system if you want to make any difference and this can be extremely challenging and even risky to do.
You are not just having to deal with the muscles but the brain and the nervous system that coordinates this complex movement pattern. This is hard for anyone to do consciously at the best of times but even harder if there is a neurological problem causing weakness and a loss of balance.
Trying to slow down the walking movement to make sense of it and control it only makes it more inefficient, awkward and unstable. For it to work correctly it needs to be completed reasonably fast and this is where it becomes risky for the person does not have enough stability to control that and risks falling over. Now you can start to see why this is so hard to get right.
Some of you reading this may know of someone who has trouble with walking or you yourself have difficulty walking on a daily basis. In the health industry walking is known as Gait.
What is Gait?
I have explained this in great detail previously in the article about learning to weight shift so I don’t want to spend too much time explaining this.
However, I will highlight the two main phases of the gait cycle for they reveal exactly where the main problems that people with impairment have with walking.
The gait cycle is divided into two phases.
1.The stance phase
2.The swing phase
Each cycle begins with the initial contact of the heel strike of the leading leg with a stance phase, into the swing phase, and ending again with the stance phase. Often foot drop and toe dragging prevents the heel strike making it impossible to progress to the next phase of being the stance phase. This is where they feel vulnerable to a fall and rely on crutches, walking sticks of walking frames which only serves to make the stance phase even weaker.
The stance phase is broken into three parts being:
- Heel strike
- Mid stance
- Propulsion
There are so many muscles firing within milliseconds of each other during this cycle in order to make this movement efficient and effortless. The different phases are designed to decelerate the forward momentum of the body while at the same time absorb shock as the body moves over the lower leg ground reaction forces.
This is the main reason why it is so difficult to improve if you have lost your ability to walk. I explain why this is the case in more detail in the video below.
In the book Movement by Gray Cook he says,
“Movement patterns are destroyed by reductionism.”
We have become so good at looking at things in such great detail we lose sight of how we really move. Focusing on single muscles and areas of weakness will do little to improve the ability to walk. This is where people think all they need to do is make specific muscles in the legs stronger and everything will be fine.
The big problem with the muscle and isolated exercise approach is that you are looking at the problem as a muscle weakness when it more to do with a neuromuscular weakness.
Secondly, and this applies to all people is that the body does not like to work in isolation and will attempt to distribute forces across as many joints as possible to reduce stress to any one region. It is not necessarily a lack of muscle strength that is the problem with gait for many people easily develop adequate strength needed in the muscles of the legs within simple isolated exercises. The problem is the body does not know how to sequence and coordinate all of the muscles correctly and at the right time.
I help a lady in QLD via Zoom calls who has Multiple Sclerosis and can easily push 100kg on a leg press, but can barely get those same leg muscles to do a body-weight lunge. How can the same muscle be extremely strong on the leg press and one minute later be extremely weak in a different movement?
If the muscle was truly weak then she would not be able to do any of the exercises but she can do anything that is supported and stable. This shows you where the problem is hiding. Plus, it also assumes that once your strength is there that your body will automatically know how to use it in complex patterns, which is almost never the case.
Gray Cook says it best,
“Patterns are groups of singular movements linked in the brain like a single chunk of information. This chunk essentially resembles a mental motor program, the software that controls movement patterns. A pattern represents multiple single movements used together for a specific function.”
What Causes Walking Impairments?
Many of the clients I have worked with over the last 20 years developed severe walking impairment from a Stroke, Multiple Sclerosis, spinal cord injury or a car accident. All of those people had spent a lot of time working with other methods of rehabilitation training that were predominately isolated training techniques, or methods using machines or equipment to assist with their lack of stability.
The more functional walking impairments I have seen are due to lateral pelvic tilt or piriformis syndrome and these are much different to the neurological walking problems. This is why I refer to those as more functional for they do not present with neurological problems like foot drop or toe dragging.
Foot drop is the inability to lift the front part of the foot due to weakness or paralysis of the ankle muscles and toe dragging refers to scraping the toes or forefoot along the ground while walking.
