Tag Archives: low back rehab

The Bird Dog – A Core Stability Classic

The ‘bird dog‘ exercise is a core stability classic in the physical therapy world, and is certainly a favorite of ours here at Elite Physical Therapy.

That being said I see this exercise done incorrectly more often than not.

The whole idea behind core stability is to resist unwanted movement through the pelvis and spine when moving through the hips and shoulders.  Watching most therapists, and even yoga and pilates instructors, teach this exercise you would think just the opposite.  Check out the video below to see the exercise performed incorrectly (first 3 reps) and then done correctly (next 3 reps).

When performed incorrectly you can see how much movement is occurring through the lumbar spine.  Many folks are stuck in excessive lumbar lordosis (too much inward curvature) which can become painful especially with prolonged standing and walking.  A majority of the athletes I work with, including the dancers and gymnasts, would fall in this category as well.  Going into even more lordosis is only going exacerbate the issue.

As you can see when performed correctly, nothing moves through the pelvis and spine.  It’s only my shoulders and hips.  Performing a bit of a posterior pelvic tilt (think tucking the tailbone) will bring the person out of the excessive lordosis and help to stabilize the trunk.  Also notice there is much less excursion with the upper and lower extremities.  There is no way you can lift the arms and legs as high as in the first example and maintain any type of stability.

There are times however that a bit of lumbar lordosis (arch) may be necessary to maintain throughout the exercise.  Sometimes this is just the more comfortable position to be in.  If that’s the case then that is going to be the appropriate position for your body.

To learn to stabilize in this position, using a water bottle either across or along the spine is a nice trick (the latter being the more challenging).  Focusing on keeping the water bottle from rolling off your back will reflexively fire more muscles and with the correct timing to keep your spine and pelvis stable.

Adding a resistance band would be a higher level challenge. Do not attempt to add resistance until you are able to control your body weight.

Give the bird dog a try yourself and see how much more challenging it can be when you actually stabilize the core!

If you have any questions, contact me at joe@elitepttc.com or at 231 421-5805.

 

Back Pain Prevention – The Glute-Ham Raise

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.

This is article #2 in 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 Joe Heiler PT, CSCS

originally published on SportsRehabExpert.com

The glute-ham raise has always been one of my favorite exercises, but what I’ve realized is that most people are going to rely too much on their spinal erectors to complete the movement at the expense of the glutes and hamstrings. Over the past couple summers I’ve worked with numerous athletes with sore backs from performing this movement, or they just felt this movement was supposed to work their backs because this is where they feel it the most.

It’s called a glute-ham raise for a reason so finding a way to lock out the lumbar spine is critical. Performing a bit of a posterior pelvic tilt will allow the athlete to ‘lock the ribs to the pelvis’ on the front side, and then place all the emphasis on the glutes and hamstrings as in the video below.

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