Strength Essentials for Lower Back Problems. Lower Back Problems. Injury and Pain issues. Tim Keeley B.Phty, Cred.MDT, APA Principal Physiotherapist

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1 for Lower Back Problems Tim Keeley B.Phty, Cred.MDT, APA Principal Physiotherapist physiofitness.com.au Lower Back Problems Hyper-lordotic / kyphotic Disc Bulge and Herniation SIJ dysfunction / no glutes What will we cover? Strength essentials Technique, instruction Only Part of the problem? Core activation / treatment Injury and Pain issues Inner Core stability Pain / reflex inhibition, Transversus and multifidus de-activation & rapid atrophy Global muscle compensation patterning / compromise Over-active lumbar extensors, QL, obliques not designed to do the work for TA, MF and PF! Bracing, pushing out, boxing Breathing and pelvic floor problems, breath holding, pressure Lumbo-pelvic instability Muscle tightness and weakness Strength in hip and pelvic stabilisers, Postural changes, tilting, joint stiffness Complex system!

2 What to RESTORE? Range of Movement Flexibility Activation, motor control Postural control, stability Functional movement patterns Strength, dynamic movement Endurance Repetitions...Timeframe...continuation! Reverse effects = success Make a plan, must rehab everyone is a individual Bridge the GAP 100% not 80%! 1. Hyper-lordotic / Kyphotic Pain: standing and running Posture internal vs external Loss of neutral (into extension) Tightness Overactivity Weakness 1. Hyper-lordotic / Kyphotic Restore and maintain neutral Improve flexibility of tight muscles Thoracic extension ROM Inner core, Gluteal and activation and strength Correct movement patterns Strengthen Hamstrings and Gluteals Relative Core strength to leg strength

3 Key Stretches QL / Lumbar Extensors Hip flexors Rectus Femoris Thoracic Extension Pectorals? Adductors 60 sec! Inner / Outer Core Pelvic Floor / Breathing Transversus, Multifidus Stable, flexible spine Control shear forces Match level to load/task Transition to exercises Optimal stability for exercise Watch brace patterns Retraining specifics refer Prone Glute (Sling) Glute Bridges BOSU Skydives Physio Lunges

4 Hamstrings Romanian Deadlift Prone Hamstring Curls Single Leg R-D/L TRX / Ball Curls Hip Extension Machine Do s and DONT S It s not the Lumbar that needs strength Hamstrings are not short! Maintain neutral Watch extension activity Overload compensation Stretch Disc Bulge and Herniation Pain: sitting, bending and lifting Referred Pain and symptoms Mechanism of Injury Loss of Extension Pain into Flexion / Spasm Core Shutdown / global bracing Lumbar support

5 2. Disc Bulge and Herniation Restore Lumbar extension ROM Activate Inner Core PF / TA Postural support and education Correct lifting and bending movement patterns Gradual strengthening program Positions to avoid... McKenzie Extension Lumbar rotation Hamstrings Neural Key Stretches Inner / Outer Core Pelvic Floor / Breathing Transversus / MF Knee Fall Outs Heels Slides Leg Lifts Arm / Leg Raises Planks NO Crunchies!...

6 Hamstrings Avoid... Romanian deadlift Heavy lifting / squat Kettle bell swings Heavy axial loading Incorrect spinal positions Correct Lifting Patterns Sumo Squats Front Squats Deadlift technique Breathing / core Function vs Bulk Fitness vs Strength Gradual return to normal fitness routine Do s and DONT S SLOWLY build spinal, core and leg strength Watch loss of neutral Axial loading rule for Squats and lifting Intra-abdominal pressure Postural life changes

7 3. SIJ dysfunction and no glutes Pain: PSIS, weightbearing, usually one sided Hypermobility, sway backs TA / MF Delayed Rotation, tilt, torsion Hip stabiliser tightness Glute Max inhibition One-sided lumbar tightness? Scoliosis Posterior slings 3. SIJ dysfunction and no glutes Restore pelvic / SIJ balance Core stabbility Activate hip stabilisers Posterior slings Single side / leg strengthening Key Stretches Lateral Rotators / Piriformis QL Hip flexor Hamstrings

8 Hip activation / stabilisation Clams Bridges / one leg Prone glute (sling) Arm / leg raises Glute / Hamstring Single leg deadlift Step downs Physio lunges Step ups Do s and DONT S Correct activation and pelvic posture Stabilisation over power Think FUNCTION Don t return to impact too early

9 Last but not least... Pain and injury seek Physio treatment PT s need to work with the Physio... Physio need s to work with the PT! Continuation of the rehab exercises Tricks for client compliance Long term outcomes Bridge the GAP 100% not 80%! Thank you! physiofitness.com.au facebook.com/physiofitness Thank you! physiofitness.com.au facebook.com/physiofitness Appointments E: timkeeley@physiofitness.com.au