lower back joint dysfunction

LOW BACK PAIN AND MOVEMENT

LOW BACK PAIN AND MOVEMENT

Movement is the best treatment for low back pain and recovery from discectomy.

FLEXED LUMBAR SPINE OR NEUTRAL PELVIS?

Picture 1 = Anterior Pelvic Tilt    Picture 2 = Neutral Pelvis    I have my finger on my Anterior Superior Iliac Spine (ASIS/most antierior bony prominence at the front of your pelvic bone) & my thumb on my Posterior Superior Iliac Spine (PSIS/bony prominence at back of pelvis, usually where your dimple is), when these two points are level, you are in a neutral pelvic position.

Picture 1 = Anterior Pelvic Tilt

Picture 2 = Neutral Pelvis

I have my finger on my Anterior Superior Iliac Spine (ASIS/most antierior bony prominence at the front of your pelvic bone) & my thumb on my Posterior Superior Iliac Spine (PSIS/bony prominence at back of pelvis, usually where your dimple is), when these two points are level, you are in a neutral pelvic position.

I wanted to bring attention to the fact that there is a difference between causing a flexed position in the lumbar spine (lower back) and creating a neutral position at the pelvis. When your pelvis is in a neutral position, it doesn't necessarily mean that your lumbar spine is going to be in a flexed position.

I say this because I often find that people who have a history of lumbar disc bulges or herniations seem to perceive a neutral pelvic position as lumbar flexion.  They also tend to be afraid of moving their pelvis out of an anterior tilt as they use it as a protective mechanism to avoid lumbar flexion.  

The main issue I have with this is that although a flexed lumbar spine (particularly under load) causes disc compression, so does an excessive anterior pelvic tilt, not only does this alter the pressure at the discs but it also causes Sacroiliac Joint (SIJ) compression & encourages core instability.  The majority of people who have excessive anterior pelvic tilts also have dysfunctional glutes (glute activation decompresses the SIJ). One of the roles of your glutes is to create a posterior tilt of the pelvis.  If you never let your pelvis move out of anterior tilt then you are disabling your glutes (compare the above two pictures again and tell me which one can you see more glutes in) and you can probably add obliques; abdominals; TvA to that dysfunctional list too. You can tell by the creases of my top that in the first picture on the left my abs are stretched and elongated and in the picture on the right, they are contracted. Stretched abs = unprotected and compressed lower back!

Your body will find stability where it can if it is lacking and this can be in the form of SIJ compression due to dysfunction in your core musculature.   Make sure you aren't forcing yourself into anterior tilt, whether under load (lifting or pushing weight) or not but working on pelvic stability instead so you know where neutral is.

Don't feed a habit...CHANGE a habit!

THINK TWICE BEFORE YOU BELT UP!

weightbelt no good personal trainer rehab trainer.jpg

More often than not I see loads of guys and girls donning the weight belt during lifting sessions, regardless of whether it is a heavy strength session or a metcon that is being carried out.  

When did the weight belt trend begin and what knowledge have we gained since then?  

Do you even know WHY you are wearing a belt if you are someone who puts one on habitually before each session?  

I have tried to breakdown an article by Paul Chek on the subject to highlight the most important points made.  I strongly advise anyone with an interest in prolonging their low back health or anyone currently using weight belts regularly to read the full article here.

Weight belts have been known to be used as far back as the early 1900's, with no clear reasoning behind the reason for their use.  It may have been in line with medical trends back then to use corsets as a treatment for scoliosis and back pain?

These days there has been much research into the area of lower back stabilisation and low back pain resulting in a much more in depth understanding of the stabilising system of the spine.

Cue The Inner Unit & The Outer Unit…

The Inner Unit consists of A)  Transversus Abdominis  (TVA) & posterior fibres of Obliquus Internus, B) Diaphragm, C) Deep Multifidus, D)  Pelvic Floor Musculature.

The Inner Unit consists of A)  Transversus Abdominis  (TVA) & posterior fibres of Obliquus Internus, B) Diaphragm, C) Deep Multifidus, D)  Pelvic Floor Musculature.

These muscles play a vital role in lower back stabilisation!  A study carried out in 1999 concluded that in people without back pain, the TVA fired 30 milliseconds (ms) prior to shoulder movements and 110 ms prior to leg movements.  During each variation of movements performed within the study there was still synergistic (muscles working together to perform a movement) recruitment of all inner unit muscles.  It was noted that regardless of movement plane or pattern of the subjects, the TVA muscle appeared relatively consistent in its activation pattern.  Researchers propose that the nondirectional, specific activation of the TVA relates to the dominant role played in providing spinal stiffness.

