Back Conditioning for the construction worker/tradesperson.

Transcription

1 Back Conditioning for the construction worker/tradesperson. Colina Morrison 10 th June , BASI Australia, Pilates Studio 64

2 Abstract Australian tradespeople, commonly referred to as tradies are traditionally tough workers. Work typically involves physical labour and long hours. The physical nature of the work can lead to injury, either suddenly or over time. According to Work Safe Queensland, Musculoskeletal disorders are the most common workplace injury in the construction industry and 42% of construction workers compensation claims in Queensland are due to musculoskeletal injuries. Of which 33% are back related. These injuries can include muscle sprains and strains, joint degeneration, nerve injuries, and chronic pain. The top three most common causes are lifting, falls, and repetitive movement or strain. In the following paper I conduct a case study on construction worker suffering from lower back pain. Using the Pilates method, I implement a conditioning program with goals to improve core strength and flexibility to reduce the risk of further injury whilst also reducing the severity of his symptoms. 2

3 Table of Contents Abstract Page 2. Table of Contents Page 3. Anatomical description Page 4-5. Case Study Page 6. Conditioning Program Page 7-8. Conclusion Page 9. Bibliography Page 10. 3

4 Anatomical Description The lower back (L1-L5) is referred to as the lumbar spine. The two lowest segments, L4-L5 and L5-S1 bear the most weight and are most prone to injury, as in the case of our case-study. Core strength, the common term used to describe the strength of the musculature of the trunk is fundamental in making movement more efficient. When a body is equipped with good core strength then the body is better protected against injury. In this study I place focus on the anatomy which makes up the internal support system (ISS). Internal Support System The abdominals are known to support the back and alleviate pressure from the spine. Learning to activate these muscles correctly is imperative to improve core strength and will be a huge focus in our back-conditioning program for my case study. 4

5 The main muscles in which I focus on in my case-study and their functions are further outlined below. Multifidus- responsible for segmental motion between each of the vertebrae. Studies have shown a decreased strength of multifidus is present with back pain hence it is very important for lower back pain rehabilitation. Transverse Abdominus- These stabilizing muscles are the deepest of the abdominal muscles and are provide vital support to the spine. These can also be found to be in a weakened state in those who have chronic back pain or back problems. Pelvic floor- The pelvic floor consists of a group of muscles which together form an internal sling which provides support to hold the pelvic and abdominal organs in place, and also allows bladder and bowel control. These muscles are continuous with transversus abdominus muscles, and activation of the pelvic floor may help with activation of the TA. Gluteus minimus, medius, maximus- stabilises the hip and pelvis laterally in single leg stance. Internal rotation, abduction, externally rotates and abducts the hip. Hamstrings- responsible for knee flexion and hip extension and when shortened/tight they pull down on the lower back which can be a common contributor to lower back pain. 5

6 Introduction Back pain is experienced by most people at some point in their life but unfortunately for tradespeople the risk of pain and/or injury is higher due to the physical labour demanded of their bodies. Many tradespeople are stoic and just accept that back is part of the job. My goal in this study is to show that with a regular Pilates program not only is it possible to alleviate back pain but also prevent further injuries. Case Study Dave is an active 40 year old male, father of one, and owner of a successful construction company. He spends his time at work divided between performing heavy physical labour on construction sites and long hours on the road driving to visit different job sites. Dave has experienced chronic back pain for the past 10years. Over the years he has had multiple treatments including sports massage, chiropractic treatement, osteopathy and physiotherapy, none of which have provided complete relief from his systems. In 2017 MRI s showed Dave had a L4/L5 disc bulge. In January 2018, Dave was referred to me by his physiotherapist and came to me with a broad goal to improve core strength, improve flexibility and mobility, all with the hope this would provide relief from his symptoms. Whilst mobile and still reasonable active, he presented with lower back pain (L4, L5), tight hamstrings, and overall stiffness in his movements. He found that prolonged sitting would aggravate his symptoms and that moving helped to relieve his symptoms. After completing and initial assessment, I recommended one Private session a week for 5 weeks, progressing to 2-3 small group sessions per week. 6

7 Conditioning Program In my studio I have access to Reformers, Wunda chair, Step Barrel, and small props/assists so my program is based around these available apparatuses. As sitting causes an increased pressure in the lumbar discs I initially chose to use the Reformer for most of the program. The Wunda chair was introduced for some exercises and will be introduced more over time. I chose to implement the following full-body conditioning program using the BASI Block system. BLOCK EXERCISE Notes Warm Up Roll down Fundamental warm up on Mat: - Pelvic curl/tilts - Supine twist (small) - Chest lift - Chest lift with rotation (introduced after 4 th session) Each session began and ended with a roll-down which provided valuable feedback regarding Dave s current physical condition. During the first 4 sessions, pelvic curls were kept to small pelvic tilts while Dave learnt to engage his deep abdominals and articulate is lumbar spine. Lateral rotation was kept minimal and introduced only once I felt Dave s back pain was under control. Footwork Footwork series Reformer Focus on hamstring activation, hip extensors and maintaining a neutral pelvis. Abdominal work Single leg lifts Chest lifts on SB Hundred Prep Standing Pike I chose these exercises to teach Dave abdominal control and provide a Lumbar stretch without aggravating his lower back. 7

8 Hip work Spinal articulation Feet in straps Reformer - Frog - Circles down/up - Hip opening Bottom lift Reformer Focus on Hip adductor strength, Hip adductor stretch and Pelvic lumbar stabilization. Introduced on 3rd session. Chosen for emphasis on hamstring strength which Dave was lacking. Stretches Standing Lunge Hip flexor and hamstring stretch. Dave noted feeling much more mobile after completing these. FBI 1 Down stretch Introduced on 4th session. Chosen to challenge Dave to keep back, hip and shoulder extensors working throughout. Arms Arm sitting series Arm kneeling series I chose the arm sitting series to begin with but had Dave seated on the long box so as to ensure less pressure on his lumbar spine. We then progressed to the arm kneeling series after his 5 th session. FBI 2 Elephant Only introduced after 5 th session and chosen for the lengthening benefits on hamstrings. Legs Lateral flexion/rotation Single leg skating Hamstring curls Side stretch wunda chair Mermaid Focus on glute and hamstring activation to strengthen these areas which will in-turn help alleviate low back pain. Chosen for its oblique emphasis and lateral stretch benefits. 8

9 Back extension Breastroke prep Swan prep wunda chair Introduced on first session with focus on TA activation and back extensors. Swan prep on the wunda chair was introduced on his 5 th session. Conclusion The above program was introduced in Private sessions and the exercises were progressively added. After the first 5 weeks Dave s mobility had greatly improved. He reported his back pain had reduced drastically and he only felt pain after long days of driving rather than most of the time. Dave has now been attending Pilates for 5 months. He continues to attend 2-3 group classes per week and is recently back at the gym and kicking the football with his 6year old son. Implementing this conditioning program has not only alleviated Dave s symptoms but has improved his core strength and that combined with his new-found awareness means he is better equipped to handle the tough demands his job as a tradesperson requires. He recently ed me saying the following, I am feeling the best I have for years. No back pain at all. I reckon I could fill all of your classes with all the tradies I have told. 9

10 Bibliography Body Essentials 1, Studio Pilates International 2008 Fundamentals of Anatomy and Physiology, 7th Edition, Frederick H Martini PhD, Pearson Education Isacowitz, Rael. Study Guide Comprehensive Course. Body Arts and Science International The Mayo Clinic, Anatomy of the Human Spine, see Mayfield Brain & Spine Tradies Health, see Work Safe Qld, see