SPINAL REHAB FOR LASTING RESULTS

Transcription

1 SPINAL REHAB FOR LASTING RESULTS

2 Contents What are "Core" muscles...2 Bad Spinal Habits...3 Proper Lifting Techniques...4 Stages of Rehabilitation...6 Warm-up the Spine...7 Gluteal Activation...8 Foam Roll Rehab...9 Home Exercise Program...10 Pain Management and Self Care

3 What are "Core" Muscles? The "Core" Muscles as demonstrated below involve the abdominal muscles, the back and gluteal muscles. Many people only strengthen the abdominals and leave the low back vulnerable to injury. NOTES: 2

4 Changing Bad Habits WALLETS: Sitting on a wallet or phone in your back pocket elevates one hip which places a curve in your spine. Over time, this stress on the low back will cause injury and pain. Instead use a front pocket wallet. SLEEPING: Lie on your back with knees elevated for best support. Alternatively, if you sleep on your side, make sure your pillow keeps your neck neutral and a pillow between the knees will support your hips. HEADSET: Cellphone technology has come a long way. Use a headset and save your neck when talking on the phone. 3

5 PROPER LIFTING x x Two examples of improper lifting are demonstrated above. The first fails to bend the legs, therefore rounding out the back.the scond fails to keep the weight close to the body. Both leave you vulnerable to injury. The right way to lift something from the floor to standing. Bend with the knees and hips, while keeping the back straight. Notice the weight is kept close the body at all times. 4

6 RISING FROM SEATED x Incorrect: Once again, notice the rounding through the spine as she progresses from a seated position to standing. Over time, this leads to undue strain in the low back and repetitive stress type injuries. Correct: The low back is kept straight and the legs are primarily used. Push your heels down and your knees out to use your gluteal muscles for hip extension. 5

7 STAGES OF REHABILITATION STAGE 1 GOALS: Decrease pain Decrease inflammation Increase spinal range of motion in all directions STAGE 2 GOALS: Increase lumbar spine range of motion in all directions Increase strength of abdominal muscles and core stabilizers Increase knowledge and performance of proper body mechanics and correct posture. STAGE 3 GOALS: Increase muscle endurance of abdominals and core stabilizers. Increase ability to perform higher level functional activities, including job tasks and/or sports. **Important Note: This rehab program is designed to work WITH your chiropractic care for lasting results. It is not inteded to be used in the absence of chiropractic care. Without proper alignment of the spine, you may end up strengthening the injury instead of correcting it. The stages of rehabilitation correspond to the stages of chiropractic corrective care and the goals or treatment outcomes are the same. For lasting results, complete all the stages of this rehabilitation program while completing your corrective chiropractic adjustments. 6

8 WARM UP THE SPINE CAT/ COW: This exercise is a great warm-up before any exercise. It wakes up your spinal proprioceptors so they are more aware of your body's limitations. 1. Starting Position is on all hands and knees. Be certain to line up your joints as shown. 2. As you exhale, tuck your tail bone down, gently arch through the spine and let your head fall between your shoulders. This is a motion exercise, not a stretch; do not push to end range of motion. 3. Return to neutral or starting position. 4. As you inhale, let your belly drop down, tail bone lifts, and look up. Repeat 10 times flowing with your breath. 7

9 GLUTEAL ACTIVATION As most people spend too much time seated, our gluteal muscles become weak and inactive. We begin to over-use our hamstrings and recruit our lowback muscles to do what our glutes were intended for. This leads to much back pain and injury. Before strengthening, we must activate the gluteals. BRIDGE: GLUTE MAX ACTIVATION A. Lying on back with knees flexed and feet on the floor. Place fingers on glute max to feel for activity. Begin by squeezing your gluteal muscles and imagine you're squeezing a penny. You may notice, your hamstrings instantly activate as well. B. Only begin to lift into a bridge when muscle activation has been mastered. Those who are hamstring dominant will immediately feel the hamstrings activate as well. C. Stroking the front of the thigh while you do this can help to override the hamstrings. Repeatedly begin action with minimal hamstring activity. CLAM: GLUT MED ACTIVATION Lying on your side, first isolate the glute med by placing your thum on the anterior hip bone (ASIS) and reach your fingers backward. With hips and knees bent, spread the knees apart like a clam shell with the feet remaining together like a hinge. 8 You should feel the glute med muscle activate with your fingers.

