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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The Yoga Injury Debate

January 7, 2014 by Leave a Comment

If you do yoga, do you experience any injuries? Come see us at San Diego Sports Physical Therapy to get back on track,

To yoga or not to yoga seems to be a common question for individuals. The debate is heating up in both trade and consumer publications, each explaining various relevant perceptions. The controversial topic has had the yoga community and advocates in upheaval about the negative perceptions that some have about yoga.

Although yoga has many advanced “acrobatic-like” qualities, classes offered in most health-club settings do not promote or practice advanced postures. In addition, yoga, like any other form of exercise or athletic pursuit, can pose a risk of injury. Awareness, acceptance and proper training are the keys to preventing injury.

What Causes Yoga Injury?

Injuries occur for a wide variety of reasons; in some cases, the cause may be unknown. Injuries may occur on the point of action, while other ailments creep up over time, with no explainable cause as to why the pain or injury occurred.

Some individuals argue that specific yoga poses cause injury due to a joint’s vulnerability in the pose, while others believe advanced postures are the primary cause of injuries.

While there is no single cause of yoga injuries, here are some common reasons why they often occur:

-Pushing beyond one’s physical capabilities to more advanced postures
-Forcing the body to stretch beyond one’s flexibility level
-Not being mentally prepared, or stable, for advanced postures
-Striving for perfection in poses

The Flexibility Spectrum

The occasional yoga participant potentially faces the greatest risk of injury due to a restricted range of motion in the joints. When there is a lack of mobility, other joints may try to compensate, which may result in overstraining, overuse or injury.

On the other hand, many yoga instructors may have experienced injuries due to having a highly flexible body. Having muscles that are too lax or flexible may make the individual more likely to overstretch the ligaments and tendons.

Ideally, one should be located near the center of the flexibility.

Personal Flexibility Awareness

Every body is gifted with a natural ability. Just as athletes are “born” with genetic gifts that, along with considerable training, enable them to excel in their sports, some individuals are naturally more flexible than others. In addition, some individuals who have practiced yoga, gymnastics or dancing from a young age are flexible and strong enough to perform advanced postures in their adult years.

Individuals who start a yoga practice after the age of 30 may or may not progress to advanced postures. It can sometimes take years to get the mind and/or body in an advanced state. Progressing yoga poses is similar to progressing traditional exercises, requiring one to build a solid foundation before moving toward the advanced state.

Wanting to look and perform like others in class, however, can increase the risk of moving beyond one’s current flexibility.

Acceptance of One’s Ability

Mass marketing yoga advertisements show yogis effortlessly performing beautiful postures. This makes us strive to or become curious about how to perform these poses. Generally, this is the point where we force ourselves to move, bend or stretch beyond our capability.

In yoga, this is called the ego—the driving force that wants to shine and succeed, or the voice that tells us we are not good or strong enough. Yoga instructors and attendees need to step off their mat and analyze their abilities and embrace their strengths. Acceptance is what keeps us satisfied in our practice and trusting ourselves on when to progress a given posture.

For example, a person may have a lack in spinal extension, which can make back-bending postures challenging, especially advanced spinal extension movements. However, this person may have exceptional wrist and forearm strength to perform beautiful inversions. This does not mean she has to avoid backbends; rather, she must understand and accept her limits and capabilities without forcing the spine into a foreign position.

What Comes First—the Fear or the Posture?

When progressing to advanced postures, many yoga instructors promote overcoming physical fear through advanced postures. For example, if someone has had wrist issues and a fear of re-injuring that joint or a fear of falling, one can perform a handstand (with or without wall support) to overcome the fear. Although this notion is successful for some, it poses another question of whether or not an advanced posture should be the driving force to overcome fear.

In yoga, as in many other sports, one must truly train the mind and be confident in one’s ability before progressing to advanced states. A baseball pitcher or tennis player must be mentally sound and visualize that perfect pitch or serve. If an athlete doubts his or her abilities, the majority of the time that pitch or serve will be unsuccessful or erratic. The same concept applies in yoga.

When performing a handstand, if one thinks, “I can’t do this. I don’t want to fall. I’m scared,” he or she is not mentally prepared yet. When the mind flutters, the physical body may weaken or fall, which can result in strain or injury.

Final Thoughts

Though some individuals have been seriously injured in yoga, it is best for practitioners to instruct various levels of yoga poses when working with the general population. Many yoga poses are not appropriate for everyone and instructors should understand which higher-risk asanas should be modified.

Neither the student nor the instructor should fear yoga. Education and awareness are essential for those who want to perform to perfection or advanced postures. Many students have that driving force to push forward, but it is through clear communication that we can educate them about the potential risks.

With various body types and mixed-level classes, the requirements are higher for instructors to know the anatomy and potential risks of each pose. When in doubt, teach the basic and common poses, such as Warriors, downward facing dog and balance poses.

References

American Academy of Orthopaedic Surgeons (AAOS) (2012). Yoga Injury Prevention.

Kerr, Z. et al. (2010). Epidemiology of weight training-related injuries presenting to United States emergency departments, 1990 to 2007.The American Journal of Sports Medicine, 38, 765- 771.

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