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. 

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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