Low back injury prevention in the gym
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Low back injury prevention in the gym



This is a brief anatomy, common complaints related to the low back from gymnast, biomechanics of a bridge, and neuromuscular recruitment and facil

This is a brief anatomy, common complaints related to the low back from gymnast, biomechanics of a bridge, and neuromuscular recruitment and facil



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  • Before we get going if you write doewn the website: perfect10physicaltherapy.com you can view the power point and videos later for more details. I should have them up by the end of next week, if not sooner.
  • Cervical spine, Thoracic Spine, Lumbar spine Normal curves with transition points at Cervical Thoracic junction and Thoracolumbar (TL) junction
  • lats, gluteus maximus, gluteus medius and under that the hip external rotators.
  • internal, external obliques. Underneath not pictured the transverse abdominus. The rectus abdominus (6 pack muscle) which does not attach to the lumbar spine or offer stability. It looks pretty and supports the internal organs.
  • Iliopsoas attaches to the low back which can offer stability when the core is strong or create abnormal stress to the low back when the hip flexor is tighter than the core is strong.
  • ----- Meeting Notes (6/28/12 18:28) ----- Before we move on. The most important thing in injury care for gymnast is they receive early treatment before the injury progresses or causes other problems. Research has shown that pt recover faster and to a higher level if treated within 16 days of onset of the pain or injury. CAN I HAVE A VOLUNTEER
  • ----- Meeting Notes (6/28/12 18:28) ----- We utilize a manual blood pressure cuff for feedback for the athlete to see they are using the proper muscles. Research was done using the cuff and they found from 40-50 mmHg the internal, external obliques and transverse abdominus fire. While from 60 above the rectus abdominus fires. (which remember earlier the rectus or 6 pack muscle do NOT offer stability to the low back). TEACH CUFF
  • I recommend that all athletes become proficient in the blood pressur cuff exercises before moving on to the rest of the exercises we will discuss.
  • This gets the athlete to engage their abdominals before they engage the hip flexors. Gymnast tend to let the hip flexors fire first which dumps the pelvis forward. This puts stress on the low back and will limit how high they can kick. Engage the abdominals, keeping back flat 1 st , then pull down with the band. Be sure the athlete is breathing during the exercise.
  • This is a great exercise to functionally work on those lower abdominals (internal and external obliques and transverse abdominus). But you have to be careful they don’ t over power with their hip flexors. Have the gymnast hold something between their knees. This gets the adductors firing while engaging the abdominals. Firing parts of the supportive sling around the spine.
  • Obliques tend to get underworked in gymnast with the 6 pack muscles doing everything.
  • This is a great abdominal stability exercise working transverse abdominus, internal, and external obliques while mobilizing the thoracic spine.
  • ----- Meeting Notes (6/29/12 10:49) ----- When do we do this stuff? Spend some time up front to teach form and technique. Incorporate it in to stations at each event. Pick 2-3 exercises at a time and then change every 3-4 weeks. In force technique and form consistently.
  • ----- Meeting Notes (6/28/12 18:44) ----- TEST PGM BEFORE AND AFTER
  • Test Seated Iliopsoas hold 90 s….Did i make her stronger? recruit the muscle better so she can utilize them throughout her workouts more effectively.
  • glut max one of the largest muscles in the body, so progress to 30 sec hold to get irradiation of all the muscle fibers
  • perfect for those athletes who when doing handstands their shoulder angle stays closed and then you ask to push through their shoulders and then their rib cage pokes out.
  • Dynamic stretching should be done during warm-up or throughout practice. However static stretching is still the best way to get tissue change over time.
  • Dynamic stretching should be done during warm-up or throughout practice. However static stretching is still the best way to get tissue change over time.
  • ----- Meeting Notes (6/29/12 11:12) ----- This concludes the lecture today. Videos using the blood pressure cuff for core recruitment are available. And just remember it's quality of movement not quantity. Focus on technique and form of the exercises to retrain muscle firing patterns and decreased muscle imbalances to achieve optimal muscle function and peak performance. Feel free to contact me if you have any questions as you return to the gym to implement these exercises.

Low back injury prevention in the gym Low back injury prevention in the gym Presentation Transcript

