Posts Tagged ‘low back pain’

This is an excerpt from an article I wrote for USA Gymnastics.  Again, although written for gymnastics the functional relationships and concepts can be applied to any movement. The lumbopelvic hip area consists of the lumbar spine, pelvis, and hip joints. The major muscles include the low back, abdominals, gluteals, and hip flexors.  Optimal strength and flexibility are required for all parts to function efficiently and harmoniously in an effort to complete a task. Compensation patterns and faulty movement occur as a result of flexibility deficits and muscle imbalances. This in turn leads to decreased performance and increased risk of injury. The hip flexors, calves, hamstrings and chest muscles are most prone to tightness simply due to the patterns of daily living. For example:  sleeping in the fetal position 6-8 hours per night, sitting in school all day, driving, sitting to read, eat, study, etc. Not to mention fatigue and over training. The human body is very adaptable and efficient. When flexibility deficits or muscle imbalances are present, the system cannot operate efficiently. But the body will find a way (compensate) to get the job done.  For example; when the hip flexors are tight, the gymnast will not be able to fully extend the hip and will compensate by increasing extension through the low back. Over time this can lead to low back pain and stress fractures. Many female gymnasts are observed to have an increased curvature of the low back, a pelvis that tilts forward and a lengthened abdominal area. Let’s look at the functional relationships of this posture and discuss how this can lead to a myriad of movement/performance problems. An anteriorly tilted pelvis is usually associated with tight hip flexors, weak abdominals, tight low back muscles, tight hamstrings and weak gluteals. Tight hip flexors will pull the pelvis forward. As a result, the curve in the low back increases which puts increased stress on the joints. 

This stress coupled with the repetitive back bending and twisting can lead to pain and stress fractures. Also, any time you need to extend through the hip (move the hip forward or the leg backward), the tightness in the hip flexor will not allow it and guess where you will get the extension…that is right, through the low back. When the pelvis tilts forward it increases tension in the hamstrings by causing them to lengthen. This creates a higher risk of hamstring strains and contributes to weakness/decreased control of the abdominals. Ultimately leading to poor trunk control. An interesting neurological phenomenon occurs as a result of muscle tightness. It is called reciprocal inhibition. Simply stated, it means that if a major muscle is tight it will inhibit the muscle that opposes it. In our example, when the hip flexor is tight it will limit the gluteus maximus muscles function. That would mean the gluteals ability to powerfully extend the hip (take off, jumping), absorb shock upon landing, and control motion of the entire lower extremity, especially rotation would be diminished. You can imagine the performance and injury risks this poses to the athlete.  Tightness in the low back will inhibit the deep abdominal muscles that are important for trunk and lumbar stability. So, not only does tightness lead to compensation but also interferes with strength. For example, when doing a split leap, the front leg is at risk for a hamstring strain because it is tight from the anteriorly tilted pelvis and it will be very difficult to get the fully extended position of the back leg/hip due to tightness of the hip flexor. This article discusses the lumbopelvic hip area and will review the anatomy and the functional relationships of the musculature. The article also describes stretches and exercises to address the problems described in the lumbopelvic hip area. Additionally, the gymnasts will have decreased strength to push off the ground to get airborne and the gluteus maximus will not have the strength (reciprocal inhibition from the tight hip flexor) to extend the hip by pulling the leg back. The gymnast will most likely compensate by extending through the low back, not to mention hurry to get her feet back on the ground due to lack of height off the ground from a diminished push off. One more thing, while we are on the subject; tightness in the hip flexor will limit maximum extension of the hip while jumping in which the body will compensate, often by hyper extending the knees thereby leading to patellar tendonitis and knee pain. Keep in mind there are just a few examples relating to the hip/pelvis that can lead to compensation, injury and poor performance. With proper stretching and strengthening many of the above mentioned problems can be avoided and proper muscle activation and control can be achieved. With gymnastics requiring a combination of 

