Tag Archives: low back pain

Elite PT Newsletter April 2018 – Running Injuries Part I – Foot/Ankle

Running Injuries – a Spring time tradition

Like the rest of you I’m done with the cold and snow and ready for some nicer weather. It’s that time of year to start thinking about summer which usually means being more active.

For you runners out there it will mean getting outside more and probably increasing your mileage.

For you athletes, it’s time to start thinking about what you’re going to do this summer to make you a better athlete for next year.

Luckily, we’ve got something this month for both of you!

Common Running Injuries
1. Patello-Femoral Pain Syndrome (anterior knee pain)
2. Achilles Tendinitis
3. Plantar Fascitis
4. Hamstring Tendinitis
5. Shin Splints
6. IT Band Syndrome (pain at the hip or lateral knee)
7. Stress Fractures
8. Patellar Tendinitis
9. Lower Back Pain

These are the most common running injuries I found searching running sites and this order is fairly consistent from site to site. We see our fair share of each of them here at Elite PT.

These are also known generically as ‘over use injuries’ – meaning that they are caused over time by repetitive stresses that gradually break down the various tissues involved (tendon, muscle, fascia, bone, etc).

These are also the most common injuries we see in high school sports that involves a lot of running, i.e football, soccer, basketball, track and cross country. So if you’re an athlete of any kind, at some point you are either going to be dealing with one or more of the above OR you should be working to prevent them.

Prevention starts from the ground up

How your foot and ankle function are huge for preventing the obvious conditions in that area but also those further up the chain in the knee, hip, and lower back.

The joints of your foot and ankle must move appropriately and the muscles must do their job to stabilize those joints as your foot hits the ground and then progresses to push off. This is a two pronged approach since the joints require adequate mobility and the muscles must stabilize at just the right times.

This month we’ll cover a few ankle/foot exercises you can use to prevent injury or to rehab from it. Sorry if I get a little deep in the ‘why’ sometimes but I do think its important to know ‘why’ you should perform these exercises.

Ankle Mobility

Here’s a great example of what good ankle mobility looks like. The knee should be able to travel 4″ past the big toe without the heel coming up or the arch collapsing.

Athletes need this much ankle mobility to squat deep, sprint, jump, cut, and so on. If you don’t then your body is going to find a way to compensate around that so you can still squat, sprint, jump, etc. Our compensations are usually what get us into trouble. In this case the common compensations are:

  •  arch of the foot collapses (excessive pronation)
  • foot turns out
  • heel comes up too soon
  • knee collapses inward

There are others but these are the easiest to see. Watch anyone with stiff ankles try to squat deep – its not uncommon to see all of the above.

These compensations put the tissues of our foot, knee and even higher up the chain into more stressful positions. With repetition, i.e. lots of mileage, this will eventually catch up with most athletes causing pain.

What to do about it?

There are two main reasons why your ankle joint may not move enough:

tightness through the muscles of the calf (will feel like stretching in the back of the lower leg)
limitations involving the ankle joint (will feel a pinching sensation in the front of side of the ankle when bending it all the way)

Tight muscles are something you can deal with fairly effectively yourself. Using foam rollers or massage sticks to loosen up the calf muscles followed by stretching are the easiest things to do. Working on ankle mobility in a kneeling posture as in the picture below is one of my favorites.

Kneeling Ankle Mobility

The goal is to get your knee as far past your big toe as possible without your heel coming up. Placing the stick at your 5th toe and taking your knee around the outside of the stick forces you to work the muscles of the foot and keep the arch high. I prefer shoes off so you can actually see what your foot is doing. It could also be done standing if kneeling causes knee pain.

If you experience that pinching sensation in the front or side of your ankle – that is going to be a tougher fix. That’s usually not something you can stretch out on your own. It’s actually a good reason to give us a call because you will need some manual therapy to deal with that stuck joint.

In conclusion

What is happening at your foot and ankle affects every other joint in your body so this is a great place to start. See how far your knee can go past your big toe – if it’s not 4″ (heel down and good arch) then it’s time to get to work.

