Golfer's Lift

Golfer's Lift

 

The golfer's lift is a helpful technique that you can use to lift lighter objects from the floor while sparing your spine. 

 

 

You can see there is a slight bend on the support leg knee, the lower back remains flat (not flexed), as a hip hinge technique is utilized rather than flexion of the spine.  There is also minimal rotation of the spine.  More helpful techniques are explained in the S.O.D. Posture & Body Mechanics DVD - Posture & Body Mechanics DVD

Postural Braces

Postural Braces

 

Many, if not all of my clients require postural education and training.  Posture seems to play a major role in most therapy conditions, especially shoulder, neck and lower back pain.  For the most part, I find myself constantly reminding clients to tuck their chin and retract their shoulders.  This "nagging" leads my clients to the question, "Can't I just buy a brace to keep me in proper posture?"  The answer is "yes, you can."  Here are two pictures of postural braces.

 

 

This brace appears to retract the shoulders/scapula and probably provides a sense of lower back support (I said a "sense" of support, not actual support").  Since many of my clients have the rounded anterior shoulder positioning, the chest muscles become tight, and the rear shoulder/scapula muscles become stretched out and weak.  The brace shown above pulls the shoulders back, stretching the chest and shortening the rear shoulder muscles.  But what happens when you remove the brace? Will the rear shoulder muscles now be strong enough to maintain the scapula retracted position against the anterior pull of the chest?  Probably not.  In my opinion, these braces are "quick fixes" that do not fix the source of the problem.  It is a superficial correction.  My goal is to have my clients rely on their own body to maintain proper body alignment.  Postural muscles work isometrically.  The posterior shoulder muscles must maintain the proper shoulder position throughout the day.  In short, you must stretch the pecs, and strengthen the shoulder/scapula retractors (muscle endurance).  I would only consider using a postural brace on a patient who has had chronic postural deformities, as the brace will assist in statically stretching muscles that have shortened over time.  I would still always include active strengthening to the affected postural muscles.  For my younger patients, I say: "Don't be lazy! Do the work! Stretch what needs to be stretched and strengthen what needs to be strengthened!"  Just maintaining proper posture as often as you can throughout your day is an exercise in itself.   

 

For the S.O.D. DVD on Posture & Body Mechanics, go to Posture & Body Mechanics DVD for over 80 minutes of educational videos

The NIOSH Risk Factors for Low Back Disorder

The NIOSH Risk Factors for Low Back Disorder

 

 

Are you at an elevated risk of lower back disorder? The National Institute for Occupational Safety and Health (NIOSH) released a list of risk factors.  They are as follows:

1. Seated or static work postures

2. Frequent trunk movement particularly rotation

3. Frequent lifting, pushing, pulling activities

4.  Seated whole body vibration (truck driver)

5. Repetitive lumbar full flexion

6. Time frame of performing the activity (how long after arising from bed)

 

Possible Solutions:

1.  Frequently change positions.  Get up and walk around a few minutes.  Stretch by reaching for the ceiling

2.  Avoid rotating the trunk if possible and pivot on your toes in order to turn your entire body in the direction of your activity

3.  Lift, pull, push with proper mechanics

4.  Avoid full lumbar flexion.  Use your legs in order to squat to get to a lower position 

5.  Do not begin these activities until you have been out of bed for at least 30 minutes-1 hour.

 

Your goal is to remove the stressors and enhance the activities that build support/stability

 

 

How Important Are The Trunk Muscles?

How Important Are The Trunk Muscles?

 

Here's a quick thought for you. Upon removing the spinal muscles from a cadaver, the lumbar spine began to buckle under a compressive load of just 20 pounds!  This tells us that stability created by our motor control system is extremely important in spinal protection during sustained postures, movements, and reacting to sudden movements.  These muscles must ensure stability, and all of the muscles are important, not just one particular group.  Poor motor control and faulty movement patterns create micro-trauma, which leads to injury, which worsens the movement patterns.  It becomes a vicious cycle that can be corrected by reeducating the faulty movement patterns.  Your goal is to work these movement patterns while maintaining a stable spine.     



Is My Patient Exagerating Their Pain Level?

Is My Patient Exagerating Their Pain Level?

 

 

Many times, when working with clients who have been experiencing lower back pain for a long time (months or even years), the slightest touch or smallest movement will send their pain level through the roof.  Initially, as therapists we may think this to be an exaggerated response, a patient with a low pain threshold, or a patient with other motives.  But can the patient's experienced pain level really be this intense upon light touch or gentle movement?  It is believed that when tissue damage in a body region exists, the nociceptors (nerve cell that responds to painful stimuli) are increasingly stimulated, which amplifies the sensitivity to that stimulus.  You do not get used to pain caused by tissue damage, but become more sensitive to it.  This may cause a doctor to prescribe higher intensity pain medications or refer their patient to the pain clinic.  However, if we take a step back and treat the source of the tissue damage, which many times may be poor body mechanics or posture, we may be able to spare the tissue damage.  Once the pain level decreases we can begin to incorporate more aggressive rehabilitation exercises.  For information on posture and body mechanics, go to Posture & Body Mechanics DVD           

Knee Arthroscopy

Knee Arthroscopy

 

 

If you or a friend/family member have recently undergone a Knee Arthroscopy Surgery due to damaged cartilage, meniscus or unexplained knee pain, specific Physical Therapy Home Exercises will be beneficial in your complete recovery.  You may be advised to attend a Physical Therapy clinic initially and will probably go 2-3 times a week (if your insurance, schedule, and wallet allows). 

