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
Hip Lifts and Roll Outs
When designing programs for rehabilitation patients and fitness clients, I often pair up exercises. This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.
Lose weight—Fat loss is a primary goal of most fitness clients. Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.
Move better—Training neurologically related movement patterns improves motor control.
Hip Lifts and Roll Outs
An intricate system of muscles holds the spine upright over the top of the pelvis. This pair of exercises coordinates and strengthens this support system. If you sit all day long, have postural problems, or a history of lower back pain this pair of exercises is worthy of your training time.
This drill coordinates hip extension and lumbar spine stability. It is very beneficial when progressed to the single leg version. Lay with your shoulders across a bench with the head supported. Place your arms out to the sides. Plant the feet on the ground with the knees bent 90 degrees and the shins perpendicular to the floor. Drop the hips to the floor and then push back up with the gluteals and hamstring muscles. Hold at the top for two counts and repeat.
The roll out can be scaled to serve any fitness level. Beginners can start with a large 65 centimeter physioball, and as they become more proficient, progress to a smaller 55 centimeter ball. The closer the hands get to the floor the more challenging the exercise becomes. If you get strong enough, you can perform the forward roll out with a Power Wheel or Sorinex roller.
Kneel on a mat to keep the pressure off your knees. Your femur (thigh bone) is positioned perpendicular to the floor and the hips are hinged at 45 degrees. Place the hands on the front of the ball and the elbows directly under the chin. Brace the abdominal muscles and roll out onto the ball until you feel a challenge through your midsection. Hold in the challenging position for three counts and then return to the starting position.
Perform twelve repetitions of the hip lifts, rest 30 seconds, and then perform ten roll outs. Rest and repeat the cycle. Work up to three sets through this exercise combination.
View video of Mike performing these exercises here: https://youtu.be/Xf08rFU7A4w.
-Michael S. O’Hara, P.T., OCS, CSCS
Three Gifts I Would Give And Three I Would Take Away
Santa Gives You Gluteal Activation
You need a responsive and strong set of butt muscles to function at optimal levels. Many gym goers have gluteal muscles that are neurologically disconnected. The term physical therapists and strength coaches use is “gluteal amnesia.” Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the butt muscles. We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement. Most fitness clients are in need of some intensive gluteal training. The hip lift is a simple exercise activity that produces a superior response. See the attached video for a demonstration.
Scrooge the Lumbar Spine Flexion
Drop the sit ups, stop doing crunches, ditch the glute ham developer sit ups, and forgo the toes to bar competitions. Father time, gravity, and the stress of prolonged sitting are already bending our lumbar spines forward all day long. The last thing you need to do is accelerate degenerative breakdown of the lumbar segments with more repetitions of spine flexion. Please forget about isolating abdominal muscles. Instead learn how to control the team of muscles that hold the lumbar spine stable. It is a neural event that is worthy of all your efforts.
Santa Gives You Medicine Ball Throws
Life is an up tempo game. What you do in the gym is reflected in how well you can move during activities of daily living. If you continually exercise at slow tempos you will get better at moving slowly. The capacity to decelerate a fall requires fast reactions. Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power and speed of movement. Medicine ball throws are the easiest way to improve power. Medicine ball throws can be scaled to all fitness levels and are safe as long as you use a properly sized and weighted ball. The large, soft Dynamax balls are a good choice for beginners. They rebound well off of the block walls in the gym and are easy to catch. Do not overload your medicine ball throws, a two to eight pound ball is best for most gym goers. Get with one of the trainers for instruction on adding medicine ball throws to your training program.
Scrooge Sitting Down in the Gym
Movement happens in an upright, standing position. “Seated exercise” is an oxymoron. If you want to improve how your body functions, you must stand up and defy gravity. Every athletic endeavor is performed in a standing position. Seated exercise reinforces poor postural habits and diminishes your capacity to move. I call it the “illusion of exercise” and it will always be highly visible in commercial gyms because it is easy to sell.
Santa Gives You Four-Point Training
Crawling is the neurological training tool an infant uses to develop the capacity to stand and walk. It is the pathway to better motor control and less pain. Nearly every physical therapy patient and most fitness clients benefit from a healthy dose of four-point position exercise. In your fitness program, reinforce the patterns of spinal stability and reboot the postural reflexes with some horse stance horizontal, crawling, and Jacobs Ladder training. Four-point training can be scaled to any fitness level. Watch the attached video for some examples.
Scrooge Elliptical Training
I know you love the elliptical. It is the no impact, cardio darling of the gym but it should be used as a fitness dessert and not a main course. Elliptical training has multiple drawbacks. Ergonomically, it is a one size for everyone apparatus that does not work well for taller or shorter people. When you walk or run, you improve the important skill of stabilizing your body over one leg. An elliptical keeps both feet stapled to the machine and deadens any neural enhancement of balance or single leg stability. Hip extension keeps our back healthy and our body athletic. Maintaining or improving hip extension should be part of every training session. There is no hip extension produced when you train on an elliptical. Many people maintain a flexed spine when they use an elliptical. Sitting produces the flexed forward spine we all need to work against in our fitness programs. The repetitive use of the shoulder girdle is a frequent generator of referrals to physical therapy for head and neck pain. Metabolic adaptation to elliptical training happens fairly quickly. In January, a 30 minute session burns 330 calories, but by June, your body becomes more efficient and that same routine creates only a 240 calorie deficit. The low impact, reduced weight bearing nature of an elliptical makes it a poor choice in your fight against osteoporosis.
I am happy when people are more active. Patients and fitness clients love the elliptical and they believe it helps. Use that belief to keep you motivated and training. I just want everyone to manage the drawbacks of this type of training. Injured people always say “Why didn’t someone tell me?” Before you jump on the elliptical, take ten minutes and improve your core stability and hip function with some four-point exercises and hip lifts. Learn how to throw a medicine ball and stay standing through the rest of your training program. Next Christmas you will thank me.
Merry Christmas and a Humbug to you.
See video of Mike in the gym demonstrating these exercises here: https://youtu.be/H0my94BPHNQ
Michael S. O’Hara, PT, OCS, CSCS
Nothing slows down your progress toward greater fitness and better performance than an injury. Bad combinations of exercises during a training session can set you up for a big crash. Poor exercise programming produces the joint overload or connective tissue stress that produces pain. Lumbar flexion activities combined with an exercise that compresses the lumbar spine is one of the more common killer combinations.
Here are some examples of lumbar flexion activities combined with exercise that increase lumbar intervertebral pressure. I am seeing these killer combos more frequently during my visits to the gym.
-Ten GHD sit ups followed by fifteen American Swings.
-Twenty medicine ball rotational crunches followed by a sixty yard farmers carry.
-Rowing machine for 500 meters followed by barbell on back walking lunges.
-Five toes to bar and then five barbell cleans.
-Five minutes of super slumped power texting followed by three heavy deadlifts.