 "The TVA, in concert with other inner unit muscles (Figure 1), activates to increase stiffness of spinal joints and the sacroiliac joints (6,7,15). Activation of the inner unit provides the necessary stiffness to give the arms and legs a working foundation from which to operate. Failure of the TVA to activate 30-110 ms prior to arm or leg movements respectively has been correlated with back pain and dysfunction (6, 16). The inner unit is part of a system of stabiliser mechanisms, all of which are dependent on the integrated function of all inner unit muscles." - Paul Chek

Couldn't have said it better myself!  

The Outer Unit consists of many muscles such as the External Obliques, Internal Obliques, Erector Spinae, Latissimus Dorsi, Gluteus Maximus, Adductors and Hamstrings working together with the inner unit to achieve co-ordinated movement.

Here is a simplified version of the inner/outer unit systems.  Using a pirate ship’s mast as a human spinal column. While the inner unit muscles are responsible for developing and maintaining segmental stiffness, the bigger muscles, shown here as guy wires, are responsible for creating movement.

The Inner and Outer Units Simplified

The outer unit muscles of the trunk demonstrated here are (A) rectus abdominis, (B) internal and external oblique, (C) erector spinae; the outer unit actually contains other muscles, which have been excluded for simplification. The inner unit, which contains all the muscles demonstrated in Figure 2. is demonstrated here as (D); the multifidus acting as segmental stabilizers for the purpose of controlling joint stiffness. To tighten the guy wires (A-C), which provide gross stabilization of the ship’s mast without synergistic tightening of the segmental stabilizers (D) would obviously result in increased potential to buckle the mast. The mast represents your spine!

The outer unit muscles of the trunk demonstrated here are (A) rectus abdominis, (B) internal and external oblique, (C) erector spinae; the outer unit actually contains other muscles, which have been excluded for simplification. The inner unit, which contains all the muscles demonstrated in Figure 2. is demonstrated here as (D); the multifidus acting as segmental stabilizers for the purpose of controlling joint stiffness. To tighten the guy wires (A-C), which provide gross stabilization of the ship’s mast without synergistic tightening of the segmental stabilizers (D) would obviously result in increased potential to buckle the mast. The mast represents your spine!

"Recruitment of trunk stabilizers via EMG with and without a weight belt has been studied. These studies concluded there was increased recruitment of the erector spinae and rectus abdominis when wearing a belt. Now that you understand the workings of the inner unit, it should be evident that by recruiting the larger, gross stabilizers without proportionate recruitment of the inner unit musculature responsible for regulating joint stiffness, the result could certainly lead to spinal joint dysfunction or exacerbate an existing condition. It is also likely that prolonged use of weight belts will result in coordination problems within the inner unit muscles and among the inner and outer unit systems." - Paul Chek.

Now, all this said, if you are someone who regularly relies on a weight belt and this article opens up your eyes into entering the world of being Back Strong & Beltless.  Please refer to Part 3 of the article where Paul will talk you through the safe and necessary steps to take in order to wean yourself off the belt.  Your current movement patterns will be reliant on your weight belt and getting rid of the belt all of a sudden will no doubt result in injury.  Wean yourself off slowly and carefully and get your internal weight belt working for you instead!  Just as nature intended!  :-)

All references can be found on Paul Chek's full article.

WHAT'S IN A SIT-UP?

A very clever and informative video clip showing the muscles used in sit-ups.

PLEASE NOTE I WOULD NOT RECOMMEND DOING THE FULL SIT-UP VERSION!

So your personal trainer gets you to do sit-ups to "strengthen" your abs and get that six-pack. And you think it's gonna happen...

Think again!

The majority of the population are walking around with dysfunctional abdominal muscles which means that they either have a sequencing problem with the muscles that function to create flexion at the spine and hips or that they have an imbalance in strength/function of these muscles. Or both, which is often the case.

This only leads to one outcome - increased pressure on the lumbar discs

Yip, not a six-pack, not strong abs but more than likely a disc herniation somewhere down the track. It could take weeks/months/years to develop. 

I refuse to let any of my clients do sit-ups and refuse to do them myself for the above reasons. There are multiple exercises out there that are heaps more effective than the sit-up in improving abdominal function/strength and they are 100x safer!

The curl up is an acceptable exercise if only your shoulders leave the ground and you exhale as you crunch, think about drawing your lower ribs towards your pelvis. Don't pull on the back of your neck but just support it loosely with your hands.

Even more ideally, I have my favourite Top 4 abdominal exercises I like to use in order to safely and effectively develop a functional central stability system.

 

 

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Pregnancy Workout Options - SQUAT

Here are some of the exercises I like to use with my pre / present / post pregnancy clients. Each week I will put up a new short clip of different exercises. This is not a prescription of course, each individual is their own case.

Some things to consider when exercising during pregnancy are:
- your exercise & fitness levels pre-pregnancy
- your current state of well-being during the pregnancy
- what stage of the pregnancy you are at
- whether or not you have any pre-existing or pregnancy related health issues
- how you feel on the day of exercise
All of the above factors affect the type of exercise you would do on that day.