If you want some other ideas, catch the video below featuring our former student Scott McKeel (who just ran the Boston Marathon this week) demonstrating some great ankle mobility drills.

And even if you don’t consider yourself a runner or an athlete, you still need a mobile ankle and stable foot to walk normal, go up and down stairs, and balance. These are for you too!

If you’re struggling to make gains or you do have that ankle pain I mentioned earlier, feel free to give us a call (231 421-5805). We can set up a free 30 minute assessment to determine if you just need more advanced exercises or you may need physical therapy to break through and get moving again.

I’ll leave this offer open through the end of April so get cracking!.

Have a great rest of April and be sure to look for the next article in our series on running injuries.

Joe Heiler PT

Elite PT July 2017 Newsletter: Lower Back Pain, Employee Spotlight – Jesie Bott, Exercise Tips and more…

Hope you’re having a great summer and surviving the craziness that is northern Michigan in July.

This months newsletter features:

  • Employee Spotlight – Jesie Bott
  • Lower Back Pain – 80% of us are going to have it!
  • Exercise Tip of the Month

Employee Spotlight
Jessica “Jesie” Bott was our very first employee starting back in 2012.  She took a bit of a hiatus after giving birth to her daughter but she’s been back a couple years now and we love having her around as much as possible.  Jesie home schools her two children and works Fridays during the school year but in the summer we’re blessed to have her 2.5 days per week.  She’s got a ton of energy and really loves to get to know her patients and clients.  She does a great job for us here at Elite Physical Therapy so we wanted to tell her story.

Jesie is an Athletic Trainer and licensed massage therapist, graduating from Grand Valley State University in 2005.  Jesie has worked in the outpatient orthopedic setting since graduation, and also worked as the athletic trainer at Kingsley High School for 5 years.  Jesie is a Graston Technique Certified Clinician, and trained through Functional Movement Systems giving her the ability to critically analyze a person’s movement ability and develop exercise programs that really work!

Why did you become an ATC/LMT?
“I had an inclination toward sports and health and wanted a career that kept me physically active and challenged me mentally.  Athletic training was a perfect fit!”

What do you enjoy most about the job?
“What I truly like best about my job is helping people feel better. I’m passionate about it.  I want to see people get results and I’m happy to be a part of that.  At Elite, I enjoy the one on one experience with each patient as well as having the freedom and ability to use my knowledge and creativity to problem solve and do everything I can to help someone feel better.”

What do you do for fun?
“Other than working at Elite….:)  I enjoy spending quality time with my family.  We love to be outdoors, camping, playing in the water and playing with our sweet puppy.”

Jesie has been married to David Bott for 13 years and have two great kids – Chase and Clare.  Jesie also owns Freedom Massage Therapy and currently sees clients at Elite PT on Tuesdays and Fridays. You can call her at 231 357-0151 for more details.

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Did you know that lower back pain will affect at least 80% of us at least once in our lifetimes.  Depending on the research article, once you’ve had a back pain episode, chances are between 60-80% that you’ll have recurring episodes beyond that.  Not great odds at all.

Here at Elite PT, lower back pain is the most common diagnosis that we treat.  There are numerous causes of lower back pain – some easier to fix than others, but it’s our job to figure that out.

One of the more common causes is Spinal Stenosis.  Stenosis literally means ‘narrowing’ and in this case the narrowing can cause compression and irritation to the nerves that leave the spinal cord and go out to the lower back, hips, and legs.  This causes pain across the lower back and can also produce symptoms into one or both legs.

spinal stenosis

How do you know that you may have Spinal Stenosis?

  • 50+ years old
  • Standing and walking increase symptoms
  • Sitting and lying down relieve symptoms
  • Leaning on the cart at the grocery store allows you to walk with less back pain

Spinal stenosis, like most types of lower back pain, is something that can absolutely be treated in physical therapy.  Certain muscles being ‘tight’ can create more compression and narrowing and therefore must be address using soft tissue techniques like massage, Graston Technique and dry needling.  Exercises must also be incorporated to stretch those tight muscles and improve how our joints move around the back and hips.

