Lordoisis Test

7/25/2019 Lordoisis Test

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Resolution: standard/ high

Figure 2.

Test protocol Sitting knee extension. Upright sitting with corrected lumbar lordosis; extension

of the knee without movement (exion of low back A. Correct Upright sitting with corrected

lumbar lordosis; extension of the knee without movement of !" (#$%&$' xtension normal. B Not

correct !ow back moving in exion. )atient is not aware of the movement of the back. Ratingprotocol: *s patients did not know the tests+ onl, clear movement d,sfunction was rated as -not

correct-. f the movement control improved b, instruction and correction+ it was considered that it

did not infer a relevant movement d,sfunction.!uomaoki et al.BMC Musculoskeletal Disorders0$$1 8:2$ doi:3$.3345/3613706167472$

8ownload authors9 original image

David KingsburyLove sport. Love food. Love London. A Personal Trainer and Part-time (read amateur) Triathlete in Central

London

GET UPDATES !"# DA$%D &%'GSU!

!ike
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Pelvic Posture and Back Pain Throughout Pregnancy

Posted* ++,,+/ *+0

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Chronic Pain,Diet And Fitness,Personal Training,Exercise,Posture,Pregnancy,Pregnancy Fitness,UK

Lifestyle e!s

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$ET UK L%FE&T'LE E(&LETTE)&*

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You may not have thought about it this way before but when you think about posture,

you're actually considering the biomechanical relationship between your body andgravity.

lthough it can be interpreted in different ways, ! like to think that good posture is

achieved when the body is aligned in such a way that there is minimal tension through

our muscles and ligaments.

Think about the construction of a tent " the guy ropes on each side provide e#ual tension

to hold the tent in an erect state. !f you were to over tighten the guy ropes on one side,

the tent will lean further in one direction than the other. !t's e$actly the same situation

with our bodies " if one set of muscles is tighter than the other, we start to see shifts inthe centre of mass and additional stress is placed on certain groups of muscles.

s you progress through pregnancy, physical, physiological and hormonal changes occur

that alter your body's biomechanics and impact on postural control. Take weight gain.

%ost women put on between && and &kg during a healthy pregnancy. Because this

weight gain is largely localised in the abdomen, it changes the position of the body's

centre of mass. t the same time, hormonal changes increase the la$ity of (oints, which

can also add to postural instability. )o perhaps it's no surprise that a significant

proportion of pregnant women end"up suffering with lower back or (oint pain in thepelvic area.

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This article considers postural changes that occur in the pelvic girdle and lower back

during pregnancy, and the steps that we can take from an e$ercise perspective to reduce

the likelihood of back pain in the long term.

Pelvic position

*ela$ation of the pelvic girdle is a normal physiological response to pregnancy. The

growing uterus rests on the surface of the pelvis, which generally becomes repositioned

into a forward tilted position.

!f you imagine the pelvic girdle as a see"saw, the muscles attached to the pelvis " the

gluteals, the hamstrings, the hip fle$ors and the abdominals " can pull it forwards and

backwards, influencing its rotation. +rom a corrective e$ercise perspective, it is common

to see the hip fle$or comple$ become stiff and tight during the course of pregnancy. t

the same time, the main hip e$tensors the gluteus ma$imus and the hamstrings- aremore likely to lengthen and weaken, as are the abdominals.

ithout suggesting that muscle imbalance will lead to back pain, there does seem to be

growing evidence of an association between muscle dysfunction and lumbo"pelvic pain

in pregnancy. /ne )wedish study found pregnant women with pelvic girdle pain 01" back

pain had lower hip e$tension muscle strength than those with no back pain. )imilarly,

weakness of the hip abductors muscles which also help stabilise the pelvis- has been

associated with pregnancy"related lower back pain. )o working towards a neutral pelvic

position, where muscles can work together in a more balanced way, seems to be a valid

approach for physiotherapists 1 fitness professionals to take in order to reduce

back1pelvic pain in pregnancy.

Lumbar spine lordosis

long with a forward tilt of the pelvis, lordosis is another postural change that can occur

during pregnancy, this time directly affecting the back itself.

Your spine has natural curves at the neck, and in the upper and lower back areas. !n part

these curves act as shock absorbers, distributing the stresses that occur as you move.hen you are pregnant, you may find that your back arches more than normal, so that

your upper body moves backwards and acts as a counterbalance for your growing

tummy.

s pregnancy progresses, mums"to"be can start to feel less balanced. hile they

naturally widen their stance to increase lateral stability, to maintain balance in the

forward 1 backward plane of movement for e$ample, when walking- they tend to

increase postural sway still further.

