Injury Prevention for the Low Back

January 21, 2014 by Leave a Comment

Injury prevention is important, especially for something as essential as back health. Look at these great exercises
by Christopher McGrath for the lower back and then come visit us at San Diego Sports Physical Therapy for more great exercises! 619-756-7500

Given the prevalence of low-back pain, it is important for fitness professionals to be prepared with preventative strategies to support their clients’ low-back health. While movement deficiencies and dysfunction at any part of the body can lead to compensatory movements that may affect the low back, special consideration can be taken with regards to the core/lumbar region, as well as the functionality of the hips and thoracic spine. Strategies that are designed to stabilize and strengthen the core, while also increasing mobility through the hips and thoracic spine, can minimize excessive stresses to the low back, and enhance overall functionality and performance.

Disclaimer: Low-pack pain can be the result of many different issues (muscular strains, arthritis, herniated discs, stress, etc.). Therefore, it is important to seek appropriate diagnosis and clearance for your client before administering any type of exercise program, especially those designed to improve back health. The principles and exercise examples in this article are designed for preventative purposes—NOT as treatment of low-back pain.
A Quick Guide to Setting Priorities

When addressing strategies for low-back injury prevention, here are some basic principles to follow:

1. Core Stability vs. Core Strength

It is commonly suggested that a strong core will protect the low back. While this is true, it is not as simple as performing a series of planks and crunches. In fact, core stability and core strength can be viewed as mutually exclusive concepts. You can have good core stability without strength and visa versa. Core stability is more about timing or sequencing of the deeper core stabilizers activating at the onset of movement to provide segmental stability of the spine, while core strength is more about fitness and is typically associated with higher intensity and volume (i.e., traditional planks and crunches). Stabilization and strength complement one another; however, deficiencies in stabilization and timing can lead to inefficient strength and place an at-risk back at even greater risk, despite high levels of fitness.

For better core stability and timing, focus on exercises that promote stabilization through relatively low intensity movements. For example:

-With palms down, place fingertips under the lumbar and/or pelvis (it’s not necessary to use your whole hand).
-Assume a neutral arch in the lumbar spine and slowly lift one foot a few inches off of the floor (larger movements can disrupt the focus).
-Place the foot back on the floor and repeat with the other leg. Start by always keeping one foot on the floor.
-Primary Focus: As you perform the marching motion, maintain even weight on both hands by preventing weight shifting from hand to hand. Pay attention to left/right difference and spend extra time developing control of the side that appears weaker.

2. Reflexive Core Strength

During everyday and athletic activities, the core must respond to changing and sometimes unpredictable environments. Therefore, isometric exercises without reactive challenges can limit the core’s ability to be functional. Creating exercises that require the core to respond to shifting resistance can be a great way to teach the core how to stabilize and stay in control during dynamic movements.

Modified Plank With Alternating Knee Extension

-Assume a modified plank position. Always have at least one knee on the floor.
-Slowly extend one knee to full extension (with toes still on the floor) for two to three seconds and return to the starting position.
-Repeat with the other leg.
-Perform a series of alternating reps. Start with lower numbers to ensure control (e.g., three to five alternating reps, short rest, reset, perform again).
-Primary focus: Maintain a perfect plank while knees shift. Resisting the body’s desire to shift/rotate will improve reflexive stability and build for a stronger plank. This deceptively challenging exercise is appropriate for everyone, and serves as a great micro-progression for those that find modified planks too easy and full planks too difficult.

3. T-spine Mobility

Thoracic mobility is important, especially in regards to rotation. If the thoracic spine is restricted, the lower back will likely assume a higher percentage of rotation, leaving it vulnerable to torque related injuries. Aim for symmetrical rotation of the thoracic region.

Active Rotation

-Begin by lying on one side, with the top leg in a 90/90 position (90 degrees at hip and 90 degrees at knee); rest the top leg on an object roughly 6- to 10-inches high (foam roller, medicine ball, etc.)
-With the top hand holding the bottom set of ribs, take a deep breath and exhale while pulling upper body into rotation. Keep the top knee on the object.
-Hold for two to four seconds, return to the starting position and repeat.
-Perform with methodical movements, using slow, deep breathing to guide tempo. Complete six to 12 reps, according to how you feel. Range of motion should increase with each rep to some degree.
-Note left and right differences. If one side is tighter, spend more time on the tighter side.

4. Rotation Control

Once an acceptable range of thoracic rotation is established (or if a client already possesses appropriate or even excessive thoracic mobility), controlling the range is the next priority.

-Lie on back in a figure 4 position, with the right ankle on the left knee.
-Place the right arm on the floor even with, or slightly above, the shoulder.
-Anchor the right scapulae to the floor and do not let it pull away from the floor. This enhances scapular stability.
-Rest the left elbow on the floor and use it as an assistor if rotation cannot be controlled without the help. Otherwise, keep the elbow off of the floor.
-Slowly rotate the lower body (right heel lowering to the left), making light contact with the right foot to the floor. Return to the starting position while maintain contact with the right scapula at all times.
-Repeat on other side. Pay attention to left/right differences. Spend more time on the weaker or tighter side.

