Incorporate This Trunk Rotation Stability Exercise

Incorporate This Trunk Rotation Stability Exercise

 

When lifting anything, we hear "lift with your legs, not your back!"  When using the spine  to perform resistive activities, many times a dangerous amount of pressure is placed on the ligaments and intervertebral discs.  Over time, this may lead to injuries such as bulging or herniated discs.  Spinal flexion places strain on the discs.  Spinal rotation also places strain on the discs.  But when you combine the movements (flexion with rotation), the discs are most vulnerable.  If these motions are dangerous, is it wise to perform them with resistance added?  I prefer to focus on Spinal Stabilization rather than Resistive Trunk Strengthening Exercises.   

 



Some common trunk exercises you may have seen are the Side Bend QL, Resistance Tubing Trunk Rotation, and the Medicine Ball Trunk Twist.

 





 

 

These exercises are aimed at strengthening the spine throughout the range of motion.  But at what cost? 

 

Try to incorporate the following exercise to your routine for Spinal Rotation Stability. 

Rack a Kettlebell in 1 hand.  This alone places an asymmetric force on your spine.  Your goal is to maintain a neutral spine and not allow the trunk to side-bend toward the added weight.  This is already working the QL on the opposite side of the Kettlebell

 

Press the weight overhead.  This continues to challenge your trunk's stability with the  direction of the force applied from a different position/angle

 

Here's where the rotation comes in.  Instead of actively twisting your spine with the applied resistance (as shown in the Med Ball Twist and Resistance Band Trunk Rotation pics above), rack the weight, rotate your trunk about 30 degrees to the right while maintaining forward facing hips (Your knees and pelvic bones continue to point straight ahead), and then perform the shoulder press.  Attempt a few reps in this position   

 

 

Then, rotate your trunk a little further from the 30 degrees to about 60 degrees trunk rotation.  Again, keep your hips and knees pointing forward.  Press the weight overhead.

 

 

Repeat to the other side at 30degrees, then 60degrees. 

 

The point to this exercise is to engage your trunk stabilizers at a spinal position, and maintaining this stability throughout the lift.  You are challenging multiple spinal positions by varying the amount of trunk rotation.  You are NOT using the spine to rotate a load. You are using the trunk musculature to stabilize the spine when in a rotated position.  This, in my opinion is a safer way to train your trunk.

 

Add even more of a challenge to your grip, trunk and shoulder stabilizers by performing the same activity with the Kettlebell in the Bottoms Up Position...Then try it with Neurogrips!!(www.neurogrips.com)

 



Leg Press and Lower Back Rehab

Leg Press and Lower Back Rehab

When working with patients recovering from lower back injuries, particularly bulging or herniated discs, I mentioned in previous posts that my goal is to improve function while minimizing irritation to the lower back.  For people rehabilitating from bulging or herniated discs, I avoid spinal flexion activities, as this may cause further disc protrusion.  I do not usually use the leg press machine, as in my opinion there are more functional lower extremity activities that I would rather spend time performing.  However, if for whatever reason you are using the leg press with your "lower back client," you can minimize the strain placed on the lower back by performing single leg presses rather than bilateral presses.  Here, the non-working leg remains on the floor during the press. 

Image 1

Image 2

In image 1, you can see that at the deepest part of the motion, where the knees are up against the chest, the lower back is extremely flexed.  This may lead to further posterior "disc creep."  In image 2, keeping the non-working leg on the floor helps to maintain a more neutral pelvis and lumbar spine, decreasing disc protrusion.  This places much less stress on the spine and intervertebral discs.

Dynamic Flexibility Activities As A Warm Up

Dynamic Flexibility Activities As A Warm Up

 

 

Viscosity is a property of biological tissues, in this case the spine and torso muscles, and it is defined as a resistance to motion.  Viscosisty of these tissues can be reduced to allow subsequent motion of the spine and torso with less stress on the tissues.  To do this, incorporate gentle motion activities (not static stretches) as part of your warm up.  It is suggested that this warm up include spinal stabilization exercises using functional movement patterns, such as diagonal chops and lifts. 

You will also want to keep in mind that the spine does have a "memory."  A prior activity can effect the spine's biomechanics during the next activity.  For example, if you are in the seated posture for a period of time, the spinal ligaments become lax and posterior disc creep may result.  This may lead to injuries such as bulging disc. 

Notice the flexion in the lower back

 Upon positional change, the nucleus of the spinal disc redistributes (no longer creeps).  Therefore, it is a good habit to alter your positions from one exercise to the next.  Follow an exercise that consists of spinal flexion with an exercise where the spine is either in neutral or extended.  This will minimize the chances of disc creep, bulging discs or even herniated discs.     

Follow the seated row exercise above with the plank hip extension exercise, moving from a flexed posture exercise to an neutral/extension exercise

Protect Your Back Even With Light Lifts

Protect Your Back Even With Light Lifts

 

 

Over ten years ago, due to heavy lifting with incorrect technique, I was unlucky enough to develop a herniated disc in my lower back.  This was the worst pain I ever experienced.  Thanks to Physical Therapy school, I was able to manage it conservatively.  However, every now and then it would "go out on me," causing severe pain with even the slightest movement.  One day, after being pain free for a few months, I told a family member I would help them move.  We had to lift and carry a 55-inch rear projection TV (the bulky kind, not the nice flat screens we have today).  I did my part without a problem.  Upon finishing up that day, I bent over to pick up a pencil from the living room floor, and fell to my knees in agony.  After everything I lifted and carried that day, a simple number 2 pencil drops me to my knees?  While on the floor, I had plenty of time to think about what had  just happened.  Why did my back tolerate heavy lifting all day long, but when I lifted something as light as a pencil, my back went out on me?  I realized that with every heavy lift, I did not just carelessly walk up to the item and lift it.  Instead, I prepared my back by co-contracting the spinal stabilizers prior to each lift and carry.  That's when I realized that it doesn't matter how heavy the object you are lifting is.  If you bend over to pick up an item, it is wise to perform the lift with proper body mechanics and pre-stress and stabilize your spine.  This will minimize your chances of injuring or re-injuring your spine. 

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.

 

 

 

 

 

 

  



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.

 

 

 



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.