Why you should use the Tall Plank Position

Why you should use the Tall Plank Position

The Tall Plank (i.e. push up starting position) is the most underutilized and underappreciated exercise position for rehab.  I think its easy to take someone from supine or prone, than to quadruped, than immediately to standing and forget all about this position.  It’s a shame because there is so much a patient could benefit from in tall plank.  Here’s why:

  1. Engages the shoulder stabilizers

There’s some great research showing really great EMG activity in the tall plank position. In fact, the very important infraspinatus, and its large influence on the shoulder girdle, demonstrated very high muscle activation, seen by Escamilla et al 2009 and Uhl et al 2003. With so much time spent releasing TrPs from this muscle and training it to facilitate inferior humeral glide, the tall plank can really start integrating the infraspinatus for functional movements.
Additionally, other muscles including the supraspinatus and serratus anterior have really solid facilitation in tall plank. Engaging so many crucial stabilizers in tall plank will promote and expedite re-education of proper scapulohumeral rhythm. While only 40-60% MVIC is needed for re-ed, the tall plank more specifically, is great for retraining the tissue.

Further, the tall plank can give great proprioceptive feedback for a “packed” shoulder.  Patients can get a feel for a properly retracted, posteriorly tilted scapula in this position.  In fact, try to have the patient raise one arm up from a poor protracted position and then compare that to a neutral position.  The patient will see improved range and find it easier to perform (and possibly abolish pain).  It’s much easier to give tactile cues here as well as compared to having the patient supine. Let he or she get a feel for the optimal position.  Let them tell you the correct position not you tell them as they do through protractions and retractions. Then you’ll know they are ready to progress and have a good understanding of proper scap and thoracic posture.  

Here’s a clinical pearl, for additional re-education, try kinesiotaping the shoulders for in tall plank.  This will provide excellent reinforcement for sitting postures and shoulder movements.

You can also differentiate scapular movement from the humeral movement in tall plank.  Let patients get a feel for how the shoulder blades move and how the posterior chain is engaged in this position.  Let them get an appreciation for how the arm and anterior upper arm wants to compensate (with the elbow bending) and how this pulls the shoulder forward.  This should carryover towards standing shoulder position and muscle recruitment during elevation.  Additionally, we often see a over facilitated biceps and anterior delt compensate for poor posterior shoulder engagement. Working with the scapula in isolation can teach patient to inhibit bending the elbow and overusing the biceps.  This is very important for our biceps tendonosis issues as well as anterior shoulder pain patients.

  1. Engages the Core

Great research shows that the multifidi, TA, and deep core are being engaged in tall plank. (Okubo et al 2010)  Additionally, tall plank can ‘prime’ the core for resistive motions in more developed positions (kneeling and standing).  The tall plank is a great position to do this because patients can get a feel for how the core and posterior chain is engaged (belly drawn in), requiring very little additional cueing.  

Before any force or exercise progression let the patient focus on how the diaphragmatic breathing can coincide with the belly being engaged.  Often patients will over engage the core disrupting proper breathing patterns.  Let the tall plank be a position that lets patients get an awareness of this so they can carry it over to functional activities and positions.

Just like optimizing scap position the tall plank can provide the proprioceptive feedback for a neutral pelvis. Half foam rolls work great here and can be utilized to engage proper anterior pelvic tilt.  Teach the patient how to move while maintaining optimal alignment. Ensure they do not go into excessive lordosis with the aide of the foam roll.  However it is a much easier position to learn as it is much inherent to engage the core and gluts in tall plank.  
  1. Easy to Progress

The tall plank position is probably the easiest position for me to mentally progress a patient.  You simply just start in the position and work on breath control if needed.  Than perturbations can be placed on nearly any body part with any direction of force with cueing for maintenance of correct position.  Then you can start easy movements like the push up plus (really not that easy for most people).

From here you can get more dynamic, first with arm and/or leg (or neck) movements with a fixed trunk. Have the patient move though all three planes, not just overhead reach, but motions like reachunders, 1 arm W’s, ER scratch,etc.  The beauty is only one arm or leg is moving so you’re always training asymmetric!

Now you can get even more dynamic and work on lateral walkouts (maybe across a BOSU,etc) or forward motions like bear crawls. Or progress them into suspension (trx) straps for a higher challenge.  Suspension straps have been shown to increase core engagement compared to regular tall plank.  (Snarr 2013)
As you can see, the tall plank can become a beast position when you really start to progress it. And in conclusion, it really facilitates proper muscle activation, postures, and movement patterns.  All leading to optimal outcomes with functional movements in standing.