Low back injury prevention in the gym

Low Back Injury Prevention in the Gym

Brandi Smith-Young, PTPerfect 10.0 Physical Therapy

Fellow, American Academy Orthopaedic Manual Therapy

Board certified orthopedic specialist

www.perfect10physicaltherapy.com

[email protected]

Introduction

Competitive gymnast

Two time USAG Collegiate National Champions at TWU

Bachelors in Kinesiology at TWU

Masters in Physical Therapy at Tx St

Practicing for 7 years

Fellowship trained in Orthopedic manual physical therapy

Board certified orthopedic specialist in PT

One of 300 therapist in the US with these certifications

My passion:

Bring sport specific quality care to gymnast

Decrease the number of injuries in gymnast

Improve performance, recovery time, decrease time lost in the gym, and improve return to sport status

Performance Enhancement

Common complaints

Pain in the front of the hip

Pain on outside of the hip

Pain in low back

Pain running down back of leg

Pain running down the inside of leg

Anatomy of Low Back

Anatomy cont’dAll these muscle

provide stabilization for the low back

If these muscles are not functioning properly increased stress will eventually lead to injury.

Muscle imbalance

Some muscles are strong

While opposing muscles are weak

Some muscles are stretched out

While opposing muscles are too tight.

Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others

Certain muscles get weak

Other muscles develop tighter

And some develop looser or stretched

Common muscle imbalances

Contribute to most injuries in gymnasticsWeak abdominals/coreWeak hip musclesHamstring doing to much and buttock muscle not

doing enough.Tight hip musclesTight IT BandTight lats or shoulder muscles

Biomechanics of bridge

Forces of arching backwards (180 deg arc) need to be shared btw the shoulders, thoracic spine, lumbar spine, and hips.

Pic: USA Gymnastics Junior Compulsory Program

Biomechanics of bridge

Poor shoulder flexibility, poor thoracic flexibility (extension), poor spine control (via sling of muscles), and/or poor hip flexibility contribute to forces being concentrated typically in the low back (L4-5, L5-S1) and/or mid back (TL junction)

Pic: USA Gymnastics Junior Compulsory Program

Demonstration Time

Ways to decrease imbalances

Strengthen the corePelvic tilt (fig 1 & 2)

Must tighten belly button up toward the nose and in toward the spine (40-50 on blood pressure cuff)

Not straight down into the floor

Marching (fig 3) Start with pelvic tilt No motion in the hips, hips

stay level (keep at 50) Alternate legs

Figure 1

Figure 2

Figure 3

Core cont’dHeel Slides (fig 4 &5)

Start with pelvic tilt (40-50 with blood pressure cuff)

Slide R leg out maintaining the tilt

No rocking of the hipsMonitor hips with handsSlide L leg out back still

flatSlide R leg inSlide L leg in= 1 rep

Figure 4

Figure 5

Active Straight Leg RaiseLay on back with band

above the head.

Pull band to the floor with straight arms & hold

Raise one leg with the opposite straight leg staying flat on floor.

Toes point upward, no rolling of hips.

Slowly lower straight leg and return arms above head.

X15-20 fwd, X15-20 side

Active Lower AbdominalsLay on back with band

above the head

Pull band to the floor with straight arms & hold

Both knees bent to 90, keeping the back flat to the ground lift both knees toward the chest

Keep back flat as lower both legs to the ground

Return arms above head x15

To progress begin to straighten knees

ObliquesEngage abs belly button up

and in, back flat

Breath in, hold as rotate the torso towards the bent knee

Breath out and in as hold 10 sec x10

Progress to 20-30-60 sec x2-5

Keep the elbow rotating towards on the ground.

Keep the opposite hip (leg straight) flat on the ground

Trunk Stability Rotation Lay on back hips and

knees flexed to 90, shoulder at 90 degrees arms straight out

Place ball or towel between knees

Rotate the knees to one side, keeping opposite shoulder blade down. Hand on side of rotation turns down the opposite hand stays turned up.

Return to starting position, repeat on opposite side

Tweaking current conditioning

Gymnast are great at compensating

Make sure they remain flat back when doing core exercises (not rounded in upper back or arched in lower back…neutral spine)

Do not allow an arch throughout the entire exercise Ie. V-ups on floor or from the bars, hollow holds, sit-ups,

crunches, hanging sit ups, etc

Modify by decreasing the lever arm (bend knees or bring arms closer to the body if unable to maintain good form. Progress as strength and control improves.

Hand Heel RocksPlace a stick

horizontally across the hips/low back

Tighten absDo not let the stick

move as rock backRock back and

forward as far as you can with control

Bird Dog with BandStart with stick

across low backTighten absPh I alternating

armsPh II alternating

legsPh III alternating

opposite leg with opposite arm

No motion at hips, no movement of stick

Bird Dog Phase 3

Hip strengthStrengthen the hip

muscles

Clam progressionPhase I (fig 6)Sidelying, roll hip

forward.Tighten abs, tighten

buttockKeep heels together

and lift one knee upMonitor hips, no motionHold 10 sec x10

Figure 6

Hip External & Internal Rotation Quadreped & Prone

Start on all 4s, knees under hips and hands under shoulders.

