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

1. Low Back Injury
Prevention in the Gym
Brandi Smith-Young, PT
P er fect 10.0 P hysi cal T her apy
Fellow, American Academy Orthopaedic Manual Therapy
Board certified orthopedic specialist
www.perfect10physicaltherapy.com
perfect10pt@gmail.com

2. Introduction
 Competitive gymnast
 Two time USAG Collegiate National Champions at
TWU
 Bachelors in Kinesiology at TWU
 Masters in Physical Therapy at Tx St

3.  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

4. 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

5. 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

6. Anatomy of Low Back

10. 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.

11. Muscle imbalance
 Some muscles are strong
 While opposing muscles are weak
 Some muscles are stretched out
 While opposing muscles are too tight.

12.  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

13. 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

15. 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

16. 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

17. Demonstration Time

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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.

25. 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

26. 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

27. Bird Dog Phase 3

28. 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

29. Hip External & Internal
Rotation 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.

30. Hip External & Internal Rotation
Quadruped & Prone

31. 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

32. 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

33. 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)

34. 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

35. 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

36. Leg Lock Bridge Knee Straight

37. 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

38. 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.

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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.

46. Contact Information
P er fect 10.0 P hysi cal T herapy
& P er for mance T rai ni ng
www.perfect10physicaltherapy.com
perfect10pt@gmail.com
512-426-6593
Follow: PERFECT10PT on

47.  All information from:
 The Manual Therapy Institute
 www.themanualtherapyinstitute.com
 Shirley Sahrmann.
 Diagnosis and Treatment of
Movement Impairment Syndrome.
 Gray Cook