To Your Health
July, 2009 (Vol. 03, Issue 07)
Rehab Protocols for Common Problems
Low Back Injury
Examples include chronic low back pain, disc herniation, spinal stenosis, etc.
Maintain neutral curve of the low back. The neutral position is designed to reduce stresses on the spine. Learning to maintain the neutral position helps you move safely when you sit, stand, walk or lift.
Stretch the tight muscles. This doesn't only mean the low back. We are also talking about the calves, the hamstrings, the gluteals, and even the mid-back muscles. One of the most overlooked muscles is the hip flexors. However, don't overstretch. Find the muscles that have limited movement and stretch them slowly.
Build Endurance. Remember that endurance exercises are more important than strength or flexibility exercises. The most common exercises to start with are planks, side planks, pelvic bridging and quadruped exercises. Notice I did not mention crunches. The reason is simple: Crunches place more pressure on your back than is reasonably acceptable.
Most exercises are performed for about eight seconds, followed by a rest period. It has been shown that back muscles get tired very quickly. So instead of trying to hold the positions for long periods of time, hold for less time, but build up to doing more repetitions.
Increase strength. Low-back extensions are good; so is progressive weight training while keeping the back in a stable position. Examples include squats, machine pulldowns, chest presses, vibration platform exercises, etc.
Improve proprioception/balance. Good ways to improve balance include standing on one foot with the eyes open and then closed; standing on a rocker or balance board; and performing vibration platform exercises.
Functional exercises. Lifting movements such as squats and lunges are good; so are reaching and twisting movements in a controlled manner. Note: Avoid any forward bending at the spine! Flexion movements are to be avoided at all costs since they put unacceptable stresses on the back.
Examples include impingement syndrome, rotator-cuff injury, frozen shoulder, etc.
Improve flexibility. You can accomplish this by stretching the chest (pectorals), mid-back (lats), upper neck (trapezius), and posterior shoulder. One of the most common stretches for the shoulder is the anterior shoulder stretch (placing an arm against a door and twisting your body away). Avoid this! It loosens the front shoulder capsule and leads to instability. Always stretch the back of the shoulders instead by crossing your arm across the front of your body to the other side.
Build endurance. Build up movements in pain-free ranges of motion. Wall crawls and lifting exercises using very low weights and high repetitions are good options. Always ensure you get adequate rest between each set.