Theraband attached to ankle pulling away from the band

Engage abdominalsGently squeeze

bottom with no hip flexor activation

Rotate the hip so the foot moves inward (ER)

In the same position; move the band to the opposite foot.

Rotate the hip so the foot moves outward (IR)

Repeat laying flat on the stomach.

May need a towel or pillow under the belly button.

Make sure abs engaged belly button moves up and in.

Hip External & Internal Rotation Quadruped & Prone

Strength IliopsoasSeated Iliopsoas (fig 9)

Sitting tall, back straightTighten absLift one leg as high as possible

to chest with no motion in back Grab under the leg and lift all

the way to chest, no motion bkLet go with hands and hold 5

secLower 5 secx10

Figure 9

Iliospoas strength cont’dLaying iliopsoas (fig

10)Laying with one leg

bent and other straight at an angle

Tighten absLift the straight leg with

foot turned outNo motion at hipsHold 10 sec, lower slowX10Monitor hips with hands

figure 10

1 knee bent

Buttock musclesGet the buttock muscles

to work instead of the hamstrings

Prone knee bend (fig 11)May need a pillow under

belly buttonSqueeze belly so back is flat

(tighten from 70-60 using the blood pressure cuff)

Slowly bend knee to buttock without motion in hips or arching at the low back (keep at 60 using the blood pressure cuff)

Figure 11

Buttock strength cont’dProne knee bend lift (fig

12)Start in with prone knee

bend, turn 1 foot inward in figure 4 position (tighten from 70-60 using the blood pressure cuff)

Keep abs tight and no motion in low back or hips slowly lift knee up of the ground (keeping the cuff btw 80-100)

Hold 10 sec x10NO ARCHING

Figure 12

Leg Lock BridgeLie on back and hold one

knee to chest, place a ball or towel between your thigh and chest.

Bend other knee and place the foot on the floor.

Lift the hips off the floor form a straight line from shoulder through the hip to the knee.

Progress with the ground knee straight

Leg Lock Bridge Knee Straight

Squat, Jump, landing mechanicsSquat with T-band and

stick Place the crossed

band behind the lower thigh or knee

Stand feet shoulder width apart with slight turnout

Press down on the stick as sit like going to sit in a chair.

Knees must stay in line with the 2nd toes and drop over the forefoot, not passed the toes

X20

*May place a small lift under the heels to start for athletes who have trouble or limited DF.

Assisted SquatUse the band to teach

the athlete to shift COG backward.

Feet shoulder width apart with slight turnout

Abs engaged as sit like sitting in a chair.

Knees stay inline with 2nd toe and over the forefoot, DO NOT let them go forward past the toes.

x20

*May place a small lift under the heels to start for athletes who have trouble or limited DF.

Quadruped T spine rotationGet on all fours (hips &

shoulders at 90)

Place on hand on low back, palm facing away from back.

Look toward & rotate that shoulder toward the ceiling. Return to start

Rotate the shoulder toward the floor. Repeat x15

Repeat with the hand palm down on the neck. x15

Repeat on opposite side

Stretch hip musclesStretch the hip

flexors (fig 12)Pull one knee to chestTighten absSlowly slide the other

leg out without any motion in hips or low back

Gently Squeeze bottom

Trying to gently straighten the leg and push down into the floor

Hold 30 sec

Figure 12

Stretch hip and Quad musclesHip/Quad stretch (fig

13)Off the edge of a blockPull one knee to chest

with flat backLet the other leg hang

downCan add 2 pound weight

to hanging legFollow with gymnast

squeezing her bottom and pushing down into coaches hand through her thigh (no arch in back)

Make sure hip flexors DO NOT contract

Hold 30 sec-1 min and repeat 3-4 times going lower each time

figure 13

Stretching PecsPec stretch (fig 14)

Have the gymnast partner up.

One gymnast lays flatThe other gymnast either

puts on hand on the hip and the other on the opposite shoulder

Or standing at their head press down on both shoulders

Hold 1 min switch partners

Repeat 2-3 times

Figure 14

Stretch LatsLat Stretch (Robots) (fig

15)Keeping belly tight

with the back flatElbows stay shoulder

width apart (may require a partner to keep them there)

Reach back toward the floor and slowly try to straighten the arms

NO ARCHINGHold 1 min repeat 2-3

time

Figure 15

UE Elevation with T BandLay face up with T band

under both feet, knees bent

Engage abdominals keeping rib cage and spine in neutral and chin tucked in.

Press the upper extremities flat to the floor.

Keeping everything flat on the floor, slide the arms upward toward the head.

Repeat x10-15

WHEN DO I STRETCH?The end of workout when the tissue has been heated

through the workout which increased core temperature. This is when you will get your greatest changes.

You must stretch within 24 hours to maintain the changes or the tissue will creep back to prior length.

Latest research is showing greatest changes with static stretching with vibration at 30 Hz (ie. Massager) Showing that stretching tolerance is the key to increased flexibility.

The vibration tricks the nerves that feel pain into relaxing and allows for a stretch without the defensive muscle contraction.

Contact Information

Perfect 10.0 Physical Therapy

& Performance Training

www.perfect10physicaltherapy.com

[email protected]

512-426-6593

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All information from:The Manual Therapy Institutewww.themanualtherapyinstitute.

com

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