10 FOAM ROLL REHAB Foam roll exercises allow for gentle mobiization of the spine in home rehabiliation. 1. Lie supine on the floor with knees bent. 2. Place the foam roll under the back of the neck. 3. Push with feet; roll the back over the foam, stretching the thoracic muscles. 4. Perform 10 times or until muscles are distinctly more mobile. 5. Perform the same activities while lying at a 45 degree angle to target the lateral spinal muscles as shown. 6. Additional muscles may be targeted as seen below. Piriformis: Sit on the foam roll slightly off center. Cross the bottom leg over the top knee to isolate the desired muscle. Roll the entire area, targeting any tender trigger points. Iliotibial Band: Lie on top of the foam roll on the side of your leg and use your upper body to roll down to the knee and back to the hip targeting any tender areas. 9

11 ABDOMINAL TRAINING ABDOMINAL BRACING VERSUS HOLLOWING: x HOLLOWING: When asked to tighten the abdominal muscles, many people pull the abs in toward the spine. This activates transverse abdominis muscle, but neglects the internal and external obliques leaving you vulnerable to injury. BRACING: Instead we prefer you simply stiffen or brace the abdominal wall which activates both the transverse abdominis and the obliques for better spinal stability. There should be no visual change to the core when you perform bracing. BEGINNER CRUNCH x a. b. Abdominal crunches are a wise choice for strengthening rectus abdominis, but any performed with poor form, injure the neck or over-stress the spine. Note: if discomfort is noted in the neck, press your tongue to the roof of the mouth to activate neck stabilization. Basic starting posture is lying supine with hands supporting the low back. Do not flatten the back to the floor. Bend one or both knees. While contracting the abdominals, keep the head and neck rigid. Flexion occurs through the thoracic spine or mid-back. The head may elevate slightly, thought spinal motion is not the goal. To make this more challenging, elevate the elbows a few centemeters. 10

12 BIRD DOG PROGRESSION STARTING POSITION: Hands and knees with hands under shoulders and knees directly below hips. This exercise trains the extensor muscles of the spine. Consciously brace the abdominals for stability. REMEDIAL: For those with a very deconditioned back, begin by just lifting a hand or knee about one inch off the floor. Advance only when you can do this without pain. PROGRESSION continues with raising one leg or one arm at a time while consciously bracing the abdominal core. Hold for 6he seconds, then return to starting position. Be sure to keep spine neutral with no spine motion. INTERMEDIATE BIRD-DOG: is achieved when you are able to raise both the opposite arm and leg simultaneously. To further challenge your muscles, after fully extending the normal Bird Dog position, sweep the extended limbs 11in toward the body and extend back out in repetition.

13 PLANK PROGRESSION PLANKS the best choice at an training level to strengthen the core while sparing the spine. In those with a very deconditioned back, you may practice the Remedial Plank which is performed upright against a wall or stable countertop. Brace the abdominals and hold this position for 45 seconds. Progress to the Beginner's Plank when this can be preformed without pain or sinking through the abdomen. *Core stabilizers may be worked daily for best results. BEGINNER PLANK: Perform by supporting your body's weight on elbows and toes, then dropping your knees for support. Keep spine, neck and head in alignment. Hold for seconds. Progress to full front plank below when you can easily hold this position for 60 seconds. FRONTAL PLANK: Support your body weight on elbows and toes for seconds. Keep entire body in straight line by bracing the abdominals. Poor form: Be sure not to let hips sag toward the floor or allow your bottom to stick up in the air. CHALLENGE: When Full Front Plank can be easily performed for seconds without deviation in form, you may further challenge your muscles by lifting one leg a few inches off the floor as shown. *Don't skip steps in the progression. Proper form is more important at all stages. 12

14 SIDE PLANK PROGRESSION SIDE PLANK OR SIDE BRIDGE is the best choice for challenging the obliques, transverse abdominis and quadratus lumborum muscles. BEGINNER SIDE PLANK: Position on your side supported by elbow and hip. Knees are bent to 90 degrees. Straighten the torso until the body is supported on the elbow and knee with some input from the lower leg. INTERMEDIATE SIDE PLANK: Position just like the Beginner Side Plank, but the legs are straight. The torso is straightened until the body is supported by the elbow and feet as shown to the right. For greater stability, place the top foot in front of the bottom foot. SIDE BRIDGE FOR THOSE WITH SHOULDER PAIN: x For those who have had shoulder injuries and connot tolerate the full weight on the shoulder, perform this modified side bridge by lying on the floor and attempting to raise the legs laterally or simply attempting to take the weight off the legs. Place a mat or towel under the hips for greater comfort in the hips. 13

15 GLUTEAL WORK POTTY SQUAT: Potition feet wider than hip width. Keeping the lumbar spine neutral and braced, squat back at a 45 degree angle. Touch bottom to the chair, squeeze the glutes and rise again, returning to a standing position. SINGLE-LEGGED SQUAT: Progress to a single legged squat, taking the free leg behind you to keep the spine neutral. Press your weight through the heel of the forward foot. LUNGES: A great exercise to gain a strong foundation in your legs. Keep the front knee inline with the toe (not in front). Your weight is in the heel of the forward leg. Squeeze the glutes and press through the heel to return to standing. If knee pain developes, take a shorter stride and lunge down lower. 14

