Tag Archives: plank

Low back pain: why and what to do about it

by Thommy Chui, PT, OCS, CSCS, TPI CGFI MP2

What does it mean when someone says I threw my back out? Was it spring cleaning and this person decided, I  don’t want it anymore?

As a Physical therapist, all too often I hear the phrase” I threw my back out”, followed by… “all I’ve done for the last week is lie down, take pain medication, and rest.  I didn’t want to make it worse.”

Our human anatomy and physiology was developed to move, however our increasingly sedentary work duties and lifestyles have done quite the opposite. Whether it’s sitting watching TV, sitting in front of a computer station for hours without breaks, sitting in meetings , or traveling by car or airplane to then sit in meetings, we just aren’t moving as much anymore.

Studies have shown that prolonged sitting can contribute to decreased disc height in our lower back.  Additionally, extensive sitting produces overly tight hip muscles and weakness in the low back and gluteal muscles.   The result is an imbalance in our core stability.

The most common non-traumatic ways in which people injure their lower back is by bending, standing from a chair, turning or twisting. This is when we “throw our backs out.” What does this mean? It means that since we have an imbalance in our core stabilization, our muscles are not working in harmony. Specific muscles around our spine end up compensating and can progressively become overworked, setting the stage for injury.  The pain we feel initially is usually  tension or spasms of these overworked muscles.  Remember the root of the problem is weakness and inadequate stability caused by not moving enough.—so the last thing you should to do when your back is sore or in pain is lie down and not move!

Research shows that continued mobility in pain free ranges in combination with modification of activities helps decrease pain significantly.

Below are some recommendations for strength and mobility exercises along with safe techniques for getting in/out of bed and standing up from chairs without exacerbating your back pain. Try these the next time you have back pain and it may help avoid a trip to your doctor’s office.

LOG ROLL (4 steps):

log roll 1 crop

log roll 2 crop

log roll 3 crop

log roll 4 crop

HIP HINGE

hip hinge crop

SIT-STAND (SQUAT)

squat crop

LUMBAR ROTATION, TRUNK ROTATION

LTR 1 crop

LTR 2 crop

FRONT PLANK

front plank crop

SIDE PLANK

side plank crop

BRIDGE

bridge crop

References:

–          O’sullivan, K et al. “Lumbar posture and trunk muscle activation during a typing task when sitting on a novel dynamic ergonomic chair.” Ergonomics. 2012;55(12):1586-95. doi: 10.1080/00140139.2012.721521. Epub 2012 Sep 25.

–          Zemp, RIn vivo spinal posture during upright and reclined sitting in an office chair.” Biomed Res Int. 2013;2013:916045. doi: 10.1155/2013/916045. Epub 2013 Sep 24.

–          Lee SH, et al “The change of whole lumbar segmental motion according to the mobility of degenerated disc in the lower lumbar spine: a kinetic MRI study.” Eur Spine J. 2014 Mar 28.

–          Kline JB et al. “Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers: a case series.”J Dance Med Sci. 2013;17(1):24-33.

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Ski/Board Strong, All Day Long: Week 4

Hooray for SNOW!!!  Welcome back to the fourth week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.  By now you should have a good base strength to protect you from injuring yourself the first day out on the slopes.  Also by now, hopefully you have made it to the slopes!  The previous weeks direct you in beginning hip, core, and balance exercises.

Week 1:  Glut med and balance progressions

Week 2: Front plank and squat progressions

Week 3:  Clams and side plank progressions

Now, we are going to work on power development:

Bridge Progression – Week 4

If there was a single exercise we’d perform on a deserted island, it’d be an exercise called bridging, or just, the bridge.  The bridge reverses so many deficits that can be detrimental to our level of conditioning.  The bridge will strengthen your core, gluteals, hamstrings, and stretch the hip flexors.  This exercise progression is great for prepping for the slopes and can be a lifelong injury prevention exercise.

Start: Double or single leg bridge.  Perform 2 sets of 10-20 repetitions or to fatigue.  Make sure your lumbar spine and pelvis is neutral and that you engage your lower abdominals.  During the single leg bridge keep your pelvis flat like a table top.