  • Low Back Injury Prevention in the Gym Brandi Smith-Young, PT P er fect 10.0 P hysi cal T her apyFellow, American Academy Orthopaedic Manual Therapy Board certified orthopedic specialist www.perfect10physicaltherapy.com perfect10pt@gmail.com
  • Introduction Competitive gymnast Two time USAG Collegiate National Champions at TWU Bachelors in Kinesiology at TWU Masters in Physical Therapy at Tx St
  •  Practicing for 7 years Fellowship trained in Orthopedic manual physical therapy Board certified orthopedic specialist in PT One of 300 therapist in the US with these certifications
  • My passion: Bring sport specific quality care to gymnast Decrease the number of injuries in gymnast Improve performance, recovery time, decrease time lost in the gym, and improve return to sport status Performance Enhancement
  • Common complaints Pain in the front of the hip Pain on outside of the hip Pain in low back Pain running down back of leg Pain running down the inside of leg
  • Anatomy of Low Back
  • Anatomy cont’d All these muscle provide stabilization for the low back If these muscles are not functioning properly increased stress will eventually lead to injury.
  • Muscle imbalance Some muscles are strong While opposing muscles are weak Some muscles are stretched out While opposing muscles are too tight.
  •  Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others Certain muscles get weak Other muscles develop tighter And some develop looser or stretched
  • Common muscle imbalances Contribute to most injuries in gymnastics  Weak abdominals/core  Weak hip muscles  Hamstring doing to much and buttock muscle not doing enough.  Tight hip muscles  Tight IT Band  Tight lats or shoulder muscles
  • Biomechanics of bridge Forces of arching backwards (180 deg arc) need to be shared btw the shoulders, thoracic spine, lumbar spine, and hips. Pic: USA Gymnastics Junior Compulsory Program
  • Biomechanics of bridge  Poor shoulder flexibility, poor thoracic flexibility (extension), poor spine control (via sling of muscles), and/or poor hip flexibility contribute to forces being concentrated typically in the low back (L4-5, L5-S1) and/or mid back (TL junction)Pic: USA Gymnastics Junior Compulsory Program
  • Demonstration Time
  • Ways to decrease imbalances Strengthen the core  Pelvic tilt (fig 1 & 2)  Must tighten belly button up toward the nose and in Figure 1 toward the spine (40-50 on blood pressure cuff)  Not straight down into the floor Figure 2  Marching (fig 3)  Start with pelvic tilt  No motion in the hips, hips stay level (keep at 50)  Alternate legs Figure 3
  • Core cont’d Heel Slides (fig 4 &5)  Start with pelvic tilt (40-50 with blood pressure cuff)  Slide R leg out maintaining the tilt Figure 4  No rocking of the hips  Monitor hips with hands  Slide L leg out back still flat  Slide R leg in  Slide L leg in  = 1 rep Figure 5
  • Active Straight Leg Raise Lay on back with band above the head. Pull band to the floor with straight arms & hold Raise one leg with the opposite straight leg staying flat on floor. Toes point upward, no rolling of hips. Slowly lower straight leg and return arms above head. X15-20 fwd, X15-20 side
  • Active Lower Abdominals Lay on back with band above the head Pull band to the floor with straight arms & hold Both knees bent to 90, keeping the back flat to the ground lift both knees toward the chest Keep back flat as lower both legs to the ground Return arms above head x15 To progress begin to straighten knees
  • Obliques Engage abs belly button up and in, back flat Breath in, hold as rotate the torso towards the bent knee Breath out and in as hold 10 sec x10 Progress to 20-30-60 sec x2-5 Keep the elbow rotating towards on the ground. Keep the opposite hip (leg straight) flat on the ground
  • Trunk Stability Rotation Lay on back hips and knees flexed to 90, shoulder at 90 degrees arms straight out Place ball or towel between knees Rotate the knees to one side, keeping opposite shoulder blade down. Hand on side of rotation turns down the opposite hand stays turned up. Return to starting position, repeat on opposite side
  • Tweaking current conditioning Gymnast are great at compensating Make sure they remain flat back when doing core exercises (not rounded in upper back or arched in lower back…neutral spine) Do not allow an arch throughout the entire exercise  Ie. V-ups on floor or from the bars, hollow holds, sit-ups, crunches, hanging sit ups, etc Modify by decreasing the lever arm (bend knees or bring arms closer to the body if unable to maintain good form. Progress as strength and control improves.
  • Hand Heel Rocks  Place a stick horizontally across the hips/low back  Tighten abs  Do not let the stick move as rock back  Rock back and forward as far as you can with control
  • Bird Dog with Band Start with stick across low back Tighten abs Ph I alternating arms Ph II alternating legs Ph III alternating opposite leg with opposite arm No motion at hips, no movement of stick
  • Bird Dog Phase 3
  • Hip strength Strengthen the hip muscles Clam progression  Phase I (fig 6)  Sidelying, roll hip forward.  Tighten abs, tighten buttock  Keep heels together and lift one knee up Figure 6  Monitor hips, no motion  Hold 10 sec x10
