What is Gluteal Amnesia?

What is Gluteal Amnesia?

 

 

"Gluteal Amnesia" is a term that describes people who do not recruit their gluteal muscles for hip extension and instead rely on their spine extensors and hamstrings.  It is common that they also present with Crossed-Pelvis Syndrome.  During squatting movement patterns, the gluteals will be under-utilized while the erector spinae muscles are over-utilized, compressing the spine.  Exercises to assist the contraction of the gluteal muscles are: Clamshells for Glute Medius and Bent Knee Bridges for Glute Max.

 

CLAMSHELL

BRIDGE

 

What is the Crossed-Pelvis Syndrome?

What is the Crossed-Pelvis Syndrome?

 

 

The term "Crossed-Pelvis Syndrome" was used by Dr. Vladamir Janda to describe common characteristics of people suffering from chronic low back issues.  The pattern describes weak gluteals (posteriorly) and abdominals (anteriorly) and tight hip flexors (anteriorly) as well as tight lumbar extensors (posteriorly). 

 

There is also an Upper Crossed Syndrome, which presents as tight upper trapezius muscles (posteriorly) and tight pectorals (anteriorly), with weak deep neck flexors (anteriorly) and weak lower traps (posteriorly)

 If you have a client with chronic lower or upper back issues, you may want to assess the muscles mentioned above in your evaluation to see if they fit these Crossed Syndrome categories.
 

What Caused My Spine to Develop Arthritis?

What Caused My Spine to Develop Arthritis?

 

It has been documented that disc damage almost always precedes facet arthritis in the spine (Butler and colleagues 1990).   This can be explained by the following: the disc damage creates an instability in the spinal joints.  The body responds to the instability with arthritic activity in order to create stability.  This arthritis causes pain and limits mobility.  So arthritis in your back may be in response to tissue damage in the spine.

 

 

For Lower Back Physical Therapy DVDs, check out www.strengthondemand.com



Can Bedrest Cause My Lower Back To Hurt?

Can Bedrest Cause My Lower Back To Hurt?

 



I wanted to share this information that I read from back specialist Stuart McGill.  In a spine study, it was thought that during bed rest, the intervertebral discs have an inflow of fluid (fluid that was pushed out during the day due to gravity and other compressive loads).  This swelling of the discs causes the spine to lengthen during 8 hours of bed rest.  Upon assessment of astronauts who spend prolonged time in a state of weightlessness (no gravity), it was noted that most of the bones lost mineral density, except the spine, which showed an increase in mineral density.  This indicates that the spinal bones were actually stimulated in response to increased loads (Wolff's Law), while the other bones began to weaken due to lack of stimulation.  The conclusion was that the higher load and spinal bone stimulation was caused by the swollen discs.  This means that being in bed for periods longer than 8 hours places more, not less, stress on the spine.  So bed rest may actually be causing some of your back pain.  I ask all my clients how long they sleep and if they feel a higher pain level in the morning.      

Plumb Line and Posture

Plumb Line and Posture

 

 

Upon meeting a new client or patient, one easy way to initiate your sessions is to assess their posture for any abnormalities.  A quick and easy way to do this is to set up a Plumb Line in your clinic.   

 
   

 

Have your client stand behind the plumb line in the appropriate position and observe.  Watch for a forward head posture, rounded shoulders, etc.  This will give you a great starting point regarding which muscles need stretching and which need strengthening.  Check out our Posture and Body Mechanics DVD for over 80 minutes of posture and body mechanics information and corrective strengthening/stretching exercises.  

Bending Forward or Bending Backward?

Bending Forward or Bending Backward?

 

Throughout Physical Therapy School, we were taught that a intervertebral disc consists of an outer layer, the annulus, with an inner region, the nucleus.  Upon bending backwards (extension), the nucleus shifts anterior (toward the front of your body), while during flexion or bending forward, the nucleus travels posteriorly (toward your back).  Most patients experiencing a bulging or herniated disc show a migration of the nucleus posteriorly, placing pressure on the posterior annulus. 

I have prescribed the Passive Cobra Stretch to many patients experiencing a bulging or herniated disc.  This passive extension exercise creates anterior shifting to the nucleus, decreasing pressure on the posterior annulus. 

Many times, the nucleus migrates posteriorly due to repeated or sustained spinal flexion.  This causes compression on the disc and if lifting is introduced at this time, even more stress is placed on the posterior aspect of the annulus.  It is recommended to avoid lifting if you have been sitting or stooping for an extended time.  You should instead stand tall and extend your spine to allow the ligaments to become stiff again (they were stretched when the spine was flexed) in order to protect your back. 

 

Drivers and athletes should pay particular attention to this.  Athletes should avoid sitting on the bench for an extended time when waiting to play. 

 

 

 

 

Drivers should use a Lumbar Support pad on their seat to maintain their lordotic curve.  This curve maintains the anterior position of the nucleus within the annulus.