Progress:  Perform the progression above on a physio ball

Hip Power Progression – Week 4

Last week, we introduced the clamshell exercise to help stabilize the hip joint and ligaments during movements requiring change of direction.  The large outer layer of the hip musculature (the gluteus maximus) along with the hamstrings are responsible for large bursts of power.  The squat below will help develop this movement, and work on upper body muscle imbalances at the same time.  To work on hip extensors, power, AND balance, perform the RDL progression.

Start: Overhead squat.  Make sure to keep your elbows locked and arms right overhead.  Squat down as far as you can before your arms start migrating forward or your heels start leaving the ground.  Perform 2 sets of 10-20 or to fatigue.

Progress: Single leg Romanian dead lift (RDL).  Perform 3 sets of 10-20 reps or to fatigue on each side.

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.

Check back for next week’s installment of the ski and snowboard series!

Ski/Board Strong, All Day Long: Week 3

Welcome back to the third week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.

Missed the earlier posts?  See them here: Week 1 and Week 2

Gluteal Progresssion – Week 3

Although it is essential to perform challenging and fatiguing large muscle strengthening exercises, it is also essential to continue working on small muscle stabilizers.  Keeping stabilizing muscles active during skiing and snowboarding will protect the joints and ligaments during movements involving large torques or change of direction.  As explained last week, holding that crouched posture down the slopes takes endurance mixed with bursts of power.  If you don’t have enough endurance to last the entire run it will be difficult for joint stabilizers to do their job during technical moves requiring quick changes of direction or bursts of energy.  Here is a video of how to keep those hip rotators strong.

Start: Sidelying clam.  Perform 2 sets of 10-20 repetitions or to fatigue.  Make sure your hips stay stacked and that you engage your lower abdominals to prevent low back twisting.

Progress:  Add resistance tubing when you can perform 20 repetitions before tiring.

Core Progression – Week 3

This closed chained progression is the best core stabilization exercise for the lower abdominals.    Having a strong core that coordinate with the hips well will dramatically improve your balance and power during technical moves.  The progression to dynamic rotations is even more specific for improving stability during change of direction on the slopes.

Start: Side plank.  Modify to bent knees if the full plank is too difficult or if you are just beginning.  Perform 3 sets of 30 seconds or to fatigue on each side.

Progress: Dynamic rotations with the upper torso.  Perform 3 sets of 10-20 reps or to fatigue on each side. 

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.

Check back for next week’s installment of the ski and snowboard series!

Wrist Pain with a New Baby

Congrats!!! The little one is finally here!

As a new mom, you’re busy settling into the routine of motherhood. The last thing you need slowing you down is wrist pain! Luckily, there are some easy tricks and tips that can help you feel better and prevent further injury to your body.

After childbirth, hormone levels are fluctuating, pressure in your body changes from a significant loss of fluid, and you’re likely tired—all the time. This can be a tricky combination, particularly when you’re now having to lift a squirmy, fragile baby throughout the day. Additionally, repetitive movements throughout the day (breast or bottle feeding, lifting/lowering your baby, carrying car seats and diaper bags), create the perfect recipe for “repetitive stress” injuries of the muscles and nerves surrounding the forearms and wrists.

Fortunately, there are some simple ways to protect you from pain, or to decrease pain if it’s already started.

While feeding baby:

  • Use a nursing pillow (i.e. Boppy, My Brest Friend [www.boppy.com, www.mybrestfriend.com). This will help support the weight of baby so your hands don’t have to!
  • Allow yourself to recline back, and support the weight of baby on your body, rather than in your arms
  • Use arm rests or pillows under your elbows for support
  • Keep your fingers/hands relaxed and shoulders back. You can even think about tightening your abs – this not only helps tighten up that baby belly, but it provides more support to your spine which in turn helps to support your neck/shoulders/arms.
  • If bottle feeding, be sure to keep your wrist in a neutral position (knuckles in line with forearm) – try holding the bottle from underneath rather than over the top and keep your elbows tucked in.baby