This increased curvature, known as lordosis or swayback, places an increased load uponthe spinal musculature for spine stabilisation. !nterestingly, research has recently shown


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that endurance of the back e$tensor and back fle$or muscles is reduced in women with

pregnancy"related lower back1pelvic pain.

)ince the pelvis is attached to the lower spine through a wedge"like section of bone called

the sacrum, the tendency for pelvic rotation is also increased as lordosis increases.

What exercises can we do to encourage good posture through the lower

body?

The main goal of an e$ercise programme targeting pelvic and lower back posture is to

promote muscle balance. Thinking back to the tent metaphor, we want to have the

muscles in the front of the body working in e#uilibrium with their counterparts in the

back of the body.

This can be difficult to achieve with so much happening all at once. But lower back pain

doesn't (ust impact negatively on daily life, it can also increase your risk of complications

during labour. %aking time for e$ercise during pregnancy not only decreases your risk of

pregnancy"related lower back pain, it also makes you more likely to lose the weight you

gained during pregnancy.

)everal e$ercises are perfectly safe to perform, but here are my favourites to work on

pelvic alignment.

Exercise 1 - Stretch of ip !lexor "omplex


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2 3neel down and step one foot forward, with a 56 bend at the knee

2 %aintain an upright body position and gently push your hips forward2 You should feel a stretch in the front of the hip and thigh on the rear leg

2 7old this stretch for 85"95 seconds

Exercise #a - $lute %ridge&


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2 :ie on your back with your feet flat on the ground

2 Push your hips up towards the ceiling until there is a straight line through the shoulder,hip and knee

2 Pause at the top and consciously engage your bum muscles

2 )lowly lower to the start position

2 *epeat this e$ercise for 8 minutes

;:ying on your back can cause di


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2 !n a side lying position, bend your legs and stack your hips, knees and ankles on top of

one another2 *oll your top hip forward slightly so that your top knee slightly overhangs the bottom

one

2 :ift your top knee up towards the ceiling, as high as you can go before you feel the hips

start to roll backwards

2 Pause at the top and then lower back down

'im of the glute bridge and clam(

To e$ercise the gluteal bum- muscles in an isolated manner

ow much) and how often?

Perform your preferred e$ercise for around two minutes or until the bum muscles fatigue

on each side for the clam-, with a focus on #uality rather than #uantity,

three times each week.

Why do it?


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ctivating and strengthening the gluteal muscles helps to unload the lumbar spine of

e$cessive force when recruited properly. The gluts are also a group of muscles that are

commonly unbalanced.

*ips(

%any of my clients like a towel under their heads to support the neck, and a rolled up

towel underneath their tummy to make it more comfortable.

Exercise + - Split S,uat


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2 )tand in a split stance with the back foot on tip"toes2 3eep the ma(ority of the bodyweight over the front foot

2 Bend the rear knee down towards the ground with a slight lean forward through the

upper body

2 Push up to the start position

'ims(

The leg muscles are among the largest and strongest in the body, so e$pect the heart rate

to rise slightly with this one. im to contract the gluteal and thigh muscles in synergy to

produce the movement.

Why do it?

This e$ercise is great for three reasons. +irstly, it will help you to maintain the muscle

tone in your thighs. )econdly, the 'isolate"to"integrate' method which has been shown to

enhance muscular recruitment patterns- is e$emplified in this e$ercise. nd finally, it

will also elevate your metabolism, and is great for any fans of the endorphin rush.

ow much) and how often?


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!'d recommend always performing the split s#uat after glute bridges or clams " that way,

you ensure that the gluteal muscles are consciously recruited. Perform 8"4 sets of &5"85

repetitions for the best results.

"onsiderations(

)plit s#uats involve moving the body up and down repeatedly, which can cause changes

in blood pressure. !f you feel di


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En.oy sweating/

&. ang et al. Balance perceived and actual- and preferred stance width during

pregnancy. >lin Biomech 855CD 89E 4C"F.

8. Borg")tein , Guggan ). %usculoskeletal disorders of pregnancy, delivery and

postpartum. Phys %ed *ehabil >lin @ m 855FD &CE 4A"F.

9. HIllestad @3 et al. ssociation between the serum levels of rela$in and responses to

the active straight leg raise test in pregnancy. %an Ther 85&8D &FE 88A"95.

4. +oti T et al. biomechanical analysis of gait during pregnancy. Bone oint )urg m8555D C8E 8A"98.

A. Bewyer 3 et al. Pilot dataE ssociation between gluteus medius weakness and low

back pain during pregnancy. !owa /rthop 855D 8E F".

