Tag Archives: squat

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 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!

Squats: Good or Bad?

Few subjects in the realm of strength and conditioning inspire the wealth of opinion that this question does. Although long recognized as one of the premier lower body exercises for developing strength and beloved by rehab professionals for its ability to screen for strength and mobility deficits, the squat is often viewed as being bad for knees and backs. Complicating matters is the fact that there are as many variations to the squat exercise (stance width, foot position, knee flexion angle, without weight or with a barbell, etc.) as there are opinions on the proper way to perform it. Even the minds behind the depraved—but frequently brilliant—sitcom “It’s Always Sunny in Philadelphia” inserted their own take on proper squat form in one previous episode:

“All right, here’s what you’re going to do. You’re going to take all the weight on your neck. Then you’re going to jam your legs down and hyper-extend your ankles, and then shoot back up and lock your knees in place.”

Ouch! Truthfully, much of the apprehension involving squats stems from this misperception that heavy weights and large movements of the body are required. Squats of this variety can only be safely performed by properly trained individuals. For the rest of you who may have avoided squats due to concerns about their safety and benefits, here are some reasons to reconsider:

Your 1-year-old son/granddaughter/nephew does it

If you’ve had the opportunity to observe a toddler, you know this: from the time a child first learns to stand, they know how to squat. Not just squat, but squat PERFECTLY. Thighs parallel to the floor, trunk upright with spine aligned and feet flat on the floor—the perfect harmony of strength and mobility. Even more humbling, watch them maintain that position for 1-2 minutes and then return to standing without even a hint of effort on their faces. The lesson: the human body was designed to squat. It’s only as we get older, start to neglect joint mobility, posture and muscle strength that squatting gets unfairly cast as a “bad” exercise.

Squats are a functional exercise

The true beauty of the squat is that its utility crosses all age and ability levels. From the high-school athlete performing off-season strength and power training to improve his vertical leap to the 80-year-old grandmother wanting to have an easier time standing up from chairs (or perhaps improve her vertical jump as well…), squatting is a requisite task for many of our daily tasks.

Squatting (correctly) can actually prevent injury

While it certainly bolsters the strength of crucial thigh, hip and core musculature to help deter injuries to the knee, hip and lower back, the benefits of squatting don’t end there. Including the squat in your regular exercise routine can also lead to improvements in balance and joint mobility, extensibility of muscles and fascia, and strength of connective tissues.

Squats are safe

But don’t just take our word for it. In a comprehensive review of research examining the biomechanics of squatting, Rafael Escamilla (Ph.D., physical therapist and noted contributor to research on all things squat) concluded that squatting not only “does not compromise knee stability, but can actually enhance stability when performed correctly” (Escamilla, 2001).

Now that we’ve hopefully convinced you of the benefits of squatting and reduced some of the anxiety related to perceived risks, the question becomes “What is the correct way to squat?” Certainly the best way of ensuring proper form is to seek the expertise of a strength and conditioning specialist, fitness professional or physical therapist—particularly if you have pre-existing joint pain or dysfunction in the lower extremities or spine. Below are some general guidelines for proper squat mechanics.

  • Set feet approximately hip width apart with toes turned slightly out.
  • Break at the hips and knees simultaneous: the hips moving backward (imagine sitting down in a chair) while the knees travel slightly forward with each knee staying centered over the middle of the foot.
  • Lower the body slowly and with control, keeping the torso as erect as possible (maintain slight arch in lower back) and the chest up.
  • Keep your chin level or slightly tilted up.
  • Feet stay flat on the ground throughout.
  • To return to the starting position, extend the hips and knees together while keeping the torso upright.

Take a look at the two photos below.

The image on the left demonstrates proper squat mechanics as described above.

In the image on the right we see unsafe squat mechanics most likely caused by decreased mobility of the ankle and tight hamstring muscles. The feet are no longer flat on the ground, the lower back is rounded with excessive forward trunk angle and the knees have traveled excessively forward. Each of these form flaws can lead to joint pain and dysfunction.

Remember, squats can be an effective exercise even when performed through smaller ranges of knee flexion (bending). Focus on proper mechanics and pain-free movement vs. depth of squat. In the end,  squats are good.  The reason they have the stigma of being bad is because people continue to do them with pain or poor form.