Strength and Conditioning in Tactical Athletes With Low Back Pain Scott D. Carow, PT, DSc, OCS, SCS

Transcription

1 Strength and Conditioning in Tactical Athletes With Low Back Pain Scott D. Carow, PT, DSc, OCS, SCS The views expressed in this presentation do not reflect the official policy or position of the US Army Medical Research and Materiel Command, the US Army Medical Commander Center and School, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, Department of Defense, or the US Government. Agenda: (Slide 3) Background What s causing all this back pain? Why traditional PT treatments may not be sufficient What do we need to train? The Problem (Slide 4) 917,738 medical encounters for 214,210 military service members in ,324 episodes of care in 1 year in non-deployed military personnel low back pain in the Army: 3 Primary Dx for 1,660,702 medical encounters 68,247 lost duty days (187 YEARS!!! of lost duty) 11.1% of medical discharges from the Army What s Causing All This Back Pain? (Slide 5-13) military training causes 30-37% of back pain 3 10% increased risk of injury during periods of heavy training 4 Night training more than doubles incidence of back pain 5 Running >5k more than 3 x per wk increases incidence of back pain by 80% 5 Occupational activities cited in 50% of cases 3 Manual handling cited in up to 16% 3 Helicopter pilots report back pain ranging from 50-92% % of pilots admit rushing flights because of back pain Approximately 50% of pilots report compromised performance due to back pain

2 What is Traditional PT for Low Back Pain? (Slide 14-15) Manual therapy, dry needling, stretching etc. to restore movement Restoration of functional movement patterns Core stability exercises Basic loaded functional movements Squats, deadlift, lunges, lifts Primary focus is on sagittal movements Often anti-rotation Occasionally resisted rotation Rarely transverse plane movements under load Back Class at Fort Bliss (Slide 16) Lunge Squat Deadlift Plank Side plank Side plank Bridge Crunch Balance drills Cable chops Review of Physical Tasks Associated with Loading a Tank (Slide 17-19) Round weighs 53 lbs Picks up round from rack on right Loading the spine while sidebent and rotated Rotates quickly under load Pushes round into the breach to his left Performs all of this from a moving/unstable platform This Soldier must manage loads while working in the transverse and frontal plane He is not afforded the luxury of good body mechanics

3 However Back class has loaded him in the sagittal plane Back class has worked isometrically in the frontal plane Performed resisted (but not loaded) exercises in the transverse plane Review of Artillery Tasks (Slide 20-21) What s this Marine doing? Pick up 100lbs while wearing about 30 lbs of gear Walk with all of this Safely set the round down Repeat Review of Road Marching Tasks (Slide 22) What are these Soldiers doing? 12 miles in <3 hours 35 lbs ruck, helmet, and rifle How Do We Bridge the Gap Between Traditional PT (Slide 23-26) Primarily Sagittal Plane Exercises Squat, Deadlift, Kettlebell exercises And Tactical Requirements Loaded Transverse Plane Movements Movement with Load

4 How Do We Train This? (Slide 27) Assess your athlete s unique occupational needs Train toward those needs in your clinic Proposed Methodology (Slide 28-29) Don t be afraid to load, lift and move heavy in clinic We don t want Soldiers injured in our clinic that doesn t mean we should hope they get injured in training instead It is better to get injured in your clinic Start with good movement Perfect fundamentals squat, deadlift, lunge Don t stop here Train resisted frontal plane movement Train resisted transverse plane movements Train carries in various positions Train transverse plane movement under load Train endurance Train Carries in Various Positions (Slide 30-32) Low KB carries unilateral and bilateral Rack position carries Unilateral and bilateral Standard position vs bottoms up position Overhead carries Unilateral and bilateral Standard position vs bottoms up position Train Loaded Transverse Plane Movements (Slide 33-35) Land Mine Presses Weight stacking with rotation

5 References (Slide 36-37) 1. Ambulatory visits among members of the active component, US Armed Forces. MSMR 2012 (Apr 2013);20(4)18-23; discussion Mydlarz D. Degenerative disc disease, active component, US armed forces, MSMR. 2012;19(5): Gruhn J, Leggat P, Muller R. Injuries presenting to Army physiotherapy in North Queensland, Australia. Mil Med. 1999;164(2): Carragee EJ, Cohen SP. Lifetime asymptomatic for back pain: the validity oof selfreport measures in soldiers. Spine (Phila Pa 1976). 2009;34(9): Hou ZH, Shi JG, Ye H, et al. Prevalence of low back pain among soldiers at an Army base. Chin Med J. 2013;126(4): de Oliveira CG, Nadal J. Back muscle EMG of helicopter pilots in flight: effects of fatigue, vibration, and posture. Aviat Space Environ Med. 2004;75(4): Gaydos SJ. Low back pain: considerations for rotary-wing aircrew. Aviat Space Environ Med. 2012;83(9): Shanahan DF, Reading TE. Helicopter pilot back pain: a preliminary study. Aviat Space Environ Med. 1984;55(2): Thomae MK, Porteous JE, Brock JR, Allen GD, Heller RF. Back pain in Australian military helicopter pilots: a preliminary study. Aviat Space Environ Med. 2013;84(1): Knox, Jeffrey B, and Orchowski, Joseph. Thoracic and Lumbar Spine Injuries'. Musculoskeletal Injuries In The Military. Kenneth L Cameron and Brett D Owens. 1st ed. New York: Springer,