. Jutke et al. ssociation between muscle function and low back pain in relation to

pregnancy. *ehabil %ed 855CD 45E 954"&&.

F. @oon %:, 7och K. >hallenges of the pregnant athlete and low back pain. >urr )ports

%ed *ep 85&8D &&E 49"C.

C. Brown , ohnston *. %aternal e$perience of musculoskeletal pain during pregnancy

and birth outcomesE )ignificance of lower back and pelvic pain. %idwifery 85&9D doiE

&5.&5&1(.midw.85&9.5&.558.

. Guckitt 3. L$ercise during pregnancyE Lat for one, e$ercise for two. Br %ed 85&&D

949E dAF&5

&5. )tokes !+ et al. bdominal muscle activation increases lumbar spinal stabilityE

nalysis of contributions of different muscle groups. >lin Biomech 85&&D 8E FF"C59.

&&. :ederman L. The myth of core stability. Bodyw %ov Ther 85&5D &4E C4"C.

&8. Price @ et al. Pelvic floor e$ercise for urinary incontinenceE systematic literature

review. %aturitas 85&5D FE 95"&A.


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Assessin2 and Corre3tin2 E43essive Lum5ar Lordosis to

#inimi6e

7* 8ustin Pri3e9 #A

The human 5od7 is desi2ned to 5e upri2ht. :hether 7ou 5elieve inevolution or 3reationism9 the same runs true. :e are 5ipedal 3reaturesdesi2ned to stand ere3t 1ith the spine on top of pelvis9 and the pelvis ontop of the le2s. "ur 5odies have t1o ver7 important elements to assist inmaintainin2 an upri2ht posture. irst9 lar2e 2luteus ma4imus mus3les pushthe hips for1ard into e4tension. Se3ondl79 a 3urvature in the lum5ar spinear3hes the spine up1ard and 5a3;1ard to lift the torso on top of the hips.

Environental Changes and Excessive Lubar Lordosis

"ver the past 3entur79 the environment in 1hi3h 1e live and a3tivities ofdail7 livin2 have 3han2ed dramati3all7. Prior to the advent and availa5ilit7 ofmodern staples su3h as automo5iles9 televisions9 3omputers and stationar75i;es9 people spent mu3h of the da7 en2a2ed in var7in2 t7pes of ph7si3ala3tivit7 and movement. Su3h te3hnolo2i3al advan3es9 ho1ever 1onderfulthe7 ma7 5e9 mean that most of us no1 spend the mauired to stand up9 the 2lutes are not stron2 enou2h to push hips for1ardto form a >ualit7 5ase of support for the spine. %n addition9 the thora3i3spine (mid to upper 5a3;)9 1hi3h has a natural sli2ht for1ard 3urve9 suffersfrom prolon2ed seated positions. After lon2 periods of sittin29 this for1ardthora3i3 3urve 3an 5e3ome e43essive9 there57 3ausin2 part of the spine tolose its a5ilit7 to ar3h 5a3;1ard and assist in standin2 ere3t.

These hip and upper 5a3; d7sfun3tions mean that the responsi5ilit7 forliftin2 the torso upri2ht falls mainl7 on one stru3ture in the 5od79 the lum5arspine. There is a natural 3urvature in the lum5ar spine desi2ned to lift thetorso up1ard. ut9 1hen used e43lusivel7 to a3hieve and maintain upri2htposture9 the lordoti3 3urve 5e3omes e43essive (a.;.a. e43essive lum5arlordosis). E43essive lum5ar lordosis 3an 3ause dis3 de2eneration9 nerveroot 3ompression and 1ear and tear to all stru3tures of the lum5ar spineand surroundin2 soft tissues.

(hat Else Causes Excessive Lubar Lordosis-


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:hen seated9 the hips are 5ent (fle4ed)9 the top of the le2s are 3loser tothe torso9 and the 2lutes are mostl7 ina3tive. "5viousl79 this 3ompressedposition 3an 3ause the mus3les and soft tissues at the front of the hips(namel7 the hip fle4ors) to 5e3ome ti2ht and restri3ted. Conse>uentl79 1hen

1e 5e2in to stand up9 these soft tissue stru3tures are so infle4i5le that thehips have a hard time pushin2 for1ard to ena5le us to stand up strai2ht.This ti2htness in the front of the hips also prevents the 2lutes from 5ein2a5le to do their


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important arti3ulation in the 5od7 that ena5les us to stand9 1al;9 run andpla7. %f there is a 1ea;ness or d7sfun3tion in this area9 then other mus3les(li;e those of the lo1er 5a3;) 1or; harder to splint the area and ;eep itsta5le. This is 1h7 so man7 people e4perien3e a ?ti2ht lo1er 5a3;?= the

lum5ar ere3tor mus3les have to 1or; t1i3e as hard to ma;e up for1ea;nesses else1here in the 5od7 (e.2.9 the 2lutes). 7 simultaneousl7stren2thenin2 mus3les surroundin2 the lo1er 5a3; and stret3hin2 others9the lum5ar spine mus3les 3an 5e tau2ht to release and there57 redu3ee43essive lum5ar lordosis.