Also one big noticeable difference is that the neurological people rarely had any pain present that was preventing them from walking correctly. If anything they had numbness and no feeling at all but felt extremely weak and vulnerable to falling.
Whereas the functional walking impairment people had significant amount of pain which was the main reason they could not walk correctly. So it is important to understand this difference for you could see the same difficulty or problem but the reason for it is completely different and your approach to helping them will be different to.
All of these people sought me out for help due to their frustration of not improving as I offered some different strategies and techniques that they saw on You Tube that looked promising. Many had tried some of the techniques I had shown and they had worked better than anything they had tried before so wanted to know if there was something else I could do for them.
The main thing to understand with all neurological impairments like stroke, TBI (traumatic brain injury), MS (multiple sclerosis) and cerebral palsy the damage is done within the central nervous system.
If you can imagine an electrical system of a house: the meter box (being the brain & spinal cord) is the central nervous system, the wires leading out to the switch are the nerves leading towards the light globe (being the muscle). If there is a problem with the meter box (the brain, movement) you will never be able to fix it by changing the light globes (the muscle via stretching, the same floor exercises you’ve been doing for months). We are here to fix the meter box to help out the rest of the system. In order to improve this we need to put the body under a challenge in order to switch on more nerves.
Make Sure You Have Someone To Help You
I cannot stress this enough you must ensure that you have safety as your first priority before trying any of these exercises.
To train balance you must be out of balance and with this comes risk, however with me being there to support them and guide them we are able to enhance the movement faster than any other form of training. It is not easy, and can take some time to do. Mentally as much as physically the clients are tested with these patterns but it is exactly what the brain needs in order to reprogram a new sequence that is more efficient.
Some of these exercises require two people for them to work as I like to use resistance bands to help the body move certain joints without stiffness robbing them of stability and strength.
Let’s start.
You Must Improve Foot Stability & Ankle Mobility
We cannot ignore the role of the feet with this and this is the logical place to begin. For the functional walking impairments this is a big factor and often contributes the most to helping the person heal. With the neurological person I mentioned earlier the problems with foot drop and toe dragging which will make it impossible for the hip and knee to function correctly if the feet continue to do this.
Once again the reason this is happening is not because the foot became weak from neglect and poor movement as you see with lateral pelvic tilt problems but the brain and nervous system being corrupted from the disease or injury. But even still you need to have some type of exercises to try and help these muscles and joints learn how to move again and you will need to use tools to help them do it which you will see shortly.
With over 100 various muscles, the feet and ankles encompass 15-20% of all the muscles in the body!
For any movement you do standing up, neural signalling begins at the feet as they are the first part of the body to feel the ground and tell the system what to do. They tell the brain where you are, if you are balanced enough to move yet and basically instigate movement before it even begins. The better the feet and ankles are functioning, the better the signal all they way up the kinetic chain.
Our feet and ankles are meant to withstand incredibly high forces and should provide more in terms of shock absorption than perhaps any other body part.
Due to the compensatory movements and often the lack of dorsi flexion of the ankle the feet gradually start to become very weak and start sending fewer and fewer signals up the kinetic chain, leading to distortions in pro-prioception and loss of overall stability. Lack of ankle mobility is a very common problem we see with walking impairments.
When we walk we need at least 10 degrees of ankle dorsiflexion with maximum ankle dorsiflexion occurring during late mid-stance. Limited ankle mobility can lead to toe dragging and create a chain reaction of compensations that compromise stability as they lean to one side to pole vault themselves forward.
My favorite ankle exercise is shown below.
You can also use some calf raises to help get their strength back for ironically even though their foot goes into plantar flexion all the time the calf often becomes very weak as it is not used correctly. I like to use the version that involves the big toe being forced into flexion for it has a connection to the glutes. I use this a lot with plantar fasciitis and it works really well.
Now that we have defined the gait pattern for you and explained how important foot stability is it is time to look at some of the best integrated exercises for improving your ability to walk.
Just remember there is no one magical exercise on its own that will “fix you”. You have to use a combination of all these ideas and apply what works best for you. And you also need to be very patient as you will make many mistakes and become easily frustrated.