Other muscles tend to be ‘weak’, specifically the abdominals and glutes.  When strong and working with the right timing these muscles can reduce damaging forces across the spine.

A comprehensive physical therapy program that addresses all these factors can be extremely beneficial.

Here is what one of our former clients with spinal stenosis had to say:

Patient Testimonial
“I came to Elite taking medication to numb the pain in my back and legs so I could make it through the day.  Thanks to Jesie I have no more pain and know how to strengthen the muscles to help prevent the pain from returning.  She is a great therapist and I will use her again in the future if the need arises.”
– D.B. from Traverse City

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Exercise Tip of the Week

Child’s Pose is a common yoga pose that produces flexion through the hips and spine.  For someone with spinal stenosis this movement frequently decreases or eliminates the person’s symptoms.  If it relieves your pain, then do it whenever you need relief!

Child's Pose

Try to sit back on your heels – unfortunately my knees don’t bend that far!

In the bottom position, take 4 breaths in through the nose and out through the mouth.  Breathing in this manner decreases tone through the back muscles and also calms the nervous system bringing further relief.

For those with knee pain who can’t perform this exercise, try the seated floor press below.  It’s basically the same movement but with more body weight (usually fine but can be too much if you’re really sore).  Use the same breathing technique but be sure to put your hands on your knees to push yourself back up when you’re done.  This just takes some extra pressure off your back.
Seated Floor Press

You may find these simple exercises can make a huge difference in how you feel and how long you can be on your feet throughout the day.  If so, just keep doing them and you may just be able to keep yourself out of pain.

If you have all the signs and can only get temporary relief with the exercises then you probably would benefit from physical therapy.  Call us if you have questions (231 421-5805) and we could tell you if PT is for you.
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Have a great month of July with hopefully more warm weather to come.

We can be reached at 231 421-5805 or through email:  Joe@elitepttc.com if you have questions or if you just want to let us know how you’re doing.

Training to Prevent Low Back Pain – Feet Raised Bench Press

Low back pain is a huge part of what we treat at Elite Physical Therapy and Sports Performance.  Even folks coming in for treatment with knee replacement or shoulder pain (just a couple examples), will often complain of pain and tightness in their low back as well.   Dysfunction and pain in the lower back can certainly contribute and cause problems in other areas of the body.

In the coming weeks I’ll be posting a series of articles written by Andy Barker (SportsRehabExpert.com contributor) and myself that discuss how to spare your lower back during the performance of popular strength training exercises.  Hopefully you’ll find some good tips to keep that spine healthy all the while making great gains with your training.

Enjoy and if you have any questions feel free to email me:  joe@elitepttc.com

 

by Andy Barker PT

originally posted at SportsRehabExpert.com

I think we do a great job at cueing and coaching good pelvic position when using standing based gym exercises.  Equally, cueing the same position in supine in an unloaded state we also get it right.

However, when adding load to supine based exercises good pelvic form is often lost.

A great example of this is the bench press. Often when the load goes up so does load through the back as compensatory lumbar extension assists the lift. This is especially so when the feet are placed on the floor either side of the bench.

One easy way to reduce the effects of possible lumbar compensatory extension is to raise the feet to put the pelvis into posterior tilt and hence out of lumbar extension. This is shown in the video below:

Feet Raised Bench Press

One potential problem with the above technique is that athletes may feel less steady with the feet not placed on the floor and hence unable to shift as much load. This might be particular so the wider the athlete and/or the narrower the bench used.

As a result an alternative way to increase support whilst also raising the feet is using plyo boxes to act as foot platforms. Using the boxes allows athletes to push into the floor, via the boxes, as they would in a standard bench press, although in a much better pelvic position. This is shown in the video below:

Feet raised bench press (plyo boxes)

Have a blast and let me know what you think

BIO

Andy is the current head physiotherapist for the Leeds Rhinos first team squad and has been involved with the club for the past six seasons.

He graduated in Physiotherapy from the University of Bradford with a first class honours degree which followed on from a previous Bachelor of Science degree from Leeds Metropolitan University in Sports Performance Coaching.