 

The S.O.D. Knee Arthroscopy DVD consists of the same Physical Therapy exercises that will be prescribed to you when attending the clinic, and will therefore help you to maximize your knee strength and mobility even when your time at the clinic has ended. 

 

To see what a knee arthroscopy surgery entails, click here: Knee Scope Video

Sit-Ups and Training

Sit-Ups and Training

 

It is somewhat common knowledge that sit-ups may not be the best exercise for anyone to perform, especially someone suffering from lower back pain.  Many people feel that this is due to the activation of the psoas or hip flexor muscle during the sit-up, which results in compression of the spine.  As a result, people have turned to performing sit-ups with bent knees, feeling that by placing the psoas muscle in a shortened position, that it will not contract as intensely, thereby decreasing the amount of spinal compression.  Unfortunately, research shows that just the opposite is true; the shortened psoas must contract at a higher level due to its new shorter length.  This places even higher compression force on the spine.  Many researchers agree that when training for health purposes, sit-ups should be avoided all together.  There are better ways to train the abdominals while sparing the spine. 

Resting Between Sets

Resting Between Sets

 

If you have read the previous posts, you have noticed that I tend to avoid or at least minimize flexion of the trunk (particularly if you are not performing the hip hinge technique).  I advise this especially upon any type of resistance training.  In the gym, I notice many members training with proper form.  However, upon completion of a tough set, I see them in a seated slumped posture.

 

With the tissues and ligaments "warmed up," this type of flexion between sets may lead to further spine injury due to 'disc creep' and decreased vertebral shear control by the now 'silent' lumbar extensor muscles.  Don't bother working so hard during your set, if you are going to place yourself at further risk of injury during your rest.  Instead, take a walk to the water fountain, perform pull-up bar body decompression hangs, or lie on your stomach and prop up into a cobra stretch.  Perform extension, not flexion. 

 



Common Morning Stretches May Be Detrimental to Your Lower Back

Common Morning Stretches May Be Detrimental to Your Lower Back

 

Below are two very common stretches that many of my lower back patients tell me that they perform regularly in the mornings.

Stretch 1

 

Stretch 2

 

 These stretches may feel good.  However, you may be causing more harm than good.  Throughout the day, your spine undergoes compression and shear forces.  Upon fully flexing the spine (Image 1), you create a "flexion-relaxation phenomenon."  With this, the lumbar spine extensor muscles "relax" and no longer protect the back from shearing forces.  Stretch 2 feels good because it applies a stretch to the gluteal muscles.  However, the further you pull your knees to your chest, the more your spine flexes, the less the extensors protect your spine.  I would advise not to do these stretches first thing in the morning, never to do Stretch 1, and to perform Stretch 2 only up to the point that you feel the stretch in the gluteals.

 

ACL Repair

ACL Repair

 

The ACL stands for the Anterior Cruciate Ligament in the knee.  The ACL limits anterior translation of the tibia on the femur. 

This is a very common injury, particularly for athletes.  It may occur upon a direct blow to the knee region from the front, which is common in football.  Sometimes you will hear a "pop" upon ligament tear, and the knee joint swells quickly, making it painful to walk.  A feeling of knee instability may also occur following this injury.  If surgical repair is necessary, you will be facing months of Physical Therapy.  This will be time consuming and may be financially stressful.  To speed up your recovery, you will want to be compliant and persistent with your home exercise program.  To help you with this, www.strengthondemand.com offers a DVD Home Exercise Program that will guide you from Week 1 through Week 12 following your ACL Repair.  This DVD includes the most common ACL Repair Therapeutic Exercises for each time frame during your recovery.  This will speed up your recovery, saving you time and money.  

 

Below is a link to an ACL Repair Surgery video, as well as the link to the S.O.D. ACL Repair Rehabilitation DVD.  Check it out.

 

ACL Repair Surgery

 

ACL Rehabilitation Protocol DVD 

Single Leg Stance Muscle Activation

Single Leg Stance Muscle Activation

 

Upon standing on one leg, in order to maintain upright proper posture, you must maintain a level pelvis by firing the Gluteus Medius and Minimus as well as the Quadratus Lumborum and Obliques.  The Gluteus Medius, Gluteus Minimus, Quadratus Lumborum and Obliques  all work together to maintain spine stability during gait. If there is weakness in the stance side musculature, you will observe a (+) Trendelenburg. 

 

 

 



(+)TRENDELENBURG STANCE:  Here, the right side is weak and to compensate for lack of pelvic control, the trunk sidebends to the right

A few exercises to help a client who presents this way are the following:

Farmer's Walk: By holding the kettlebell in the right hand, whenever you are in single leg stance on the left leg, you are challenging those hip and trunk muscles.  Your trunk is fighting the right sidebending force that holding the kettlebell in the right hand is introducing to your body

 



 



 Your body wants to take the easy route like in 'a' by sidebending to support the weight.  You must incorporate the proper trunk and hip musculature in order to maintain proper posture ('b')

 



The Bottoms Up Carry is more difficult due to the weight distribution of the kettlebell.  Here, you are incorporating grip strength, shoulder stability, as well as trunk and hip stabilizers

The Double Kettlebell Racked Walk adds more weight to be supported by each individual hip when in single leg stance and the compression on your trunk makes it a challenge to fully inhale easily.