While it may seem you are getting nowhere as you continually mess things up, keep at it, for the mistakes are exactly what the brain needs to see in order to make some adjustments.
The Line Drill
Watch the video above to see how to complete this exercise. I also use this a test with older adults to predict a fall as you can see in the video at the end of the article with an older adult performing it.
For such a simple exercise this is extremely effective at enhancing the entire body to fire an instant reflex to react to sudden stability challenges.
For most people when they slip or trip their reactions are extremely fast. The brain sends a very rapid response to adjust your centre of gravity, step forward, grab something and prepare your body into a safer position for impact with the ground. This all happens in the blink of an eye and is not a conscious thought. We do not need to train this skill when we are younger as we very active and constantly exposing our bodies to this ability in daily life.
However with neurological conditions this brain response has much slower firing speed leaving their body exposed to falling. As their brain recognizes this weaker signal it compensates by making several changes to how we move and adopts a stiffening approach to stabilizing.
People with poor balance often apply a rigid and stiffening strategy of locking the knees and straightening their legs and stiffening all their muscles to prepare for impact. This strategy makes falling inevitable and the consequences of one much more severe.
This exercise has 5 levels to the test and its purpose is to increase the stride length and increase the time for the stance leg to support the body. In the early stages you may require the use of a stick or cane to learn how to move the feet in the right position and make this exercise safer until you develop more confidence.
The hips may also require mobilizing and some additional exercises for strengthening the legs will help. But really this will come down to how well your body coordinates the gait cycle with large steps.
Read this article to see more about these tests – 2 simple gait assessments to determine the risk of a fall
Walking On The Sensa Mat
This is where the feet become a big factor and I would go as far to say that this piece of equipment is the “BEST” thing I have added to our programs in the past 15 years, it is that good! I won’t go into too much of the science behind this as I have written a detailed article about this before you can read here – How the sensa mat improves joint stability and your ability to walk
This exercise can be very painful and daunting to begin with but the rewards are so worth it! This is one time that pain can be of great benefit and actually help the body to move better. The pain they feel on their feet forces their body to move faster than normal to get off the mat and you have to see it with your own eyes to believe it. The purpose of walking on the Sensa mat is to fire more sensory nerves within your feet, by doing so this has been shown to improve motor nerve function within your feet and up through the rest of the leg.
The image above shows me using this and also one of our clients who has been improving the control aspect of her walking after suffering from a severe car accident that left her with symptoms similar to a stroke. Since adding this type of training she demonstrated significantly better stability and walking patterns. Her improvement in just a few short weeks was nothing short of incredible!
Her gait and overall foot stability progressed so fast she was able to begin walking over high objects, and was able to walk down stairs without holding the rails for the first time in 15 years!
A great video of this in action is below.
My Favorite Exercise – Walking With Band Assisted Knee Flexion
This is where you will need a second person to help you and not just for safety but to help the body complete the ankle and knee flexion needed in the swing phase. In this example I cheat on the stance phase so we can focus solely on the swing phase and teach the body the timing needed to execute this efficiently.
This is a perfect example of just how complex and fast this movement must be and something we take for granted.
I instruct the person to try and slide their foot backwards like wiping mud of the bottom of their shoes and then I use a light resistance band to help pull the ankle backwards and the instantly upwards so that the knee flexes and they place their foot on a step.
I really like the band assisted exercise the most for it taps into the very heart of the problem at the source with very similar timings and positions. The downside is it is very frustrating for there is only so much you can do before fatigue sets in and it needs thousands of reps for it to have any chance of being encoded into the nervous system as a new motor program to keep.
This is definitely one of my “go-to” exercises and depending on the person I can start to develop it into more functional movements like the walking lunge.
I also use some simple floor based exercises in combination with this to help improve knee flexion with heel slides and Swissball leg curls to help develop the feeling of this without the complication of balance being a factor. They are shown towards the end of the video above.
Obviously there are a lot of other similar exercises like single leg hip extension, bird-dog, clamshells, and crab walks that can also be helpful.