Andy currently works privately in addition to his sporting work and has also previous experience within National League basketball and professional golf.

Andy has a keen interest in injury prevention and the biomechanics of movement in which he is continuing his studies with the start of a MSc degree later this year in Sports and Exercise Biomechanics.

Andy is also the creator and author of rehabroom.co.uk. RehabRoom is a free online rehab resource site aimed at but not exclusive to physiotherapists, strength and conditioning coaches and personal trainers. To visit the site, click here:  www.rehabroom.co.uk

Increasing Intensity Without Increasing Load

This is an article I originally posted on SportsRehabExpert.com, and thought it would be a great piece for the blog audience as well so I apologize ahead of time if some of the terminology is a bit too ‘medical’.

 

I’m constantly on the lookout for ways to challenge my patients and athletes, but without overloading their joints and tissues.  Many of them want to really push themselves, but sometimes they are at that point in their lives or careers where it’s just not appropriate for longevity sake.  In this article I’ll discuss some of the strategies I use to get the most out of strength training without overloading the weakest link.

There are 4 basic ‘solutions’ to this problem that I will use.  I think the best way to cover these would be to describe a couple cases for the lower body and upper body:

Case 1:  Active military gentleman with 2 episodes of disc hernation and radicular symptoms within a two year period.  Both episodes were brought about with heavy lifting, but he also spends quite a bit of time sitting in the back of a helicopter in a seat that’s about 6″ off the ground (his knees are practically in his face).

I worked with him after the first incident, cleared his movement and had no symptoms.  He resumed weightlifting and all other previous activities. After 6 months in the clear he went back to heavy squats and deadlifts, and after 2-3 months of that began noticing the radiating pain into his left leg again.

This guy is an absolute beast when it comes to his fitness level and his form has always been very good.  But because of his past and his work demands, this is a guy that I want to limit the load he is using, as well as the positions he puts himself in.

Solution #1 – Move from bilateral stance to split or single leg stance

This one is pretty obvious in that there is no way he is going to load single leg activities the way he can load a traditional squat or deadlift.  Single leg deadlifts and squats are great options here because of the extra stabilization needed just to balance and control the trunk.  There is only so much weight you’re going to pull with these single leg movements.

Solution #2 – Asymmetrical loading

An example of this would be a single leg deadlift in which the weight is held in the opposite hand (of the stance leg) so the trunk must work in an anti-rotation manner as well as anti-flexion (see video above).  Another great example would be a front squat with a kettlebell in one hand (see picture below) using either the traditional grip or bottoms up.  The demands on the core can be quite high loading in this manner so the athlete gets a great workout with less overall load.

Single Arm Kettlebell Squat

Solution #3 – Postural Assist

Split squats or rear foot elevated split squats (REESS) are ideal for this type of athlete because the positioning makes it easy to maintain an upright spine and therefore decrease the shearing type loads you would see with a traditional squat where the trunk is angled forward.  Mike Boyle (one of the top strength coaches in the world) has talked extensively about this and thus his programs have moved from back squats to front squats to RFESS over time.  This type of squat can easily be asymmetrically loaded as well (different weighted dumbbells in each hand).

Rear Foot Elevated Split Squat

Solution #4 – Bottoms Up

There are many reasons I like kettlebells, and the ability to go bottoms up is another one of those reasons.  I can instantly make any kettlebell exercise much more challenging to the athlete’s grip and stability.  The video above showing the KB front squat is a great example, plus I will frequently use this with Turkish Get-Ups, various carries, and presses.

Double Bottoms Up Kettlebell Squat

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Case 2:  This is more of a general example here as I work with a number of adult athletes post rotator cuff repair looking to return to their sport and the gym.  Unless they are competing in powerlifting or weightlifting events, I really don’t need them putting a whole bunch of weight on the bar to bench or shoulder press any longer.

