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Lumbar Spine Fitness Guidelines

Janet injured her lower back while exercising in her local gym.  She was taking a trip through her favorite “ab ciruit” when she felt a snap in her lumbar spine.  The next day she was unable to stand up straight.  Two weeks later, we met her in physical therapy for her initial evaluation.  She was ready to return to her fitness program three weeks later.  Janet was very concerned she may suffer another exercise induced back injury and requested some advice.  These are the simple guidelines I give to physical therapy low back patients returning to exercise.

Mobilize the Thoracic Spine and Hips

Movement is supposed to happen at the thoracic spine and hips.  Unfortunately, prolonged sitting, deconditioning, and poor training choices tends to restrict mobility in these areas.  If you are unable to rotate and extend at the hips and thoracic spine, your brain will use other joints to make up for the deficit.  Pushing extra rotation and extension forces into your lumbar spine is never a good thing.  Dedicate some training time to improving thoracic spine rotation and hip extension / internal rotation range of motion.  If you sit for a living, work on your mobility everyday.

Make the Lumbar Spine Stable

Most fitness clients believe that more lumbar spine movement is a good thing.  They perform toe touches, back twists, and the many breeds of up and down dogs.  Unfortunately, greater lumbar spine range of motion is positively correlated with a higher incidence of lower back pain.  The incidence of low back pain escalates even further when we move those hypermobile lumbar spine segments against a resistance.  What does keep lumbar spines healthy is high level of lumbar spine strength endurance.  Can you hold the lumbar spine stable and prevent movement from occurring at the pelvis and five lumbar vertebrae.  Your lumbar spine stays happy and healthy when you focus training efforts on planks, roll outs, crawls, carries, and Pallof press exercises.  Avoid the sit ups, crunches, sidebends, toes to bar, and other assorted “ab” exercises that create lots lumbar spine motion.

Avoid Muscle Isolation Exercise Activities

The muscles that support the lumbar spine work together as part of a neurally connected team.  Training activities that support better communication between the team members will create optimal performance.  The neuroanatomy saying is “What fires together, wires together”.  Ditch the “upper abs”, “lower abs” baloney and sprint away from anyone who trys to strap you into a machine in an effort to “isolate your obliques”.

On her discharge from therapy, Janet was unable to perform a single roll out and fatigue fairly quickly with a twelve pound suitcase carry.  For the last three months, she has followed the guidelines and her progress has been excellent.   Janet is currently performing a suitcase carry with fifty pounds and has worked up to ten full reps on an ab wheel roll out.

Michael S. O’Hara, PT, OCS, CSCS

A Little Realistic Reasoning

Worst:  I want to lose weight.
gym photoMost people are not successful in losing weight with exercise.  The ones who are have generally been diligent in following a disciplined nutritional regimen and this was the reason the numbers on the scale went down.  Now whether the reduction was good—fat loss, or bad—bone and muscle loss, we do not know, but exercise alone is generally a poor method of weight loss.  Not losing any weight is a primary reason people stop participating in an exercise program.

Best: I want to stay healthy.
Two thirds of the American population get no regular physical activity.  The adverse effects of a sedentary lifestyle have been proven.  Physical inactivity is far more debilitating than most of us realize.  One way or another, you will end up spending time and money on your health.  Spend it up front with exercise and proper education, or spend it later on medical tests, disease treatments, and doctors’ bills.  The good news is you get to choose.

Worst:  I want six pack abs.
This is probably not going to happen no matter how hard most of us train.  Body fat levels have to get down to well below 12 percent to see an outline of the abdominal muscles.  Twelve percent for men is low and for women it may be unhealthy.

Best:  I want my brain to function at high levels.
Lots of new research has been done on exercise and its effect on the brain.  The animal and human research subjects that perform the most physical activity have the best scores on brain function tests.  Read the book Spark: The Revolutionary New Science of Exercise and the Brain by Dr. John J. Ratey.  I would rather have a pumped frontal cortex and a jacked hippocampus than chiseled abs.

Worst:  I am making up for eating like an idiot.
You can’t out run a cookie.  It is much easier to ingest more calories than burn them off with exercise.  The damage caused by a diet filled with bad food, alcohol, and tobacco cannot be magically counter balanced with an hour on the elliptical or a step class.  Success with exercise has a huge psychological component.  Several studies have shown it is difficult to stay consistent with exercise if you mentally approach it as punishment for bad behavior.

Best:  I want to feel good for a long time.
Move well and you feel well.  If you can maintain the capacity to get off the floor, squat, lunge, and rotate, you will be far less likely to have pain.  Rarely do I evaluate a patient with shoulder, neck, knee, or lower back pain and not find a glaring loss of mobility or strength.  Maintaining the ability to move should be a lifelong pursuit for anyone interested in staying active and independent into old age.

-Michael S. O’Hara, P.T., OCS, CSCS

If a fitness magazine puts the word ‘abs’ on the front of an issue, it is guaranteed to sell more copies.  The fitness world is infatuated with whatever ‘abs’ means, yet most gym junkies get abdominal muscle training wrong.

The segmented “six pack” muscle that covers the front of the torso is the rectus abdominus.  The function of the indentations in this muscle is to create hoop stress that holds your body tight and tall, much like the support bars on a cellular tower.  The internal and external oblique muscles are the angled wires of the tower that create intersecting diagonal forces that keep the torso upright and stable.