However, as I have said several times in this article they only take you to a certain point and do not change anything. This is because they are a muscle based isolation approach and it is the neuromuscular system that is affected.
Developing Stability & Strength With The Single Leg Stance
If the previous exercise works on the swing phase then this is where you need to work on the stance phase and this can be even harder to do and you will have to experiment with several different exercises to find what works best.
At first I use single leg stance holding onto a fixed barbell, the wall or even a TRX. This takes the balance part out of it and helps to develop their strength and confidence in the single leg stance. To work on the balance I might use single leg standing still proprioception tasks like throwing a tennis ball or even eyes shut. Once again it all depends on the person and the severity of their condition.
As they improve I like to try and progress to the Toe Touch Drill where you need to balance on one leg while the leg in the air moves in multiple directions. This forces to the body to learn how transfer body-weight into different directions as well.
I like to use this as an assessment tool with every client I meet on their first day, and especially with people suffering lower limb injuries or walking impairments. The reason for this is, it exposes mobility restrictions and weaknesses that are often hidden in other tests, helping me to design a corrective program that addresses these faults. It predicts future injuries in the lower limb without the risk of increasing pain.
And the other reason I like it is that it is a great core exercise. In reality it is so much more than just a simple core exercise as it influences many joints and muscles all within the blink of an eye. It is unique in that it has the ability to change the way a person walks for it shares the same relative timing used by all the joints of the stance leg in the gait cycle.
Also make sure you read the article – Why I love the Toe Touch Drill for improving hip and pelvic stability
Squats & Lunges
Learning to squat is actually a primitive skill you learn as a toddler, and it is where your body first finds the skill to be able to stand. Without this ability we would have great difficulty in performing even the simplest everyday tasks and be reverted back to a toddler and forced to crawl!
This means that it does possess some software within the movement pattern that has the potential to reboot the computer. The same with the lunge which is something I discussed in more detail in the article about infant development exercises.
Obviously there are much bigger obstacles and problems with someone who has a walking impairment from a disease or severe injury versus a toddler who is developing new brain connections at rapid speeds but there is still a use for these functional movement patterns.
The squat is a great way to build functional strength within the legs, no matter what level you are at there is a way we can perform this exercise. If you have a walking impairment it may take considerable time to develop your strength with this movement and you may need to get very creative with the methods you use to improve this.
By holding your walking frame or gait aid is a great start to get the nervous system fired up to help recruit more muscles, therefore, assisting you in improving your walking speed and endurance. Other progressions from squatting up from a chair with your aid is holding sticks to enhance the stability requirement needed for you to balance yourself up, needing more strength to squat up and to lower yourself down with control.
The image above below one of our clients with Cerebral Paulsy performing squats. The harder version, instead of using his frame, we use two unstable sticks, therefore increasing the strength and balance requirement needed to perform the squat. Even though he may not be perfect and there are many things we cannot change, this type of activity has a profound effect on the rest of this body.
The LUNGE is another foundational movement pattern like the squat and deadlift although this one has some unique characteristics.
This is one of the more difficult patterns of movement needed to learn in order to get program your walking on automatic reflex. Like the squat it will improve your strength, however, because this exercise is placing your legs in a split stance it simulates the action of walking much greater, and therefore correlates with walking more closely than the squat.
The lunge is superior to most other patterns with relation to walking for it brings into play what is known as the Slings Of The Body. These slings are like chains or cross wires that integrate our lower body with our upper body to produce movement. This is why our left leg moves with our right arm.
These exercises are often extremely difficult with walking impairments due to the instability on one side of the body. The stiffness the body uses to maintain some stability compromises their ability to effectively rotate leaving the movement feeling awkward and robotic. Great care has to be taken when using these exercises for they have the potential to really help but at the same time can leave them vulnerable to falling. I find the single cable pull much easier to work with in the beginning.
You can see several examples of these in the video below.
To read more about the slings read this article – Core Strength Training and How To Do It Correctly
The split stance position requires much more strength and balance required to keep your body in the upright stance and this is where I like to use a floor based regression to focus solely on the stability.