16 UPPER BACK REHAB YWTL EXERCISES: Stage one, squeeze your shoulder blades down and together. Imagine trying to hold a pencil between them without dropping it. Hold that contraction, point your thumbs backward as you progress from the first image to the last, holding each position for 15 seconds. Progress to holding each for 30 seconds. WALL ANGELS: Heels, hips, shoulders, and head should all align against a wall or door. Squeeze the scapulas together as above. Hold the contraction as you move your arms through a range of motion similar to making a snow angel. 15

17 ISOMETRIC NECK Those who experience neck pain may find benefit by building the neck muscles as part of a spinal rehab program. In all of these exercises, the head and neck unit does not move, and the tongue is placed on the roof of the mouth behind the front teeth. The hands are placed on the forehead to resist cervical flexion. Press the head and fingers toward one another resisting motion. Hold for several seconds and release. Build up resistance over time. Repeat with the back of the head for extension and each side for lateral flexion. 16

18 NECK STRETCHES TRAPEZIUS AND LEVATOR MUSCLES: Stretch the left side by holding the fleshy top of the shoulder with the left hand. Look down and the right. Use the right hand to gently guide the head downward. Repeat on opposit side. Perform throughout the day for best results. ANTERIOR NECK MUSCLES: Hold at the bottom of the neck as shown. Gentle look up and feel a stretch on the front of the neck. Perform throughout the day for best results. PECTORALIS STRETCH: These muscles become chronically short and tight in individuals who spend the majority of their day seated at a computer or driving. Find a corner, place one hand on either side of the corner as shown. Lean into the corner and feel a stretch on the front of the chest. Perform throughout the day for best results. This also works in a doorway. Perform w/hands above shoulder level and below to stretch multiple planes. 17

19 OTHER STRETCHES HAMSTRING STRETCH: Lying on your back to protect your spine, use a band, belt, or towel as shown. Place the band closer the heel to target the hamstrings. You may place it closer to the toe to target the calf muscles. ALTERNATE HAMSTRING STRETCH: Keeping the lumbar spine straight at all times, plant one heel forward. Bend through the free leg while hinging at the hip and feel a stretch down the back of the leg. Perform daily. QUADRICEPS STRETCH: To stretch the front of the thigh, grasp a chair to steady your balance, bend one leg back and grasp your ankle with your hand. Press hips gentle forward and feel the stretch on the front of the thigh. Perform daily. 18

20 ILIOPSOAS: Take a lunge position as shown to the left. Keeping the back straight, tuck your tailbone and push foreward through the hips. To add intensity, you may take your arm overhead or across your body in front. PIRIFORMIS MUSCLE: Perform seated or supine as shown. Cross one leg over the other in a figure-4 position. Keep the back straight, hinge foreward and feel it in your buttocks. PIGEON (PIRIFORMIS VARIATION): Taking a prone position, bring one leg forward in front of the body as shown. Square your hips and relax into the position. Hold for 90 seconds. 19

21 Pain Management and Self Care Your doctor may choose to use modalities to address your pain. The following are descriptions of modalities and their purpose. WHEN SHOULD I USE ICE AND HEAT? Ice is generally used directly following an injury or surgery. Ice can be used to limit or reduce the amount of inflammation caused by the injury, and is also effective to control pain and reduce muscle spasm. Heat/hot packs may also be used in healing. The increased temperature accelerates the rate at which blood and nutrients are delivered. Heat is effective in controlling pain and reducing muscle spasm and may be used prior to rehabilitation to decrease muscle tightness. If your muscles are already inflamed, heat is contraindicated as it may increase the inflammation. SHOULD I GET A MASSAGE? Your muscles attach to your bones and are controlled by your nerves. Tight muscles WILL respond to your adjustments, but this may take some time. A massage may speed this process along and help you get better faster. TOPICAL RELIEF? We recommend you use Biofreeze topically for pain management. CAN I USE (OVER THE COUNTER) PAIN MEDICATIONS? It is recommended you avoid pain meds unless absolutely necessary. Pain signals help you know your limits and can be used to prevent further injury. Never use a pain medication to push through an exercise or activity that pain would otherwise limit. ARE THERE ANY SUPPLEMENTS I CAN USE? Arnica Montana is a homeopathic remedy used to reduce soreness and bruising. 20

22 Family First Chiropractic & Wellness Center 2024 Cherry Hill Drive, Suite 101 Columbia, M This information is intended for education of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis, and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described herein, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention. 21