5. Hip Mobility

Ensuring adequate levels of flexibility and control through hip flexion, extension, internal and external rotation can help prevent unwanted movements of the pelvis and low back. In addition to traditional hip flexor and glute stretches, also focus on external rotators.

Hip Mobility of the External Rotators – Standing Figure 4 Hip Stretch

-Left leg instructions: Place left leg on a table approximately mid-thigh height with the femur perpendicular to the pelvis and the knee at approximately 90 degrees.
-Support the left leg with a roller, ball or towel under the knee.
-The pelvis must be parallel to the table (do not rotate the pelvis open or away from the table).
-The stretch should be felt deep in the hip (external rotators).
-Maintain a tall posture. With hands crossed over the shoulders, slowly exhale and rotate the torso to the left (towards the stretching leg); return to the starting position.
-Perform enough repetitions that hold the stretch for at least 45 seconds (six to 10 slow reps with pauses in between should be sufficient).
-Repeat on the other side. Pay attention to left/right differences, and spend more time on the tighter side as needed.

6. Hip Rotation/Integration

This exercise integrates a pressing motion with hip internal rotation and core stabilization.

-With a band or cable to the right side of the body, start with a wide, athletic stance.
-With the handle placed in front of the right chest/shoulder region and the right elbow pointing directly toward the weight/anchor, perform a single-arm press across the body.
-Keep the left leg, knee and foot pointing forward, so that the pelvis rotates over the left femur. Resist the foot turning or the leg bowing out.
-Pivoting the right foot (back foot) will result in greater rotation into the left hip.
-Return to the starting position and perform preferred number of repetitions (fitness reps/sets may apply).

One of the best strategies for remaining injury free is to not get injured in the first place. Once the injury cycle has started, however, incidence of future injury increases dramatically. Taking unnecessary risks can lead to a lifetime of recurring, frustrating issues. By prioritizing prevention strategies through proper preparatory work, sensible progression strategies, and knowing how to listen and react to warning signs (in other words, don’t “push through it”), can keep your clients exercising for a lifetime without hassle.

Chris McGrath, M.S., is the founder of Movement First, a New York City-based, health and fitness education, consulting and training organization. With more than 20 years of fitness and coaching experience, McGrath specializes in a variety of training modalities including sports performance, injury prevention, post-rehabilitation and lifestyle/wellness coaching. McGrath is a Senior Fitness Consultant to the American Council on Exercise and has established himself as an international fitness expert.

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Myths and Misconceptions: Muscle Soreness

January 9, 2014 by Leave a Comment

Is it good to be sore after workouts? Check out this ACE Fit article to see if you may be over-doing it. Then come see us at San Diego Sports Physical Therapy for some great rehabilitation exercises to get you back on track. 619-756-7500

There is a common misconception that muscle soreness through exercise is inevitable and necessary to see results. For many, soreness acts as an indicator of a great workout. But this is a shortsighted view of exercise benefits and can have detrimental effects in the long run.

To clarify, this is not about the minor muscle stiffness that can be felt the day after a workout. This is about excessive soreness—the kind of soreness that lasts for a few days, has you avoiding stairs and dreading everyday activities such as putting on pants, getting in and out of a car, and even sneezing. Some people actually strive to experience this. And while a little soreness is safe and may motivate even the most sensitive among us, when it crosses the line toward debilitating movement, your body is telling you that you went too far.

The Science
In short, all muscle soreness is a result of microscopic tears that take place through workouts, followed by swelling as part of the repair and rebuilding process. This may sound like a violent way to treat your body, but it is a necessary process to stimulate changes that improve strength and fitness. But how much is enough? To answer this accurately, lets look at the available research and remove any anecdotal biases from the equation.

Cause and Effect
Many people argue in favor of soreness because they have experienced positive results and associate soreness with the results. But soreness does not necessarily equate with a cause and effect for the improvements. In fact, there is no scientific evidence that proves soreness gets better results. While there is a lack of research in this specific area, there is no shortage of research indicating that progressive challenges are responsible for improving fitness. The question then becomes, can we progress effectively without soreness? And the answer is a resounding YES.

Consider world-class athletes. No athlete, after falling short in competition, has ever said, “I should have trained to be more sore.” Yes, athletes do sometimes experience sore muscles from training. But it is neither the purpose nor the target of their training. In fact, workouts are often modified for athletes if they are experiencing excessive soreness. The measuring stick used to track success for an athlete has nothing to do with the level of soreness derived from day-to-day training and everything to do with the longer-term outcome of their training program and competition goals. In fact, too much soreness will negatively impact training and competition.

Overload
To improve fitness, it is true that an “overload” is required. This means you need to apply a challenge that is greater than what your body is accustomed to. However, this “overload” can be applied aggressively or it can be applied gradually. Many assume the more aggressively you overload, the faster you will see results. But the body is more complex than that and pain is its way of telling us to slow down with the overload.