flexibility, strength, power and balance/control; it is important to recognize the functional relationships and devise exercise strategies that are effective in optimizing performance and minimizing injury. Hopefully, this article shows how one tight muscle can lead to a series of compensations and altered muscle firing patterns that effect strength and control around the hip/pelvis area. Now we will focus on a few flexibility and muscle activation exercises to address the problems identified above. Initially, once a muscle tightness is identified it should be stretched utilizing the “traditional” static stretches. Paying close attention to posture and form to ensure the appropriate area is being stretched. Unfortunately this is the only way many continue to stretch. The next step should be to incorporate dynamic multi plane flexibility exercises. Knowing that gymnastics requires dynamic movement in all three planes of motion simultaneously, a question to ask is why do we only do static stretching that is isolated to one plane of motion? Yes, it can increase flexibility, but is it the best way to improve, maintain and carry over flexibility to performance? Maybe not.  Stretching dynamically in all three planes of motion better prepares a muscle to move in those planes and complete a skill such a back hand spring without unwanted compensations that could lead to injury. The benefits of dynamic stretching include increased neurophysiologic input to the system which enhances its ability to perform a task or series of tasks and maintain flexibility. This is because the muscle and the joint are getting stimulated similarly to the activity taking into account momentum, gravity and ground reaction forces in three planes. These are the things that turn on and drive the muscles. 

See this full article with pictures of the stretches at

www2.usa-gymnastics.org/publications/technique/2004/5/hip.pdf.

Get Strong! Stay Strong!

Chris

Many people are plagued by low back pain (LBP). It ranges from severe pain and disability to general achiness and stiffness. Many (not all) of today’s problems can be linked to one simple fact—we sit too much! In fact, technology has created a society that you don’t even have to move to be part of. This leads to muscle and joint stiffness, decreased flexibility, poor posture and deconditioning. In particular the hip flexors, hamstrings, calves and chest get tight while the upper and lower back get rounded. This creates muscle imbalances and causes specific muscles to be “turned off” via reciprocal inhibition. Then, when and if we decide to do something, ouch! Pain develops. Sometimes the pain can be linked to a specific incident, but many times it gradually occurs with no seemingly apparent reason. The latter is where the compensatory effects of posture and deconditioning (becoming more cmmon in todays society) come into play. For example, when you sit a lot the hip flexors are in a shortened position and over time will get tight. Upon standing the hip extends. If the hip flexor is tight the hip won’t be able to extend through its full range and can place more stress on the lumbar spine as it tries to extend more to make up for the lack of motion its supposed to get in the hip. This not only occurs with standing but with every step you take. Over time this can increase the wear and tear on the spine and be setting you up for back pain, in addition to a number of other problems. There is good news. Many of the problems associated with LBP can be significantly reduced and prevented with the help of a knowledgeable professional. Understanding “functional” anatomy and biomechanics allows the professional to evaluate, identify altered movement patterns, weakness and inflexibity in order to develop a custom program that will get you moving in the right direction.  Personally, one of my favorite books on low back is Stuart McGills Ultimate Back Fitness and Performance.

Get Strong!Stay Strong!

Chris

 

 

 

 

 

Millions of Americans suffer from low back pain each day. This can range from minor aches and stiffness to severe debilitating pain and spasm. There are many disorders such as degeneration, spurring, bulging and prolapsed discs, pinched nerves and fractures, which are the result of what we do (or don’t do) to our bodies day in and day out. So, the question you should ask is; what can I do to prevent back pain or at least reduce my risk? Simply stated, just get up off your butt. While simple, it is true. Too many people have become sedentary.  Many jobs require hours of sitting, driving or flying, Technology has created an environment in which you don’t even have to move to be part of it. Adults and children are lulled into inactivity with television and video games. Schools are also taking part by eliminating physical education from many curriculums.  Most people we see with back pain are deconditioned, have tight calves, hip flexors and chest muscles, weak hip and trunk muscles, rounded shoulders and poor abdominal integrity. Inactivity (exercise), poor nutrition and aging are a potent recipe for many ailments.  Now, there are specific exercises for the core. I advise you to see a qualified physical therapist to evaluate and instruct you in the best exercises for you. In general, some useful tips for the “health” of your back include, but are not limited too: Drink plenty of water, many joint problems can be minimized with proper hydration (most Americans are chronically dehydrated).  Utilize a lumbar or towel roll in low back to maintain good sitting posture, don’t sit for prolong periods, get up and stretch frequently.  Get in shape with general exercise, lose those unwanted pounds. Avoid bending over for the first hour upon waking because your discs are more “swollen” due to reabsorbing water through the night.  As a result, you are more prone to a back injury in that first hour. When at the sink, open cupboard and place foot on ledge. Now when you bend over to brush teeth or wash face you will bend more at hip and less from the low back.

 

Get Strong! Stay Strong!

Chris