Lbp Management and Prevention

7/30/2019 Lbp Management and Prevention

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Lower Back Pain:

Management and Prevention

Jon Rowe, Bkin, CEP


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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


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Sources

McGill, Stuart; Lower Back Disorders,

2nd edition

McGill, Stuart; Ultimate Back Fitnessand Performance, 4th edition


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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


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Intervertebral Disks

Rigid annuli surrounding

viscous nucleus

Notice cross fibers ofannulus rings allows for

greater protective forces

under compression in

multiple planes


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Interspinous Ligaments


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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


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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


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Abdominal

Complex

rectus abdominus internal oblique

external oblique

transverse abdominus

responsible for trunk

flexion, lateral flexion,

rotation, and stabilization


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Hoop

Stresses


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Psoas

acts mostly as a hipflexor

when the hip is flexed,

psoas can also act as a

lumbar stabilizer


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Quadratus

Lumborum

lumbar stabilizer


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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


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When does injury occur?


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Tolerance Until Failure

Injury, or failure of a

tissue, occurs when

the applied loadexceeds the failure

tolerance (or

strength of the

tissue), LBD, p11.


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When the tissue fails


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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


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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.


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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


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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


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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


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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


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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


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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


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2. Spinal Stability

Big Three

1. Curl-Up

2. Side Bridge

3. Birddog

Abdominal bracing vs. hollowing or

protruding Fascial raking


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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


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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


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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.


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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


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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.


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Be wise

and be careful

Documents

Lbp Management and Prevention