 

 

 

 

 

 

  



Walking And Your Lower Back

Walking And Your lower Back

 

 

Here's a quick tip that may help you if you are experiencing lower back pain when walking.  First of all, when you are walking, the compression placed on your lumbar spine is equivalent to 2.5 times your body weight (ouch!).  To reduce the compressive loading, muscle activity and torque placed on the lumbar spine, you should attempt to walk at a slightly faster pace while swinging your arms (at your shoulders not your elbows).  Faster walking may assist in "sharing" the compressive load, while walking slowly increases the static load on your spine and may be more painful.  It is hypothesized that swinging of the arms helps the body use elastic energy to move the body rather than just muscle contractions which are compressive to the spine.  So if you are experiencing lower back pain when walking, take notice of the speed of your gait.  Try to increase the speed while continuing to walk with a reciprocating pattern (right arm moves forward as left leg moves forward).  See how your back responds. 

Morning Exercises

Morning Exercises

 

 

A study in 1998 advised that people should avoid full lumbar (low back) flexion activities in the morning in order to minimize back symptoms.  The reason?  At night when you lay in bed, gravity and body weight are no longer compressive forces on your spine/discs.  The discs "refill" and expand with fluid that was "pushed out" throughout the day due to the compressive forces.  The increased fluid in the disc lengthens the spine and causes it to become resistant to flexion.  Ligament and disc-bending stresses are thought to increase 80% and 300% respectively in the morning when compared to the evening.  During the day when you are up and active, pressures placed on the spinal discs push fluid out of the disc.  This narrows the space between each vertebrae which reduces tension on the ligaments.  Approximately 54% of this decrease in disc height occurs 30 minutes after you get out of bed in the morning.  Less disc height means less tissue stresses.  Therefore, it is advised that you wait at least 30 minutes after getting out of bed to safely bend forward and perform your daily activities or exercises.   

Sitting and Lower Back Pain

Sitting and Lower Back Pain

 

 

Many people complain of lower back pain, especially upon sitting.  If they have computer based occupations, this is a major problem for them.  Sitting posture is very important to educate your patients/clients on in order to reduce the stresses on the spinal tissues.  Sitting in a slouch position decreases muscle activity, stresses the annulus portion of the lumbar discs, and may lead to "disc creep" and disc herniation. 

 

SLUMPED

Sitting upright activates the hip flexors and lumbar extensors which in turn create compressive loads on the spine. 

UPRIGHT

 

You can teach your clients/patients how to find a "pelvic neutral" posture, but many feel that by maintaining any one position for an extended period of time will place a stress on the lumbar tissues. 

PELVIC NEUTRAL

 

It is recommended that your position changes frequently in order to shift the stress from one tissue to another, avoiding any type of overload.

 

 

 



Training Spinal Extensors on Clients With Lower Back Conditions

Training Spinal Extensor Muscles on Clients With Lower Back Conditions

 

 

When training a client who is rehabilitating from a lower back condition, besides strengthening the abdominal and core muscles, you will also want to focus on the posterior spinal muscles, the extensors.  Which of these exercises have you used with this goal in mind?

Exercise 1

 

Exercise 2

 

Exercise 3

 



It is recommended when training these muscles to treat them as 4 separate groups, two thoracic sections (right/left) and two lumbar sections (right/left).  Training one section at a time will minimize the amount of spinal load/compression.  Exercise 2 places the most compression load on the spine, while Exercise 1 places the least spinal compression load.    This is because Exercise 1 is activating one lumbar and one thoracic section, while the other two exercises are activating all 4 sections during each contraction.  Keep this in mind when working with clients with lower back conditions and try your best to minimize spinal compression loads during your sessions.

The Sit-Up and Your Spine

The Sit-Up and Your Spine

 

 

 

Here's a quick FYI!  The National Institute for Occupational Safety and Health set a limit for low back compression to 3300 Newtons.  This means that if you repetitively load your spine above this level, an injury is more likely to occur.  What's scary is that each repetition of the CRUNCH exercise produces this much force on your spine.  Some believe by bending the knees and performing the crunch, the compressive force is reduced.  According to a study by Dr. Stu McGill, this is not correct.  Dr. McGill recommends the Side Bridge Exercise for the abdominals and obliques.

 



Lower Back Herniated Disc

Lower Back Herniated Disc

 

 

 

 

When dealing with a posteriorly herniated lumbar spine disc, one initial treatment that may be beneficial is extending the trunk, either in the standing or prone position (Cobra Stretch).  The idea is that extending backward will force the herniated nucleus material of the intervertebral disc forward within the disc and pressure will be removed from the spinal nerves.  This usually centralizes your symptoms, relieving any neurological pain/symptoms in either leg.  

 

For a full video-based Physical Therapy Rehabilitation Exercise Protocol, go to  https://strengthondemand.com/Low_Back.html

to order your Lower Back Herniated Disc Exercise DVD.