My #1 job is to protect the repair while they are seeing me in PT, but also when they are beyond my care.  Job #2 is to give them tools to enhance performance and get them back to the sports they enjoy.  Again I believe this can be done using the ‘Solutions’ mentioned above.  Here are some examples for the upper body (although in the clinical or performance setting I would never really divide them up this way).

Solution #1 – Move from bilateral to single arm exercises.

The same idea applies to upper body as lower.  The amount of stabilization and balance needed to perform single arm presses (horizontal and vertical) is going to make it quite difficult to really load up with weight.

The single arm bench press is one of my favorites.  I have the athlete scoot their hip and shoulder off the bench so they really have to fight the weight pulling them off the bench.  I usually have to start athletes at about 50% of what they could dumbbell bench using the traditional two arm method.  Athletes are not always happy about going down in weight but they feel right away this is going to make them work.

Solution #2 – Asymmetrical loading

In the case of upper body pushing and pulling, the ‘solution’ of asymmetrical loading is usually just a version of ‘Solution #1’.  Another way to inject greater asymmetrical loading into singe arm lifts would be to have the athlete lift from a single leg stance position.  This isn’t something I use real often but there have been times I’ve had to be cautious with someone’s shoulder and wanted to increase intensity without increasing load.  Single leg/single arm kettlebell presses fall into this category, as well as single leg rows (hamstring killer!).

Can’t believe I couldn’t find a better picture than this!

Solution #3 – Postural Assist

In this instance, requiring the athlete to stand to overhead press (or go tall or half kneeling) brings a lot of postural and stability requirements to the table.  It makes it more difficult again to really load up the lift when they don’t have a bench to press into.

Solution #4 – Bottoms Up

Same thing again using the kettlebell bottoms up to work the grip harder and force great stability from the upper quarter.

Single Arm Press – Now that’s a picture! That KB is 55 KG by the way

Now don’t get me wrong, I still love to see big lifts.  There are just times when the person in front of you needs less loading so be creative and use these techniques to help create an optimal environment to make gains without risking injury.

Low Back Pain and Asymmetries

I was just looking back through the last two years of blog posts and realized I really hadn’t written anything specifically discussing low back pain.  Low back pain ranks second only to the common cold when it comes to work days missed every year, and is also the second most costly ailment to treat.  Low back pain is also the most common complaint that I treat here at Elite Physical Therapy and Sports Performance.

I will admit there was a time when I dreaded seeing that diagnosis on the physician’s order, and I guarantee you most other PT’s would agree with me.  The spine is so intricate, there are so many muscles that attach throughout that area, and so much freedom of movement through the spine, pelvis, and hips that it used to be hard to know where to start.

Over the past five years I’ve learned a few more things and have really come to enjoy treating low back pain.  When you really study human movement and learn to detect common asymmetries in how we are aligned and move, it really isn’t that hard anymore to know where to start and make quicker changes in how someone feels and moves.

There are a number of great examples but today I want to look at one of the most prevalent:

Asymmetry #1 – Inability to Internally Rotate over the Left Hip

Check out the pictures below – seeing it will probably make more sense than me trying to describe it although I’m going to try anyway.

This guy is standing with more weight on his Right leg and pelvis rotated to the right. Check out how his trunk rotates back to the Left to compensate. You can even see how the rotation torques his abdominals and chest!

Almost all of us tend to stand more on our Right leg, and when we do our pelvis shifts and rotates over that hip just fine (this is relative internal rotation of the hip).  The pelvis in this instance is rotated to the Right just like in the  picture above and below.

Here is another great example from my friend Michael Mullin with some arrows drawn in to help you get the idea of the torque it can create in the body:

When we do stand on our Left leg, our pelvis tends to stay rotated to the right (this is relative external rotation of the hip).  This tendency results in a loss of internal rotation ability of the Left hip and a pelvis that does not rotate correctly when we walk or run.  Lots of other bad things happen right up the spine and down the lower extremities because of this.

Check out what happens with this runner who is stuck in this pattern.

No problem rotating into his Right hip during stance. No such luck on the Left.

