Tag Archives: Strengthening exercises

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 2

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

Last week’s blog emphasizing gluteal and balance progressions can be performed in addition to this week’s series emphasizing more advanced gluteal and abdominal stability work.

Core – Week 2

After performing the floor gluteal strengthening and balance exercises a couple of times we are ready to progress to what we call closed chained strengthening (feet on the ground), which is very specific to skiing and snowboarding.  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, you will be too gassed to perform any technical moves requiring quick changes of direction or bursts of energy.  The best way to develop both types of strength in the core is by performing a variety of plank exercises described in the video below.

Start: Stationary plank on elbows/toes.  This can be modified to elbows and knees.  Perform 3 sets of 30 seconds – 1 minute or to fatigue.  If you are able to hold the stationary plank for > 30 seconds with good form, attempt the more challenging versions.

Progress:  Dynamic plank on BOSU hands and toes or leg extension.  Perform 2 sets 10-20 of each or until fatigue.

Circuit these sets with the squats (below) or balance drills from last week to save time and keep your heart rate up.

Gluteal Progression – Week 2

This closed chained progression is the most specific to both skiing and snowboarding technique.  Having stong hip extensors and the ability for your core / hips to coordinate well together will minimize the possibility of improperly edging or wiping out on the board because you couldn’t get your hips centered in time.  The progression in the video below (to one leg squats) emphasizes glut and core coordination for improving quick change of direction.

Start: Double leg squats.  Perform 2 sets of 10-20 reps or to fatigue.  Add hand weights and lower body slowly to increase load.

Progress: Single leg Squats.  Perform 2 sets of 10-20 reps or to fatigue.

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 to snow sports fitness.

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

Ski/Board Strong, All Day Long: Week 1

Ski and Snowboard Series

Thanksgiving is fast approaching and you are probably feeling the pressure of the holiday season.  Having a goal in mind and program in place will alleviate some of the pressure and keep you focused.   Knowing that there is a 10 foot base of snow will keep you motivated to start prepping for ski and snowboard season.   To help you progress your training safely, we will be uploading weekly videos.   We will also be posting about common snow sport injuries and training pitfalls.

If you routinely hit the slopes every winter, you are already aware of the potential risk of injuries without prepping your trunk and legs properly.  You are not only at risk for injury, but at risk for poor performance.  Everyone dreads the soreness after their first day back on the mountain.  Doing just a little bit of training will dramatically reduce the aftermath of that first day.  Each week we will post two sets of exercises that are focused on a specific muscle group or coordination of multiple muscle groups specific for skiing or snowboarding.  Get going today with these exercises for week 1.

Week 1 – Gluteal Progression

Week one of snow sport training involves waking up dormant hip muscles (specifically the gluteus medius).  This muscle is essential for stability and power during change of direction while carving or shredding down the mountain.

Start: sidelying hip abduction  – Perform 2 sets of 10-20 reps on each leg or until fatigue in the side of your hip.

Progress:  band walks – perform 1 minute walking even distances to the right and the left or until fatigue.

Week 1 – Balance Progression

Without superior balance we would not be able to stand up let alone descend the mountain on our skis or snowboards.  Standing on one leg coordinates glut and core activation, also essential for safe and efficient mechanics on the slopes.  Balance can be improved in extremely short amounts of time IF you practice it.

Start: Single leg stance.  Hold for 30 seconds.  Repeat on both sides.  Progress to performing with eyes closed.

Progress:  Single leg stance on an unstable surface and/or ball toss.  Hold for 30 seconds.  Progress by closing eyes.  Also, progress by tossing a ball for 30-60 seconds.

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 special exercises geared for snow sport fitness!

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

Work Hard Now for a Better Snow Sports Season

Ski and Snowboard Series

Thanksgiving is over and you are probably feeling the pressure of the holiday season.  Having a goal in mind and program in place will alleviate some of the pressure and keep you focused.   Knowing that there is a 10 foot base of snow will keep you motivated to start prepping for ski and snowboard season.   In effort to help you progress your training safely we will be uploading weekly videos.   We will also be posting about common snow sport injuries and training pitfalls.

If you routinely hit the slopes every winter, you are already aware of the potential risk of injuries without prepping your trunk and legs properly.  You are not only at risk for injury, but at risk for poor performance.  Everyone dreads the soreness after their first day back on the mountain.  Doing just a little bit of training will dramatically reduce the aftermath of that first day.  Each week we will post two sets of exercises that are focused on a specific muscle group or coordination of multiple muscle groups specific for skiing or snowboarding.  Get going today with these exercises for week 1.

Week 1 – Gluteal Progression

Week one of snow sport training involves waking up dormant hip muscles (specifically the gluteus medius).  This muscle is essential for stability and power during change of direction while carving or shredding down the mountain.

Start: sidelying hip abduction  – Perform 2 sets of 10-20 reps on each leg or until fatigue in the side of your hip.

Progress:  band walks – perform 1 minute walking even distances to the right and the left or until fatigue.

Week 1 – Balance Progression

Without superior balance we would not be able to stand up let alone descend the mountain on our skis or snowboards.  Standing on one leg coordinates glut and core activation, also essential for safe and efficient mechanics on the slopes.  Balance can be improved in extremely short amounts of time IF you practice it.

Start: Single leg stance.  Hold for 30 seconds.  Repeat on both sides.  Progress to performing with eyes closed.

Progress:  Single leg stance on an unstable surface and/or ball toss.  Hold for 30 seconds.  Progress by closing eyes.  Also, progress by tossing a ball for 30-60 seconds.

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 special exercises geared for snow sport fitness.  Later this week we will be posting a blog specific to common skiing injuries.

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.