Law of Diminishing Returns
Most improvements follow a basic premise of “the more you put in, the more you’ll get out.” However, there is a tipping point that suggests a certain level of extra work does not yield any additional benefits. In short, it means you are working overtime and not getting paid for it. This can be illustrated through the concept of exercise dosage. Much like medical prescriptions, too high of a dose does not provide additional benefits nor increase the speed of benefits. Additionally, repeated “overdosing” can invite negative consequences. Extreme soreness is often just that—an “overdose” to the body.

Why it is Important to Avoid Muscle Soreness?
The Hot Iron syndrome…
Most kids only need to touch a hot iron once. If you simply don’t like to feel pain, soreness is more likely to be a deterrent to exercise, not a motivator. In fact, it may be a subconscious reason it is so difficult to start up or get back to that first workout after a layoff.

Fitness should make everyday life easier, not harder…
Extreme soreness naturally alters choices for activity outside of workouts. If your weekly leg workout leaves you feeling sore for three days, and you choose escalators over stairs, it defeats the functional purpose of being more fit.

Tighten up those muscles…
This phrase, which is often used to describe a positive outcome, may literally mean “tighten” in this case. Consistent states of soreness can easily reduce range of motion and lead to permanent changes to your movement patterns.

Overtraining and overuse injuries…
Overtraining and overuse injuries take time to develop. Unfortunately, by the time they are noticed, you are too deep to reverse the process quickly. Aiming for and achieving soreness week in and week out is inviting either or both.

Distraction from more important goals of exercise…
Exercise and fitness success needs to have a far more sophisticated evaluation tool than the level of soreness. By aiming for soreness in the short term, we may be ignoring the true measurements of success for exercise, such as fitness, strength, functionality and longevity, among others.

How to Avoid Muscle Soreness and Still Achieve Great Results
Avoiding soreness is not the same as avoiding high intensities. High intensities and maximum effort can be reached through sensible and progressive overloading strategies. You just don’t want to start there. Gradual progressions are very effective and are a far more reasonable and comfortable way to improve fitness and reduce short- and long-term risks. This can be accomplished by understanding your current levels of fitness and strength, and applying small and frequent increases in intensities and volume according to where you are now—not the level you someday hope to reach.

Remember, fitness is built. It is not injected. Build it wisely…

By Christopher McGrath

Chris McGrath, M.S., is the founder of Movement First, a New York City-based, health and fitness education, consulting and training organization. With more than 20 years of fitness and coaching experience, McGrath specializes in a variety of training modalities including sports performance, injury prevention, post-rehabilitation and lifestyle/wellness coaching. McGrath is a Senior Fitness Consultant to the American Council on Exercise and has established himself as an international fitness expert.

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Why Your Muscles Shake During a Hard Workout

December 31, 2013 by Leave a Comment

If you think you may be straining yourself during a workout, take a look at this article by Jay Cardiello. Then come see us at San Diego Sports Physical Therapy to get your work outs under control.

Pushing yourself during a workout is never a bad thing, and going so hard that your muscles start to shake is certainly a sign that you’re at your max—but your body may also be trying to tell you something. While many people pass this off as a simple sign that they’re out of shape and a majority of my fitness colleagues would agree that this trembling is not a great cause for concern, it could also lead to injury if you’re not careful to use proper form.

Let’s explore why your muscles may quiver during a barre class, Pilates, strength workout, or other type of exercise—and what to do about it.

1. Inadequate sleep. If you are heading into a cardio or strength training session feeling lethargic or lacking a good night’s rest, you will probably experience tremors at some point in your routine. [Tweet this fact!] The body continues to grow and heal when you get the proper amount of sleep. Disrupting this can cause your muscles to stay in a catabolic-like state. If you’ve been skimping on sleep, I recommend you skip the gym and stay in bed (if you work out in the morning) or head to bed (if you’re a p.m. exerciser).

2. Going to extremes. With fitness crazes like CrossFit and endurance events like Tough Mudder becoming the staple in mainstream fitness, people are really pushing themselves to the extremes these days. However, take caution and implement mandatory rest days into your fitness routine. Check out my last blog for the proper way to rest so you can keep up a sustainable workout routine and stop the shakes.

3. Too new, too much, too soon. If you try a new fitness class or jump into a new routine, at some point during your workouts you may feel your body start to wobble because working different muscles than you’re used to may be too much, too soon. While it may not be a cause for great alarm, it’s probably best to lighten up. You could place stress on other parts of your body in order to compensate for weaker muscles, which may cause injury. For example, if it’s your first time performing burpees, by the fourth or fifth one your legs may start to shake. Instead of resting, you decide to continue but with bad form, which can strain your lower back. Bad idea.

4. Dehydration. Your workout can be one of the best indicators of whether or not you are hydrated. When your body is low on water, your muscles and connective tissues have difficulty performing what they are meant to do, as improper hydration can cause an imbalance of your electrolytes, which are involved in muscle contraction. [Tweet this fact!] I recommend drinking half of your body weight in ounces daily. Remember, if you’re thirsty, you’re dehydrated.

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