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This is a brief anatomy, common complaints related to the low back from gymnast, biomechanics of a bridge, and neuromuscular recruitment and facil
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Low Back Injury Prevention in the Gym
Brandi Smith-Young, PTPerfect 10.0 Physical Therapy
Fellow, American Academy Orthopaedic Manual Therapy
Board certified orthopedic specialist
www.perfect10physicaltherapy.com
Introduction
Competitive gymnast
Two time USAG Collegiate National Champions at TWU
Bachelors in Kinesiology at TWU
Masters in Physical Therapy at Tx St
Practicing for 7 years
Fellowship trained in Orthopedic manual physical therapy
Board certified orthopedic specialist in PT
One of 300 therapist in the US with these certifications
My passion:
Bring sport specific quality care to gymnast
Decrease the number of injuries in gymnast
Improve performance, recovery time, decrease time lost in the gym, and improve return to sport status
Performance Enhancement
Common complaints
Pain in the front of the hip
Pain on outside of the hip
Pain in low back
Pain running down back of leg
Pain running down the inside of leg
Anatomy of Low Back
Anatomy cont’dAll these muscle
provide stabilization for the low back
If these muscles are not functioning properly increased stress will eventually lead to injury.
Muscle imbalance
Some muscles are strong
While opposing muscles are weak
Some muscles are stretched out
While opposing muscles are too tight.
Due to the stringent requirements placed on gymnast certain muscles tend to develop stronger than others
Certain muscles get weak
Other muscles develop tighter
And some develop looser or stretched
Common muscle imbalances
Contribute to most injuries in gymnasticsWeak abdominals/coreWeak hip musclesHamstring doing to much and buttock muscle not
doing enough.Tight hip musclesTight IT BandTight lats or shoulder muscles
Biomechanics of bridge
Forces of arching backwards (180 deg arc) need to be shared btw the shoulders, thoracic spine, lumbar spine, and hips.
Pic: USA Gymnastics Junior Compulsory Program
Biomechanics of bridge
Poor shoulder flexibility, poor thoracic flexibility (extension), poor spine control (via sling of muscles), and/or poor hip flexibility contribute to forces being concentrated typically in the low back (L4-5, L5-S1) and/or mid back (TL junction)
Pic: USA Gymnastics Junior Compulsory Program
Demonstration Time
Ways to decrease imbalances
Strengthen the corePelvic tilt (fig 1 & 2)
Must tighten belly button up toward the nose and in toward the spine (40-50 on blood pressure cuff)
Not straight down into the floor
Marching (fig 3) Start with pelvic tilt No motion in the hips, hips
stay level (keep at 50) Alternate legs
Figure 1
Figure 2
Figure 3
Core cont’dHeel Slides (fig 4 &5)
Start with pelvic tilt (40-50 with blood pressure cuff)
Slide R leg out maintaining the tilt
No rocking of the hipsMonitor hips with handsSlide L leg out back still
flatSlide R leg inSlide L leg in= 1 rep
Figure 4
Figure 5
Active Straight Leg RaiseLay on back with band
above the head.
Pull band to the floor with straight arms & hold
Raise one leg with the opposite straight leg staying flat on floor.
Toes point upward, no rolling of hips.
Slowly lower straight leg and return arms above head.
X15-20 fwd, X15-20 side
Active Lower AbdominalsLay on back with band
above the head
Pull band to the floor with straight arms & hold
Both knees bent to 90, keeping the back flat to the ground lift both knees toward the chest
Keep back flat as lower both legs to the ground
Return arms above head x15
To progress begin to straighten knees
ObliquesEngage abs belly button up
and in, back flat
Breath in, hold as rotate the torso towards the bent knee
Breath out and in as hold 10 sec x10
Progress to 20-30-60 sec x2-5
Keep the elbow rotating towards on the ground.
Keep the opposite hip (leg straight) flat on the ground
Trunk Stability Rotation Lay on back hips and
knees flexed to 90, shoulder at 90 degrees arms straight out
Place ball or towel between knees
Rotate the knees to one side, keeping opposite shoulder blade down. Hand on side of rotation turns down the opposite hand stays turned up.
Return to starting position, repeat on opposite side
Tweaking current conditioning
Gymnast are great at compensating
Make sure they remain flat back when doing core exercises (not rounded in upper back or arched in lower back…neutral spine)
Do not allow an arch throughout the entire exercise Ie. V-ups on floor or from the bars, hollow holds, sit-ups,
crunches, hanging sit ups, etc
Modify by decreasing the lever arm (bend knees or bring arms closer to the body if unable to maintain good form. Progress as strength and control improves.
Hand Heel RocksPlace a stick
horizontally across the hips/low back
Tighten absDo not let the stick
move as rock backRock back and
forward as far as you can with control
Bird Dog with BandStart with stick
across low backTighten absPh I alternating
armsPh II alternating
legsPh III alternating
opposite leg with opposite arm
No motion at hips, no movement of stick
Bird Dog Phase 3
Hip strengthStrengthen the hip
muscles
Clam progressionPhase I (fig 6)Sidelying, roll hip
forward.Tighten abs, tighten
buttockKeep heels together
and lift one knee upMonitor hips, no motionHold 10 sec x10
Figure 6
Hip External & Internal Rotation Quadreped & Prone
Start on all 4s, knees under hips and hands under shoulders.
