Lbp Management and Prevention
-
Upload
luhur-budi-adhiapto -
Category
Documents
-
view
225 -
download
0
Transcript of Lbp Management and Prevention
-
7/30/2019 Lbp Management and Prevention
1/31
Lower Back Pain:
Management and Prevention
Jon Rowe, Bkin, CEP
-
7/30/2019 Lbp Management and Prevention
2/31
Objectives
Review specific anatomy in relation to
the lower back (lumbar spine)
Touch on a few spinal injuries andmechanisms of injury
How to determine some causes of lower
back pain (LBP)
Action after identifying cause of LBP
Management and Prevention
-
7/30/2019 Lbp Management and Prevention
3/31
Sources
McGill, Stuart; Lower Back Disorders,
2nd edition
McGill, Stuart; Ultimate Back Fitnessand Performance, 4th edition
-
7/30/2019 Lbp Management and Prevention
4/31
Anatomy of the Lumbar Spine
Highly vascular, with the exceptionof the disk only they remain
avascular
Circular vertebral body,
filled with cancellous bone
Pedicle attaches body
to posterior elements
Neural Arch is composed of
laminae and pedicles;
transverse processes
and spinous processattach to neural arch
Neural arch is relatively flexible
while body is more rigid
-
7/30/2019 Lbp Management and Prevention
5/31
Intervertebral Disks
Rigid annuli surrounding
viscous nucleus
Notice cross fibers ofannulus rings allows for
greater protective forces
under compression in
multiple planes
-
7/30/2019 Lbp Management and Prevention
6/31
Interspinous Ligaments
-
7/30/2019 Lbp Management and Prevention
7/31
Some Key Musculature
Iliocostalis and longissimus both act
as thoracolumbar extensors; also
posterior shear force protectors,
moreso in the lumbar region
Thus, they are essential formaintaining a neutral spine
Multifidus also act as extensors, but
more local to lumbar spine
Function can change through
thoracic flexion, hip flexion, and
lumbar flexion erectors to shearforce protectors
-
7/30/2019 Lbp Management and Prevention
8/31
Latissimus Dorsi
Involved in lumbar extensor moment
generation; often acts as a major
stabilizer
Originates at each lumbar spinous
process and inserts on humerusgiving it a very large extensor
moment arm
Active during pulling and lifting,
which has implications for training
proper functional motion patterns
-
7/30/2019 Lbp Management and Prevention
9/31
Abdominal
Complex
rectus abdominus internal oblique
external oblique
transverse abdominus
responsible for trunk
flexion, lateral flexion,
rotation, and stabilization
-
7/30/2019 Lbp Management and Prevention
10/31
Hoop
Stresses
-
7/30/2019 Lbp Management and Prevention
11/31
Psoas
acts mostly as a hipflexor
when the hip is flexed,
psoas can also act as a
lumbar stabilizer
-
7/30/2019 Lbp Management and Prevention
12/31
Quadratus
Lumborum
lumbar stabilizer
-
7/30/2019 Lbp Management and Prevention
13/31
How does a normal spine
function? [compression]tolerance of the lumbar
spine in an average healthy young man
probably approaches 12 to 15kN (2688-3360 lb), LBD, p. 82
Competitive weight lifters have safely
exceeded 20kN (4480 lb) The lumbar spine can withstand up to
2000-2800 N of shear force
-
7/30/2019 Lbp Management and Prevention
14/31
When does injury occur?
-
7/30/2019 Lbp Management and Prevention
15/31
Tolerance Until Failure
Injury, or failure of a
tissue, occurs when
the applied loadexceeds the failure
tolerance (or
strength of the
tissue), LBD, p11.
-
7/30/2019 Lbp Management and Prevention
16/31
When the tissue fails
-
7/30/2019 Lbp Management and Prevention
17/31
Optimal Loading
very few back
injuriesresult from
a single event,LBD, p11
Just as most
systems of the body,
the spine needsappropriate loads to
improve capabilities
-
7/30/2019 Lbp Management and Prevention
18/31
What are some causes of tissue overload?
jobs characterized by manual handling of
materials, sitting in vibrating vehicles, and
remaining sedentary are all linked with lower back
disorder, LBD, p 29.
Though these risk factors do not necessarily
determine LBP/LBD, they are part of a list of
surrogate factors: static work posture; seated work
postures; frequent bending and twisting; lifting;
pulling and pushing; and vibration (especially
seated), LBD, p 29.