  • Hip External & InternalRotation Quadreped & Prone  In the same position; move  Start on all 4s, knees the band to the opposite under hips and hands foot. under shoulders.  Theraband attached to  Rotate the hip so the foot ankle pulling away from moves outward (IR) the band  Engage abdominals  Repeat laying flat on the stomach.  Gently squeeze bottom with no hip flexor  May need a towel or pillow activation under the belly button.  Rotate the hip so the foot moves inward (ER)  Make sure abs engaged belly button moves up and in.
  • Hip External & Internal RotationQuadruped & Prone
  • Strength Iliopsoas Seated Iliopsoas (fig 9)  Sitting tall, back straight  Tighten abs  Lift one leg as high as possible to chest with no motion in back  Grab under the leg and lift all the way to chest, no motion bk  Let go with hands and hold 5 sec  Lower 5 sec Figure 9  x10
  • Iliospoas strength cont’d Laying iliopsoas (fig 10)  Laying with one leg bent 1 knee and other straight at an bent angle  Tighten abs  Lift the straight leg with foot turned out  No motion at hips  Hold 10 sec, lower slow  X10  Monitor hips with hands figure 10
  • Buttock muscles Get the buttock muscles to work instead of the hamstrings Prone knee bend (fig 11)  May need a pillow under belly button  Squeeze belly so back is flat (tighten from 70-60 using the blood pressure cuff) Figure 11  Slowly bend knee to buttock without motion in hips or arching at the low back (keep at 60 using the blood pressure cuff)
  • Buttock strength cont’d Prone knee bend lift (fig 12)  Start in with prone knee bend, turn 1 foot inward in figure 4 position (tighten from 70-60 using the blood pressure cuff)  Keep abs tight and no motion in low back or hips slowly lift knee up of the ground (keeping the cuff btw 80-100) Figure 12  Hold 10 sec x10  NO ARCHING
  • Leg Lock Bridge Lie on back and hold one knee to chest, place a ball or towel between your thigh and chest. Bend other knee and place the foot on the floor. Lift the hips off the floor form a straight line from shoulder through the hip to the knee. Progress with the ground knee straight
  • Leg Lock Bridge Knee Straight
  • Squat, Jump, landing mechanics Squat with T-band and stick  Place the crossed band behind the lower thigh or knee  Stand feet shoulder width apart with slight turnout  Press down on the stick as sit like going to sit in a chair.  Knees must stay in line with the 2nd toes and drop over the forefoot, not passed the toes *May place a small lift under the heels to start for athletes who have trouble or limited DF.  X20
  • Assisted Squat Use the band to teach the athlete to shift COG backward. Feet shoulder width apart with slight turnout Abs engaged as sit like sitting in a chair. Knees stay inline with 2nd toe and over the forefoot, DO NOT let them go forward past the toes. *May place a small lift under the heels to start x20 for athletes who have trouble or limited DF.
  • Quadruped T spine rotation Get on all fours (hips & shoulders at 90) Place on hand on low back, palm facing away from back. Look toward & rotate that shoulder toward the ceiling. Return to start Rotate the shoulder toward the floor. Repeat x15 Repeat with the hand palm down on the neck. x15 Repeat on opposite side
  • Stretch hip muscles Stretch the hip flexors (fig 12)  Pull one knee to chest  Tighten abs  Slowly slide the other leg out without any motion in hips or low back  Gently Squeeze bottom  Trying to gently Figure 12 straighten the leg and push down into the floor  Hold 30 sec
  • Stretch hip and Quad muscles Hip/Quad stretch (fig 13)  Off the edge of a block  Pull one knee to chest with flat back  Let the other leg hang down  Can add 2 pound weight to hanging leg  Follow with gymnast squeezing her bottom and pushing down into coaches hand through her thigh (no arch in back)  Make sure hip flexors DO NOT contract  Hold 30 sec-1 min and repeat figure 13 3-4 times going lower each time
  • Stretching Pecs Pec stretch (fig 14)  Have the gymnast partner up.  One gymnast lays flat  The other gymnast either puts on hand on the hip and the other on the opposite shoulder  Or standing at their head press down on both shoulders Figure 14  Hold 1 min switch partners  Repeat 2-3 times
  • Stretch Lats Lat Stretch (Robots) (fig 15)  Keeping belly tight with the back flat  Elbows stay shoulder width apart (may require a partner to keep them there)  Reach back toward the floor and slowly try to Figure 15 straighten the arms  NO ARCHING  Hold 1 min repeat 2-3 time
  • UE Elevation with T Band Lay face up with T band under both feet, knees bent Engage abdominals keeping rib cage and spine in neutral and chin tucked in. Press the upper extremities flat to the floor. Keeping everything flat on the floor, slide the arms upward toward the head. Repeat x10-15
  • WHEN DO I STRETCH? The end of workout when the tissue has been heated through the workout which increased core temperature.  This is when you will get your greatest changes. You must stretch within 24 hours to maintain the changes or the tissue will creep back to prior length. Latest research is showing greatest changes with static stretching with vibration at 30 Hz (ie. Massager) Showing that stretching tolerance is the key to increased flexibility.  The vibration tricks the nerves that feel pain into relaxing and allows for a stretch without the defensive muscle contraction.
  • Contact InformationP er fect 10.0 P hysi cal T herapy & P er for mance T rai ni ngwww.perfect10physicaltherapy.comperfect10pt@gmail.com512-426-6593Follow: PERFECT10PT on
  •  All information from:  The Manual Therapy Institute  www.themanualtherapyinstitute.com  Shirley Sahrmann.  Diagnosis and Treatment of Movement Impairment Syndrome.  Gray Cook