Kneeling Stability Lunge
This is one of those exercises that looks really easy until you try it. The best part about this exercise is it gives the same feeling as falling but without the danger of falling as you are already on the floor. It also demands very little in terms of strength which makes it a good starting point for some people. The only problem I have at times is the problem with moving the hip into flexion as severe cases cannot do this at all. It all depends on the person.
There are three levels you need to master.
1.Hands by your side
2.Hand on your head
3.Hands on your head and eyes shut! (Very difficult)
If you can master level two you will be making great progress with your reflex stability. I very rarely see anyone with walking difficulty be able to do level three but it is a good challenge if they are up to it.
Once you have mastered the kneeling version it is time to build the strength into the standing version. Once again you may need to “cheat” on this at first to allow your body time to adapt. If you are working on your squat and deadlift already you will be making some good progress to improving this one as well.
Below is a picture of us helping Frank to improve his lunge using sticks.
Walking Deadlift
This is highly coordinated movement and many people struggle to get their timing and feet working correctly when they first try it. It is definitely not one you can start with and in some cases you may not be able to really ever use it with some severe cases. But where I can I will try to progress to this for it has some amazing benefits. While it does move faster than all of the previous exercises it still does have an element of control which is why I really like this as it has a good mix of both.
The hip-hinge action used in this exercise is excellent for strengthening the glutes specifically for the walking and running action. However, the main benefits of this exercise are also the same problems that many people with neurological problems find the hardest to do which are.
- The speed at which it must be completed
- The rotation element and weight shifting used
- The constant switching from right to left and left to right
It is easy to see how this relates to walking so well especially if you can execute it at high speed and with a challenging load that forces you to swing the dumbbell. One of those deceptively hard exercises at first but quite rewarding and soothing once you figure it out.
Walking With Increased Intensity
This exercise seems impossible to most which is why it is the last step. However, if you feel you have made some improvements to your strength and efficiency with the other exercises it could be a good opportunity to increase the intensity of your walking and not just the distance.
Increasing the intensity of your gait will recruit more nerves through shocking the body, therefore recruiting more neural connections and the reflex stability that is missing. It goes without saying that is risky so you must have safety supervision in order to perform this. An example here we have one of our clients walking using a frame through a distance of 10 meter bursts, this is harder than what he currently uses; holding his parallel bars.
Another example is steeping over objects, adding this object will initiate the nervous system to have no choice but to try and act upon it and therefore lift the leg up.
See examples of this in the video below of a gait assessment where you can test someone to see what their current level of ability is.
Do You Need Proof That This Type Of Training Works Then Read The Stories Below
The two clients pictured above suffer from serious neurological injuries. The client in picture on the left and middle (Frank Cannizzo) has a spinal cord injury affecting his balance and motor control on his left leg. The client on the right Steve Nikolovski has Multiple Sclerosis. Both of these clients have been using many of the drills featured in this article and to see just how much impact it has made on their life here is their stories.
“My journey started some 18 months ago. After a couple of years of trying to find a cause for my back pain, the doctors found that I had a 65mm long tumour growing inside my spinal cord between T4 – T7 vertebrae. I never would have expected anything like that! Doing nothing was not an option, so I was booked in and had the tumour surgically removed. Doctors did say there was a chance of paraplegia, but I thought that would never happen to me. “Lucky Frank” ! The tumour was benign, but it did leave me numb from the waist down and with no motor function in my left leg and impaired sensory function in both legs. I had never been in a wheelchair before but soon mastered it, as it was the only way I could get around. I spent hours just doing laps of my ward at Cabrini. Determined to regain some sort of mobility.
I then proceeded to endure a couple of months in Rehab at Caulfield Hospital. Great staff and facilities, but the accommodation and food are a good reason to get well as soon as possible and get the hell out of there. I was doing rehab at the Angliss when my wife asked me to consider coming down to No Regrets. Nella was doing the cancer patients program and was really loving her time with Elley and the crew. She told me about some of the different people that No Regrets had worked with, and how they had some amazing results. I came on down and had a chat with Nick and have never looked back.