When lifting/carrying baby:

  • Get in the habit of tightening your abs and pulling your shoulders back, this gives you a stronger core and makes it easier for your arms and hands to do their job efficiently
  • Get close to your baby. The more you have to reach with your arms, the more stress you place on your wrists, elbows, and shoulders.
  • Train yourself early on to carry baby on both sides, or in the middle using both arms. Holding your baby too much on just one side places increased stress that side.
  • If you’ll be needing to hold your baby for more than a couple of minutes, use a baby carrier (i.e. Ergo, Baby Bjorn, Moby Wrap) to help distribute the weight from your arms to your trunk.

Here are some great exercises to help prevent overuse:

Wrist flexor/extensor stretches: Start with right arm stretched out in front of you, palm down. Grasp fingers of right hand with left hand. Keeping right elbow straight gently pull fingers down towards the floor until you feel a comfortable stretch in the forearm. Hold for 15-20 seconds, then relax. Repeat with palm turned up towards the ceiling.

Plank: Get on the floor on your hands and knees. Tighten your abdominal muscles (think about pulling the belly button up towards your spine). Extend one leg back, then the other, until you are in a pushup position. Hold for 2-3 deep breaths, up to 1 minute as tolerated.

Exercises to do with your Newborn

Baby Kisses (pushup): With baby lying on the floor, get into pushup position, either on your knees or toes. Bend elbows to lower yourself towards the floor, giving baby a kiss when you get to the bottom. Be sure to keep your abs tight and your spine straight and long!

Baby press (chest press): Lie on your back, with baby on your chest/stomach. Holding baby around the ribs, under the arms, press the baby up towards the ceiling, then lower back down for a kiss. Repeat 5-10 times as baby allows!

Baby reach arms and legs (bird dog): Start on hands and knees. Tighten abdominals. Reach right arm forward and left leg backward. Hold for a breath, then switch arm/leg. You can hold a rattle or baby’s favorite toy in each hand to keep baby interested. Wiggling the fingers works too!

If you have ongoing pain, numbness or any other symptoms see your doctor for apropriate care. Physical Therapy may be warrented. Go to Sports Wellness Center for more information and subscribe to our bi-monthly blog for ongoing fitness and wellness tips.

Best Core Exercises

Does doing sit-ups give you six-pack abs? The rectus abdominis are the muscles that give you flat abs, but from a back safety prospective, sit ups should not be your focus. Instead, spend your time strengthening the core.

THE INSIDE SCOOP…
As a physical therapist, when talking about “the core,” I’m referring to the lower abdominal muscles that help to support the lumbar spine. The core includes the transversus abdominus muscle, as well as the obliques, mutifidus, erector spinae, and quadratus lumborum. As a group, these muscles help to provide a stable base and foundation for one’s body to function. Just as a house needs a stable foundation to withstand environmental stresses, your body needs a strong core to carry out physical tasks.

GET THE MOST BANG FOR YOUR BUCK:
These exercises activate many of the core muscles to support the back like a back brace. Integrate these core strengthening exercises into your daily exercise program to not only tone your middle section, but also to prevent back injuries.

SIDE PLANK:
The side plank has been shown to produce high levels of muscular activation in the obliques and transversus abdominus muscles, yet produces low compressive forces on your spine. Start this exercise supported on your forearm and knees and progress to forearm and feet. Hold for 20 sec and repeat 3 times, once you have perfected this move, progress to 30 second holds. Progress this by planking on elbows and feet like the video below.

DEAD BUG:
Recent evidence has shown that engaging the lower abdominals without flattening the spine (neutral position) will activate the tranversus abdominus to a greater degree than a traditional pelvic tilt or segmental bridge exercise. With this evidence in mind, it is importance to encourage a neutral back position when strengthening your lower abdominals.

QUADRUPED BIRD-DOG:
Exercises performed on your hands and knees are a safe way to strengthen the muscles along your back (multifidus and erector spinae). Research has shown muscle activity levels of 30% maximum voluntary contraction can be achieved with this exercise.