Notice how when he is on his right leg, his right foot is directly under his body (in the mid-line) and his foot lands in a fairly neutral position.  Now check out his positioning on the left leg.  His left foot is more under his left hip than directly under him causing his knee and foot to roll inward to support him.  He cannot get over his left hip and rotate his pelvis as efficiently on the left as he can on the right.

This picture shows the proper positioning over the Left leg with the pelvis facing Left.

Michael is looking pretty content on his Left leg now

An inability to move out of this pattern will change the way we stand, walk, and run, and can potentially lead to a host of injuries even beyond the lower back.  Fortunately this asymmetry is manageable with some simple exercises that can be worked into warm-ups or between sets when at the gym.

If you’ve been suffering from chronic back, SI joint, or hip problems that have failed traditional treatment, then it may be because the underlying asymmetry has not been addressed.  I’ve had some great success treating these areas by identifying and correcting these asymmetries so definitely something to think about.

Stay tuned and next time I’ll talk about why your ribs flare more on the left than on the right (I’m such a geek!).  If you have any questions feel free to email me:  joe@elitepttc.com

 

Exercise of the Week – Front Plank

I’ve discussed the front plank here previously as a way to demonstrate the mistakes many people will make when performing ‘core’ exercises.  The most basic mistake is allowing too much lumbar extension (excessive inward curve of the spine).   In this position, the spinal joints are compressed and providing the stability.  This is a great way to hurt your back over time!

In that post I wrote about achieving a more neutral spine position by trying to pull the belly button to your nose.  This activates the abdominals and rotates the pelvis backward slightly bringing the spinal curve to a more neutral position.  Check out the examples below.

Too much extension

Neutral spine posture

You can see in the second picture that a straight line could be drawn from her hips through her spine to her shoulders.  That straight line should also extend through the neck to the ear, but I’ll talk more about that in a moment.  The neutral spine position is the first correction that must be made, but once you’ve mastered that here are a few other  techniques to get the most possible benefit from the front plank exercise:

1.   ‘Breathing behind the shield’ – this is a cue used by the RKC (Russian Kettlebell Challenge) to improve spinal stability and strength in the plank and other kettlebell exercises.  When breathing appropriately, you should feel the abdomen expand circumferentially (see the picture below).  The chest will expand slightly but definitely do not want to feel the shoulders rise toward the ears.

Using the diaphragm appropriately during any activity triggers the deep muscles of the core that are responsible for segmental spinal stability.  This is the most basic level of stability in the spine and what keeps our vertebrae in proper alignment.  This is a must for injury prevention and optimum performance.  We all breathed this way when we were younger but most of us lose this ability especially when challenged.  Check your breathing right now.  Do you feel your abdomen expand when you inhale?  Or do you feel the expansion in your chest?  Worst of all are your shoulders rising when you inhale?  Pathological breathing pattern can contribute to all sorts of orthopedic ailments and reduces your ability to exercise efficiently.

The ‘shield’ refers to the braced muscles of the abdomen.  If you’ve taken the steps I’ve described above then you should feel the abdominals contacting hard.  The breath should feel like it is pressing out into the abdominals.  Many trainers and clinicians advocate drawing the belly button in toward the spine, but this only destroys the breathing pattern and weakens the deep stabilizing unit.

2.  ‘Pack the Neck’ by pulling the chin back to your spine.   The common mistakes here are to bring the chin down toward the chest or to look up.  You should be looking straight down and feel like your head moves up away from the floor.  This small movement activates the deep flexor muscles in the front of the neck which are known to be a ‘trigger’ for recruitment of the inner core muscles I spoke of in #1.  Again, anything that makes you stronger in this exercise will only help bring you closer to your fitness goals, prevent back pain, and improve carry over to everyday activities and sports.

Packing the Neck – I was unable to find a good example in the plank position – which should tell you how few people do it correctly!

3.  Increase abdominal muscle activation by pulling your elbows to your toes.  The elbows aren’t going to move, but you want to feel yourself pulling into the floor in that direction.  You will feel the abdominal contract much harder as well as the large latissimus muscles on each side of the upper back.  Once you can hold your plank using this technique, now try to pull your toes toward your elbows.  Once again you will feel everything tighten down and bring more muscles into the exercise including the abdominals.  This uses the principle known as irradiation which basically means the more muscles you can recruit the stronger you will be.