The first exercise is the SQUAT. Squatting is the best exercise you could do before, during and after pregnancy. When focussing on your breathing technique it is a great exercise to encourage better functioning of your core muscles and of course to work on strengthening your legs and butt.

Below is a short clip of 3 versions of squats, each at a different level of intensity. When doing squats under load you need to make sure you maintain good Intra-Abdominal Pressure, this can be done by taking a sharp diaphragmatic breath in through your nose and holding it whilst you descend into the squat, as you are about to push out of the squat you want to let out a short Tsssss sound (with your tongue on the roof of your mouth and your teeth together gently, not clenched) and slowly continue to exhale as you come back up to standing. Repeat with another inhale before you squat down.

overhead squat form

Spot the difference:  Left = good...Right = compromised joints

Spot the difference:  Left = good...Right = compromised joints

I often see pictures posted of people with loads of weight above their heads but in very compromised positions, both in the press & the Overhead Squat (OHS). A common trend is to hyperextend the upper back and compromise the shoulders. (This only overloads the lower back and hip flexors and stresses out the anterior shoulder muscles).

This can be for various reasons:

  • Lack of shoulder stability

  • Lack of thoracic mobility

  • Lack of pelvic stability

  • Lack of hip mobility

  • Lack of knee stability

  • Lack of ankle mobility

Any one of these things, or a combination, can change the OHS dramatically. Don't sacrifice form for numbers.

Just make sure if this is a movement you do regularly, particularly if it is loaded, that you can tick all the above mentioned criteria prior to load. Or at least be working on your weaknesses and immobilities that are apparent and improving them prior to load.

Nothing wrong with working the dowel rod guys. I don't know about you but I'd rather achieve a perfect or close to perfect dowel rod OHS whilst preventing injury than an ugly weighted one which causes dysfunction in the system.

 

deadlift - the do's and don'ts

The deadlift is the one movement that most people struggle with and where a lot of injuries occur, now you can't blame this on the deadlift as it is a fantastic exercise that if done correctly, can actually protect your lower back and strengthen your stability muscles. Herein lies the problem, most people do not deadlift correctly and this is mostly due to them not being taught the correct steps involved in a deadlift. It is not just about bending over and picking up a weight with a straight back. Cueing is everything and teaching a person HOW to move well is imperative, their technique won't change just by telling them to keep a neutral spine or giving them a lighter weight. You have to find a way to communicate what you want them to do so their BRAIN GETS IT! And then making sure they do it correctly often enough in order for the movement pattern to stick. Without changing their motor control system you aren't changing anything.

Before I hand a weight to deadlift to any of my clients I can commonly spend several sessions coaching them through the breakdowns of an efficient deadlift, some require less time, others more.

There are several ways to safely coach an individual through each separate step of the deadlift movement prior to even going near a weight, all of which can be practiced at home, with no special equipment needed. Once they are ready to add weight to the lift I always start with a medium weight kettlebell as it is a much easier piece of equipment to learn with than the barbell.

The most common problems I see with the deadlift, in order of popularity are:

  1. people hinging off their necks

  2. not engaging their lats (resulting in either pulling weight through their shoulder blades or lower back)

  3. not using their breath (therefore putting their lower backs at risk)

  4. not sitting into their hips enough (can be due to dysfunctional gluts or immobile hips)

  5. pulling the weight off the floor as opposed to pushing the ground away from them.

 

A great deadlift should be:

  1. neutral neck throughout

  2. lats engaged throughout

  3. tibias (shins) vertical throughout

  4. barbell touching shins or kettlebell handle in line with ankles and follows that line throughout movement (weight stays as close to you as possible throughout movement)

  5. short and sharp sniff into belly to create Intra-Abdominal Pressure before lifting and lowering

  6. pushing through the heels to activate your posterior chain and initiate the deadlift

  7. a neutral standing position at the top of the lift (ankles, knees, hips, shoulders, ears in one straight line), not hyperextending through the back

  8. on the way down: not losing the lats; neutral neck; vertical shins and keeping the bar moving through the same line so it grazes shins on way down.

That is what every deadlift should look like, no exceptions, no excuses. If you are finding you're not achieving some of these steps then I'd urge you to seek help. You may have some mobility issues that need addressing first or maybe it is just a case of changing the way you move.

 

DOWNLOAD OUR INFORMATIVE DEADLIFT TUTORIAL VIDEO BELOW...

Deadlift Video Tutorial
3.99 4.99

A simple to follow instructional video of how to breakdown the deadlift for correct technique.

Suitable for anyone who has been deadlifting but may not be sure of their technique or are getting pain with deadlifts.

Also suitable for anyone who has never deadlifted before and would like to learn how. 

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