NEUROGRIPS

NEUROGRIPS:

 

Created by KB Fitness, LLC and new to the Fitness and Rehab industry,  Neurogrips is the most versatile grip training accessory on the market.  It can not only be used on barbells, dumbbells and the most common fitness center equipment handles, but can also  be used on Kettlebells, Sledgehammers, Indian Clubs, Persian Mil, Ropes, Suspension Trainers such as TRX and Gymnast Rings, Resistance Tubing, etc.  If you can grasp the device with your hand, NEUROGRIPS will enhance the grip demand by adding approximately 1 inch to the diameter of the tool you are training with.  So the standard barbell with a 1 inch diameter can instantly turn into a 2 inch "Fat Bar" 

 

Go to www.strengthondemand.com and check out  NEUROGRIPS. 

Made in USA and a Lifetime Warranty. 

Click link below:

NEUROGRIPS

Knee Hyperextension Following a Stroke

Knee Hyperextension While Walking

 

 

Upon assessing a client's gait pattern, I look for full knee extension when in the single leg stance position.  Many of my patient's recovering from a stroke present with knee hyperextension.  Upon full weight bearing on the affected leg, the knee "snaps" back forcefully into hyperextension.  This can become painful and damaging to the knee joint.  An example of this can be seen in the video below.

Walking with knee hyperextension

 

 

A brace may be beneficial to protect the knee joint due to the constant forceful hyperextension.  However, I also focus my sessions on strengthening the quadriceps muscles by performing squats and repetitive sit to stand transfers while providing verbal and manual cues to control and minimize forceful knee locking.  Many times, this gait abnormality is due to quadriceps weakness.  A client may feel like they can not depend on their leg strength to keep them upright.  To compensate and avoid knee buckling and falling, a person will lock the knee joint into extension upon weight-bearing. 

 

For more fitness and rehabilitation information, go to www.strengthondemand.com

CPM Unit following a Total Knee Replacement

CPM Unit Set-Up Following a Total Knee Replacement

 

 

Many times, immediately following a Total Knee Replacement surgery, a patient will wake up to find their surgical leg in a contraption that bends and straightens their knee.  This unit is called a C.P.M. or Continuous Passive Motion unit.  Some doctors strongly believe in its utility, while others are against it.  I have found that the doctors who oppose the use of the CPM unit feel this way because many times the unit is set up incorrectly, and this may cause more harm than good.  The purpose of the CPM is to bend and straighten the operative knee as much as the patient can tolerate in order to maximize their rehabilitation potential.  It is advised to use the unit 6-8 hours a day and to increase the flexion range of motion 5-10 degrees each day.  The initial goal following a Total Knee Replacement is full knee extension (full straight), while flexion takes a bit more time.  The goal range of motion of the knee is 0-135 degrees or symmetry between both knees.  For function, usually 0-117 degrees is needed.  For walking, 0-60 degrees is necessary.  Below is what a CPM looks like and how it should be set up.

 

 

Some points on the set up:

1.  Avoid direct contact between the skin and the metal parts of the unit.  Make sure the wool covers all areas that your leg will touch

2. Your foot should rest flat on the foot rest.  The length of the lower leg portion can be adjusted to guarantee this.

3.  Try to set it up so that your hip is not abducted out to the side but is in a more neutral position (foot in line with your hip)

4.  The hinge on the middle portion of the unit should line up with the center of your knee joint to allow smooth flexion/extension motion

5.  For this to be set up properly, the upper thigh section of the unit  has to be positioned very close to your hip.  You will practically be sitting on it.

6.  Make sure when the unit is bending your knee, that your knee and toes are pointing up to the ceiling.  You do not want any rotation of the hip.

7.  Use a tibial (lower leg) strap and/or thigh strap to maintain proper position

 

Following use of the CPM, make sure to use ice on your knee.

 

For more information on Total Knee Replacement Rehabilitation, go to www.strengthondemand.com

 



Be Cautious When Training Your Glutes

Be Cautious When Training Your Glutes

 

 

The gluteus maximus muscles act to extend the hips.  Many times I will see both men and women training their gluteal muscles with either straight leg hip extensions or flexed knee hip extensions (minimizes the hamstring involvement).  Their goal may be to gain hip strength, or to "shape" their butt muscles.   

 

The normal hip extension range of motion is 10-30 degrees from the neutral position (neutral being when the ankle is in line with the hip and the shoulder).  People tend to over-extend the hip's available flexibility.  By doing this, additional movement is "taken" from the lower back.  So not only is the hip extending, but segments of the lumbar region are also extending.  This may lead to lower back pain or may worsen existing conditions.  

 

Try to avoid accessory motions at the lumbar spine when training your hip extensors.  Focus on maintaining core muscle recruitment (trunk stability) while extending your hip.  You will feel your gluteal muscles contract prior to your lower back extending.  Stop here and return to neutral.  If you feel your lower back extend, you went beyond your hip's available range of motion.
 

More for Fitness and Physical Therapy Rehabilitation information, go to www.strengthondemand.com