-
7/30/2019 Lbp Management and Prevention
19/31
The Spine Itself
A purely ligamentous spine buckles
under 90 N of compression, about 20
lbs (LBD, p. 114) Since we know the spine can withstand
much more compression, this shows
how the musculature greatly increasescompressive load potential by acting as
guy wires
-
7/30/2019 Lbp Management and Prevention
20/31
What are some specific injuries?
Bulge/Herniation
Compression +
flexion, especially fullflexion = herniation
Add rotation and the
disk tends to bulge
away from the axis of
rotation
Spondylolisthesis
Full cycling of flexion
and extension canfatigue the neural
arch (laminae and
pedicles)
Excessive shear
force can cause
damage to posterior
elements
-
7/30/2019 Lbp Management and Prevention
21/31
Lower Back Pain vs. Injury
Assuming spinal injury is not present, ie:
fracture, bulge, spondy, avulsion,
neural, etc. Assess each client to see what
movement causes the pain or where
deficiencies lie
-
7/30/2019 Lbp Management and Prevention
22/31
After Injury
It is necessary to identify the mechanism of injury,
ascertain potentially injured tissues (bone, ligament,
muscle, etc); and develop the next plan of action
There is strong evidence to support that after a lower
back injury, muscle activation patters are altered
stability comes from stiffness, passive stiffness is
lost with tissue damage and active stiffness
throughout the range of motion is lost with perturbedmotor patterns following injury, LBD, p. 119
-
7/30/2019 Lbp Management and Prevention
23/31
McGills 5 Steps
1. Groove motion patterns, motor
patterns, and corrective exercise
2. Build whole-body and joint stability
3. Increase Endurance
4. Build Strength
5. Develop speed, power, agility
-
7/30/2019 Lbp Management and Prevention
24/31
1. Grooving Patterns
It is important to begin corrections pain
free
Neutral spine is desired and should neverbe compromised in this phase
Proper motor control is correct muscles
engaged for corresponding movement Eg: gluteal amnesia following injury
Eliminate the faults in testing movements
-
7/30/2019 Lbp Management and Prevention
25/31
2. Spinal Stability
Big Three
1. Curl-Up
2. Side Bridge
3. Birddog
Abdominal bracing vs. hollowing or
protruding Fascial raking
-
7/30/2019 Lbp Management and Prevention
26/31
Why the Big Three?
Curl up imposes minimal
compressive loads to the
lumbar spine and allows neutral
lordodic curve
Side Bridge activates entireabdominal complex, plus lower
back stabilizers like QL and lats,
while maintaining neutral spine
Birddog activates entire set of
spinal extensors, though not toMVC, while keeping the spine in
neutral
Compressive forces reach
~3000N
Traditional sit up imposes
~3300N (~730lbs) of
compression on lumbar spine;
plus add full flexion!
Superman extension exercisecan impose up to 6000N (over
1300lbs) of compression on
spine; Roman Chair extension
can impose over 4000N
(~890lbs), LBD, p. 91
-
7/30/2019 Lbp Management and Prevention
27/31
3. Building Endurance
Do not take muscles to fatigue failure
Complete repetitions while muscles are
still strong: McGill advocates reversepyramid reps/sets
Side plank, birddog, chin ups, squats
-
7/30/2019 Lbp Management and Prevention
28/31
4. Building Strength
This is where you get creative
Know what will be required of your client
and train them accordingly
Be sure to maintain proper progression
Never let a regression of technique
occur: DO NOT compromise neutralspine!
Can introduce labile surfaces: SB,
wobble boards, Airex pads, etc.
-
7/30/2019 Lbp Management and Prevention
29/31
5. Develop Speed, Power, Agility
Once sufficient endurance and strength
are achieved, performance skills should
be integrated into training regime Olympic Lifting, MB work, sport specific
exercises
-
7/30/2019 Lbp Management and Prevention
30/31
The motor control system is able to
control stability of the joints throughcoordinated muscle coactivation and to
a lesser degree by placing joints in
positions that modulate passive
stiffness contribution. However, a faulty
motor control system can lead to
inappropriate magnitudes of muscle
force and stiffness, allowing for ajoint to buckle or undergo shear
translation, LBD, p. 119.
-
7/30/2019 Lbp Management and Prevention
31/31
Be wise
and be careful