In fitness centers, you see whole sets of circuit machines that flex, rotate, and extend the torso.  People perform endless repetitions of forward bending, side bending, leg lifting, and haphazardly crunch away.  These activities are well-intentioned, but are unfortunately far from optimal training.  Most of these people already spend too much time, working and driving, in a slumped forward spine position.  Their vertebral columns need less, not more, movement into flexion and rotation.

True core stability involves using your abdominal muscles to hold the pelvis, spine, and rib cage in a solid, stationary position while you move the arms and the legs.  When you run, jump, lift, or carry, the muscles in the middle must efficiently transfer force from the lower extremities through your pelvis and spine to the arms.  Any weakness in the “core stabilizers” creates a power leak that reduces performance and makes you more susceptible to injury.

ROLL OUT

One of the best training exercises for developing better core stability is the Roll Out.  The Roll Out can be progressed or regressed to fit all strength levels.  It requires minimal equipment and produces carry over to other fitness activities.  Getting stronger at the Roll Out exercise will enable you to lift, carry, push, pull, squat, hip hinge, and lunge more efficiently.

PHYSIOBALL ROLL OUT

Kneel on a padded surface.  The hips are bent to 45 degrees and the spine is held in a neutral position.  Place the wrist on the front part of the ball.  Take a deep breath and brace the abdominal muscles.  Initiate a forward roll of the ball by extending at the hips and shoulders simultaneously.  Stop just short of the point where you begin to have difficulty holding good spinal alignment.  Hold this position for 3 seconds before returning to the start position.  Rest for three seconds between repetitions.  Perform two sets of ten repetitions.

There are several ways to make the physioball roll out more challenging:

1.         Roll farther forward so long as you maintain perfect form.

2.         Extend the hold time from three to five seconds.

3.         Use a smaller ball

4.         Use a Power Wheel instead of a ball.

POWER WHEEL ROLL OUTRoll_Out

Roll Outs with a Power Wheel are a challenging step up from Roll Outs with a Physioball.  It will take some time to master this exercise, but the reward of better functional strength is big.  Power Wheel Roll Outs develop the total body tension you need to successfully lift and carry greater loads.  They will increase your pull up power and enhance squat mechanics.  The Power Wheel Roll Out serves to counteract the stress of repeated hip hinging activities such as Olympic lifting, kettlebell training, or a challenging Zumba step class.

Kneel on a mat to keep the pressure off your knees.  Your femur (thigh bone) is positioned straight up and down from the floor and the hips are hinged at 45 degrees.  Place the hands on the padded handles of the Power Wheel and the elbows directly under the chin.  Brace the abdominal muscles and roll out until you feel a challenge through your midsection.  Hold the challenging position for three counts and then return to the starting position.  Perform five to ten repetitions.

RESISTED POWER WHEEL ROLL OUT

Progress the Roll Out by adding a sandbag across your back or by wearing a weight vest.  Challenge yourself even more by attaching resistance tubing to the Power Wheel.  The forward pull of the tubing will make it more difficult to pull back up to the starting position.

Take six weeks off the crunches, sit ups, side bends, and leg lifts and get better at Roll Outs.  Your body will thank you.

-Mike O’Hara, P.T., OCS, CSCS

Rolling Over

Creating Strength With The Lifeline Power Wheel

True core stability involves holding your pelvis, spine, and rib cage in a solid, stationary position while you move the arms and the legs.  When you run, jump, lift, or carry, the muscles in the middle must efficiently transfer force from the lower extremities through your pelvis and spine to the arms.  Any weakness in the “core stabilizers” creates a power leak that reduces performance and makes you more susceptible to injury.  The Lifeline PowerWheel is one of my favorite core stability training tools for plugging those leaks.

Your core stabilizer muscles act to prevent or limit joint movement.  They function as anti-extensors, anti-flexors, and anti-rotator muscles.  Exercising with the Lifeline Power Wheel trains all aspects of core stability.

PowerWheel Roll Outs
Kneel on a mat to keep the pressure off your knees.  Your femur (thigh bone) is positioned straight up and down from the floor and the hips are hinged at 45 degrees.  Place the hands on the padded handles of the Power Wheel and the elbows directly under the chin.  Brace the abdominal muscles and roll out until you feel a challenge through your midsection.  Hold the challenging position for three counts and then return to the starting position.  Perform five to ten repetitions.

PowerWheel Resisted Roll Outs
Progress the roll out by adding a sandbag across your back or wearing a weight vest.  Challenge yourself even more by attaching resistance tubing to the PowerWheel.  The forward pull of the tubing will make it more difficult to pull back up to the starting position.

Wheelbarrow Walking
Velcro strap the Power Wheel onto your feet and assume the push up plank position.   Tighten up the gluteals and shoulder girdle muscles and walk down the turf.  Do not let your middle sag and try to keep a steady pace.  Twenty yards is a good goal for a beginner.

Alligator Push Ups
Set up just like the wheelbarrow walk, but instead of just traveling down the turf, perform a push up with every step you take with the arms.  Alligator Push Ups are tough–if you can travel twenty yards you have my compliments.

PowerWheel Jackknifes
Assume push up plank position with the wheel on your feet.  Draw the knees up toward your elbows and try to keep the hips from rising more than six inches.  Hold for one count and then return to the starting position.  Try to work up to ten solid repetitions.

Power Wheel Leg Curls
Lay on your back with the Power Wheel Velcro strapped to your feet.  Place the arms to the side and use the gluteals and hamstrings to bend the knees and extend the hips as you curl the wheel up toward your butt.  Return to the start position and repeat for five to ten repetitions.
Michael S. O’Hara, P.T., OCS, CSCS

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