Theraband attached to ankle pulling away from the band
Engage abdominalsGently squeeze
bottom with no hip flexor activation
Rotate the hip so the foot moves inward (ER)
In the same position; move the band to the opposite foot.
Rotate the hip so the foot moves outward (IR)
Repeat laying flat on the stomach.
May need a towel or pillow under the belly button.
Make sure abs engaged belly button moves up and in.
Hip External & Internal Rotation Quadruped & Prone
Strength IliopsoasSeated Iliopsoas (fig 9)
Sitting tall, back straightTighten absLift one leg as high as possible
to chest with no motion in back Grab under the leg and lift all
the way to chest, no motion bkLet go with hands and hold 5
secLower 5 secx10
Figure 9
Iliospoas strength cont’dLaying iliopsoas (fig
10)Laying with one leg
bent and other straight at an angle
Tighten absLift the straight leg with
foot turned outNo motion at hipsHold 10 sec, lower slowX10Monitor hips with hands
figure 10
1 knee bent
Buttock musclesGet the buttock muscles
to work instead of the hamstrings
Prone knee bend (fig 11)May need a pillow under
belly buttonSqueeze belly so back is flat
(tighten from 70-60 using the blood pressure cuff)
Slowly bend knee to buttock without motion in hips or arching at the low back (keep at 60 using the blood pressure cuff)
Figure 11
Buttock strength cont’dProne knee bend lift (fig
12)Start in with prone knee
bend, turn 1 foot inward in figure 4 position (tighten from 70-60 using the blood pressure cuff)
Keep abs tight and no motion in low back or hips slowly lift knee up of the ground (keeping the cuff btw 80-100)
Hold 10 sec x10NO ARCHING
Figure 12
Leg Lock BridgeLie on back and hold one
knee to chest, place a ball or towel between your thigh and chest.
Bend other knee and place the foot on the floor.
Lift the hips off the floor form a straight line from shoulder through the hip to the knee.
Progress with the ground knee straight
Leg Lock Bridge Knee Straight
Squat, Jump, landing mechanicsSquat with T-band and
stick Place the crossed
band behind the lower thigh or knee
Stand feet shoulder width apart with slight turnout
Press down on the stick as sit like going to sit in a chair.
Knees must stay in line with the 2nd toes and drop over the forefoot, not passed the toes
X20
*May place a small lift under the heels to start for athletes who have trouble or limited DF.
Assisted SquatUse the band to teach
the athlete to shift COG backward.
Feet shoulder width apart with slight turnout
Abs engaged as sit like sitting in a chair.
Knees stay inline with 2nd toe and over the forefoot, DO NOT let them go forward past the toes.
x20
*May place a small lift under the heels to start for athletes who have trouble or limited DF.
Quadruped T spine rotationGet on all fours (hips &
shoulders at 90)
Place on hand on low back, palm facing away from back.
Look toward & rotate that shoulder toward the ceiling. Return to start
Rotate the shoulder toward the floor. Repeat x15
Repeat with the hand palm down on the neck. x15
Repeat on opposite side
Stretch hip musclesStretch the hip
flexors (fig 12)Pull one knee to chestTighten absSlowly slide the other
leg out without any motion in hips or low back
Gently Squeeze bottom
Trying to gently straighten the leg and push down into the floor
Hold 30 sec
Figure 12
Stretch hip and Quad musclesHip/Quad stretch (fig
13)Off the edge of a blockPull one knee to chest
with flat backLet the other leg hang
downCan add 2 pound weight
to hanging legFollow with gymnast
squeezing her bottom and pushing down into coaches hand through her thigh (no arch in back)
Make sure hip flexors DO NOT contract
Hold 30 sec-1 min and repeat 3-4 times going lower each time
figure 13
Stretching PecsPec stretch (fig 14)
Have the gymnast partner up.
One gymnast lays flatThe other gymnast either
puts on hand on the hip and the other on the opposite shoulder
Or standing at their head press down on both shoulders
Hold 1 min switch partners
Repeat 2-3 times
Figure 14
Stretch LatsLat Stretch (Robots) (fig
15)Keeping belly tight
with the back flatElbows stay shoulder
width apart (may require a partner to keep them there)
Reach back toward the floor and slowly try to straighten the arms
NO ARCHINGHold 1 min repeat 2-3
time
Figure 15
UE Elevation with T BandLay face up with T band
under both feet, knees bent
Engage abdominals keeping rib cage and spine in neutral and chin tucked in.
Press the upper extremities flat to the floor.
Keeping everything flat on the floor, slide the arms upward toward the head.
Repeat x10-15
WHEN DO I STRETCH?The end of workout when the tissue has been heated
through the workout which increased core temperature. This is when you will get your greatest changes.
You must stretch within 24 hours to maintain the changes or the tissue will creep back to prior length.
Latest research is showing greatest changes with static stretching with vibration at 30 Hz (ie. Massager) Showing that stretching tolerance is the key to increased flexibility.
The vibration tricks the nerves that feel pain into relaxing and allows for a stretch without the defensive muscle contraction.
Contact Information
Perfect 10.0 Physical Therapy
& Performance Training
www.perfect10physicaltherapy.com
512-426-6593
Follow: PERFECT10PT on
All information from:The Manual Therapy Institutewww.themanualtherapyinstitute.
com
Shirley Sahrmann.Diagnosis and Treatment of
Movement Impairment Syndrome.
Gray Cook