I have gone from barely being able to struggle from the street into the Gym, to now being able get around the garden, mow the lawn, wash the car and do all those things we take for granted when you are able bodied. Although still reliant on my faithful crutch, I am moving with some confidence and a lot more stability than months gone by. With the structured exercise programs developing core and targeted areas, we have been working towards getting up and down stairs, up and down off the ground, bending , stretching, and all movements which are part of every day life. Challenging the body to re learn and find new ways of getting these legs working again.
Elley and Dylan are always encouraging and supporting me, and with Nick Nathan and Mel all putting their two bobs worth in, how can you go wrong? There is a wealth of knowledge and experience there, and they always have the day’s workout prepared and ready for me. It was pretty sedate in the past, but as I improve, the buggers are starting to make me sweat!
I have found it a great environment to be in at No Regrets, and find encouragement from fellow clients like Dave and Laurie a great help to make sure you never miss a session. No excuses , No Regrets!
I have heard about good personal trainers, but I think this place is pretty special.
Thanks No Regrets”. Frank Cannizzo.
Here is a picture of Frank doing a trap bar deadlift!
And here is Steve’s story.
“When I was around 16 years old I was really into going to the gym. I’d go 6 days a week with my mates and always reach new heights in strength and muscle size. One day when I came home from gym I felt numbness in my face and I could barely walk. I didn’t think it was anything serious, as my mates and I would joke about it after a heavy gym session. Then, a few months before my 18th birthday I was diagnosed with MS and the specialists said it was an unknown cause.
From then on I was getting medicated for my condition as the neuro-specialists were saying it was the best thing for MS, however, I felt it was making things worse. I was losing mobility in my legs and losing some strength in my arms, then, about 7 years later I couldn’t walk. From then on I have been doing some rehabilitation with occupational therapists and physio’s who have helped me gain function with certain tasks and getting around places in everyday life, although, there were some stages where I felt like I wasn’t getting pushed hard enough, having my typical gym mentality haha.
Now that I have found No Regrets I feel like I am getting pushed to my limits. Since I have been here I have had two operations on my toe that they had to take the toenail off from the ongoing MS symptoms, however, that isn’t stopping me from trying to get back into things that I need my toes to help me walk and work my leg shard. Nathan has been getting me to walk with my walking frames, doing squats up and down the chair holding on sticks instead of using the frame, and now to the point of standing up without holding on! (see picture) I wish I would have found these guys earlier as I feel like I am getting closer to achieving my goal to being able to walk again. ” – Steven Nikolovski.
Here is a picture of Steve standing completely unassisted for the first time in years.
Summary
I know it’s a lot of information, so in summary for you to take in the difficulty of walking resulting from a neurological condition is the nervous system shutting down, not the muscles individually!
Therefore, to improve your walking you must put your body under the stimulus to improve it through complex tasks and movements as seen in a few of the exercises shown above. These will work well in conjunction with your current stretching, nutrition, pharmaceutical or other therapies you are already undertaking. Just remember that you will only change according to the level of challenge you subject your body to.
These exercises may not improve your walking to 100% perfect efficiency and they do not need to either. If they just make gait even a tiny bit more effective and more stable it can have a profound effect on the quality of the person’s life, mentally as much as physically.
I hope this article gives you some ideas and helps you out.
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If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualized program.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Barefoot Strong – By Dr Emily Splichal
•Whole Body Barefoot – By Katy Bowman
•Rebuilding Milo – Dr Aaron Horschig
•The Vital Glutes – By John Gibbons
•Movement – By Gray Cook
•Corrective Exercise Solutions For The Hip & Shoulder – by Evan Osar
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Built From Broken – By Scott Hogan
•Athletic Body in Balance – by Gray Cook
•Anatomy Trains – by Thomas Meyers
•Motor Learning and Performance – By Richard A Schmidt and Timothy D Lee
•Assessment & Treatment Of Muscle Imbalance – By Vladimir Janda
•How To Eat, Move & Be Healthy by Paul Chek
•Scientific Core Conditioning Correspondence Course – By Paul Chek
•Advanced Program Design – By Paul Chek