When you try these techniques you realize how hard the plank exercise should really be.  I’m not impressed by people that tell me they can hold the position for 5 minutes because they are doing it wrong.  This should be an extremely difficult exercise.  Start with 10 second holds with 10 second rest breaks.  The goal should be to hold 20 seconds per rep, rest 10 seconds in between, and then work up to 10 reps.

Feel free to leave your comments and let me know what you think.  Thanks!

PT Minute- Snow Shoveling and Back Pain

Snow shoveling can be hard on your back, not just from moving heavy snow, but also from the postures that are used.

A rounded back places greater strain on the discs, muscles and other structures of the spine.  The safer posture is a flat back with the hips pushed back.  This is known as a hip hinge.

To work the hip hinge, simply place a stick along the spine touching the head, mid-back and tailbone.  Slightly bend your knees and push the hips back.  The stick should stay in contact with all 3 points.  Go as far as you can without losing contact.  The goal would be to feel a good stretch in the hamstrings.

 

This can be a difficulty move for many.  If so, practice the hip hinge pattern on your hands and knees first.  With a water bottle across the low back, push the hips back toward the heels maintaining a slight spinal curve.  If you lose the water bottle, you’ve lost posture.

Stay within a comfortable range of motion with perfect posture, and absolutely no pain.  Perform 10 repetitions to re-establish your hip hinge prior to taking on the snow.

Here is the link to the PT minute video:  PT Minute – Snow shoveling and Back Pain

 

PT Minute – Core Strengthening

I filmed a short ‘PT Minute’ on this topic this week, but wanted to write it up so folks had a place to go to get more information (it will be running on 7&4 during the morning news – I think between 5-6am).  It’s not comprehensive by any means, but should definitely get you thinking:

Core Strength has long been touted as a way to prevent or eliminate low back pain, but did you know that many of the traditional exercise like sit ups, crunches, and back extensions can actually hurt your back?

The plank exercise is a safe and popular alternative that works the abdominals to provide support to the lower back, but it too must be done properly to produce the desired results without creating additional problems.

To perform a plank, first assume a push-up position on your forearms and up on your toes.  Then lift your body off the ground, getting everything in a straight line.  Hold this position for 10-20 seconds for as many repetitions as possible with perfect form and no pain.

A typical mistake is to have too much of a curve in your low back, which puts too much stress on the joints of the spine.  To make sure your form is perfect, try placing a stick along your spine, touching the head, mid-back and tailbone.  This will give you the postural feedback needed to know if your alignment is correct.

You can see in this picture that I could fit 3-4 finger-widths between the spine and the stick which is way too much.  She’s resting on her joints and ligaments versus using her abdominal muscles.

What you want is 1-2 finger-widths.  To achieve this you must more actively engage your abdominals by tilting your pelvis backward.  Think about bringing your belly button closer to your nose to reduce this curve to a more neutral position.  The women in the picture below looks much better!

This is a great exercise for core strength and for stability of the low back when done correctly.  Once you’ve mastered the position, now work on belly breathing throughout the set.  You should feel your abdomen and sides moving in and out, not your chest and shoulders.  If you cannot breathe correctly, this also means your abdominals are not doing the job, and it’s time to take a break.

Here is a link to a short article that appeared in Newsweek on the danger of crunches and sit-ups:  http://www.thedailybeast.com/newsweek/blogs/the-human-condition/2009/06/03/stop-doing-sit-ups-why-crunches-don-t-work.html.  They frequently quote Dr. Stuart McGill who is the foremost spine biomechanist in the world, and definitely knows his stuff when it comes to preventing injury and enhancing performance.  On the other hand, ignore the knucklehead trainer talking about the Transverse Abdominus – so far from the truth I bet McGill had no idea that would be in the article.

Any other questions on planks or core training just send them on over.  Thanks!

Here is a link to the PT minute video:  PT Minute – Core Strengthening