References

1. Axler CT, McGill SM. Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge. Med Sci Sports Exerc. 1997;29:804-810.

Ski and Snowboard Series – Week 4

Hooray for SNOW!!!  Welcome back to the fourth week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.  By now you should have a good base strength to protect you from injuring yourself the first day out on the slopes.  Also by now, hopefully you have made it to the slopes!  The previous weeks direct you in beginning hip, core, and balance exercises.

Week 1:  Glut med and balance progressions

Week 2: Front plank and squat progressions

Week 3:  Clams and side plank progressions

Now, we are going to work on power development:

Bridge Progression – Week 4

I always tell my patients that if I was stuck on a deserted island and I could only choose one exercise, it would be the bridge.  The bridge reverses so many deficits that can be detrimental to our level of conditioning.  The bridge will strengthen your core, gluteals, hamstrings, and stretch the hip flexors.  This exercise progression is great for prepping for the slopes and can be a lifelong injury prevention exercise.

Start: Double or single leg bridge.  Perform 2 sets of 10-20 repetitions or to fatigue.  Make sure your lumbar spine and pelvis is neutral and that you engage your lower abdominals.  During the single leg bridge keep your pelvis flat like a table top.

Progress:  Perform the progression above on a physio ball

Hip Power Progression – Week 4

Last week, we introduced the clamshell exercise to help stabilize the hip joint and ligaments during movements requiring change of direction.  The large outer layer of the hip musculature (the gluteus maximus) along with the hamstrings are responsible for large bursts of power.  The squat below will help develop this movement, and work on upper body muscle imbalances at the same time.  To work on hip extensors, power, AND balance, perform the RDL progression.

Start: Overhead squat.  Make sure to keep your elbows locked and arms right overhead.  Squat down as far as you can before your arms start migrating forward or your heels start leaving the ground.  Perform 2 sets of 10-20 or to fatigue.

Progress: Single leg Romanian dead lift (RDL).  Perform 3 sets of 10-20 reps or to fatigue on each side.

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.  There will be no class Sat Dec. 25th or Sat Jan. 1st.  In the meantime, keep working hard!

Last minute shopping:  Give the gift of fitness with CPMC Sports Wellness holiday specials.

Happy Holidays!

Ski and Snowboard Series – Week 3

Welcome back to the third week of the Ski and Snowboard Series.  This is a progressive strength and conditioning program specific to snow sports injury prevention and performance enhancement.  Week 1 and Week 2 Series emphasized beginning hip, core, and balance exercises.

Gluteal Progresssion – Week 3

Although it is essential to perform challenging and fatiguing large muscle strengthening exercises, it is also essential to continue working on small muscle stabilizers.  Keeping stabilizing muscles active during skiing and snowboarding will protect the joints and ligaments during movements involving large torques or change of direction.  As explained last week, holding that crouched posture down the slopes takes endurance mixed with bursts of power.  If you don’t have enough endurance to last the entire run it will be difficult for joint stabilizers to do their job during technical moves requiring quick changes of direction or bursts of energy.  Here is a video of how to keep those hip rotators strong.

Start: Sidelying clam.  Perform 2 sets of 10-20 repetitions or to fatigue.  Make sure your hips stay stacked and that you engage your lower abdominals to prevent low back twisting.

Progress:  Add resistance tubing when you can perform 20 repetitions before tiring.

Core Progression – Week 3

This closed chained progression is the best core stabilization exercise for the lower abdominals.    Having a strong core that coordinate with the hips well will dramatically improve your balance and power during technical moves.  The progression to dynamic rotations is even more specific for improving stability during change of direction on the slopes.

Start: Side plank.  Modify to bent knees if the full plank is too difficult or if you are just beginning.  Perform 3 sets of 30 seconds or to fatigue on each side.

Progress: Dynamic rotations with the upper torso.  Perform 3 sets of 10-20 reps or to fatigue on each side. 

Still not motivated or don’t have enough time to practice every day?  Come to Total Body Fitness every Tuesday and Saturday where we will feature specific exercises geared towards snow sports fitness.  Later this week we will be posting a blog specific to common skiing injuries.