Thursday, September 17, 2015

Take Back Your Back

Muscle imbalances are a common cause of back pain.
PHOTOGRAPH BY MARCUS MOK/GETTY IMAGES
Muscle imbalances and dysfunction in the lower half of the kinetic chain most often set the stage for a “bad back.” At the same time, imbalances in the upper body can also play a role in nonspecific lower back pain. 
What to Watch For
In the Overhead Squat Assessment, look for compensations such as rounding of the lower back, increased lordosis (swayback), and forward trunk lean. Also ask:

Does your job require you to sit for long periods? Prolonged sitting can cause anatomical changes that impact the kinetic chain. The changes include a shortening of the gastrocnemius, soleus, and hamstrings and a tightening of the hip flexors. 

What’s your current workout program? Many athletes overlook the importance of core-strengthening and stability work. Core weakness can lead to an increase in shear forces during athletic movement, which can escalate into lower back pain. 

Easy Checks for Imbalances
In almost every client, one side of the spine is overactive (in righties, it’s typically the right-hand side that dominates). Add these simple checks to identify the extent and nature of the imbalance. 

Leg raise on a foam roller. Have the client lay on his back, knees bent, feet flat on the floor, a foam roller positioned lengthwise along the center of his spine; cross his arms over his chest, elbows falling to sides. Have him raise the right leg off of the floor. If the right transverse abdominis and left quadratus lumborum fire correctly, he won’t fall. If they fail, he’ll roll to his right elbow. Repeat with other leg. 

Hip hike on a step. Have the client stand with a neutral spine position, right foot at the edge of a 2-inch riser, left leg hanging to the side. Have him keep shoulders level and right leg straight while “hiking” left hip upward. In many people, the dominant hip rises 2 to 3 inches higher. 

Back to the Doctor
If your client’s back pain is or has been severe, ask these five questions before starting any routine. If any of the answers are “yes,” refer the client to a doctor and require the doctor’s OK before you work together.

● Do you feel any tingling or numbness?
● Do you have any loss of sensation?
● Do you have any loss of motor control, such as an inability to raise your arm over your head?
● Do you have or have you ever had a loss of bowel or bladder function?
● Do you have severe immobility or an inability to walk?

Other red flags: recent falls, a history of herniated disks, and back pain that is constant throughout the day. The PAR-Q evaluation should help you identify these issues.

A Simple Move to Ease the Ache
Many of the most effective moves for lower back pain don’t seem to involve the back at all. Here’s one that can help get a client’s lumbo-pelvic-hip complex back on track.

hamstring stretch
Hamstring Stretch
Tight hamstrings increase posterior pelvic tilt, which is evidenced by a rounding of the lower back during the Overhead Squat Assessment. Try the Opposite Side Biceps Femoris stretch: Client stands on the right leg with left heel propped on a 6-inch step, left leg crossing the midline of the body toward the right. Clasp hands and rotate trunk to the left. Repeat standing on the opposite leg.

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