The dome shape of the Tma;es it perfe3t for performin2 e4er3ises for thelum5ar spine 1hile l7in2 in a prone position. %t posteriorl7 tilts the pelvis andfle4es the lum5ar spine9 redu3in2 tension to the lum5ar ere3tors.urthermore9 the air inside the T dome 3an 5e used as resistan3e durin2

advan3ed stret3hin2 e4er3ises to 3ontra3t and rela4 a 2roup of mus3les 57pressin2 into the dome surfa3e. This 3ontra3t,rela4 te3hni>ue mimi3s the1a7 mus3les rea3t to real life movements and allo1s the 5od7 respond tospe3ifi3 stret3hes more effe3tivel7. Usin2 the T in this 1a7 ma;es it anideal tool to utili6e 1hen tr7in2 to alleviate 5a3; pain 3aused 57 e43essivelum5ar lordosis.

Exercises

$luteal Activation Lift

his exercise -wakes

up- the gluteal

muscles responsible

for extending the

hips. his will help

,ou or a client get the

hips under the torso

when standing+

thereb, reducing thecompensator,

excessive arching of

the lumbar spine.

3oveent Directions*

Lie fa3e do1n 1ith 3enter of the hips over top of theT dome.Posteriorl7 tilt the pelvis to de3rease the ar3h in

the lo1er 5a3;. Lift one le2 off the 2round a5out / to in3hes 1ithout ar3hin2 the lo1er 5a3;. !eturn le2 to

2round. Perform repetitions on 5oth le2s.
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4i5 Flexor &tretch

The hip flexors are one of the main muscle groups

responsible for flexing the hips. These muscles can becomevery restricted and tight in people that have excessive lumbar

lordosis. By contracting the gluteal complex on the back of

the hips while stretching the hip flexors, hip flexor muscles

are released more effectively.

Movement Directions:

Put right knee on the BT domewith the left leg forward and

left foot positioned flat on the ground. Posteriorly tilt the

pelvis by using the abdominal muscles and gluteal complex

to bring the pelvis up and forward (i.e., "tuck the tail under".

!heck that the right glute is contracted. aise right arm to

increase stretch to hip flexors (front of the hip. #aintain

posterior tilt and gluteal contraction for the duration of the

stretch. $old position for %& to '& seconds on each side.

Advanced 6ersion*

After holdin2 the hip fle4or stret3h for a fe1 se3onds9 rela4 2lutes and tr7 to pull the ;nee that is restin2 on the T

dometo1ard the front le2. &eep ;nee in 3onta3t 1ith the T dome and use it as resistan3e. So9 hip fle4ors are

no1 3ontra3tin2 1hile pushin2 do1n and for1ard into the plia5le9 dome surfa3e. After a + to / se3ond

3ontra3tion9 rela4 hip fle4ors and en2a2e 2lutes a2ain 1hile posteriorl7 tiltin2 pelvis. This 3ontra3t,rela4 te3hni>ue

1ill 2reatl7 in3rease the a5ilit7 of hip fle4ors to release so the hips 3an move more easil7 for1ard into e4tension.

Perform the 3ontra3t,rela4 se>uen3e for + to B repetitions on 5oth sides.

%f 7our or 7our 3lient has trou5le ;eepin2 the pelvis posteriorl7 tilted and 2lutes a3tivated durin2 either version of

the stret3h9 simpl7 2o 5a3; to the first e4er3ise (see ?Gluteal A3tivation Lift?) to fa3ilitate the re>uired movements

and mus3le a3tivations.

Contract7)elax )ectus Feoris &tretch
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he rectus femoris is the onl, uadriceps muscle

that originates from the front of the pelvis. (he

other three uadriceps muscles originate from

the top of the leg. uen3e for + to B

repetitions on 5oth sides.

%f 7ou or 7our 3lient has trou5le ;eepin2 the pelvis posteriorl7 tilted and 2lutes a3tivated durin2 either version of

the stret3h9 simpl7 2o 5a3; to the first e4er3ise (see ?Gluteal A3tivation Lift?) to fa3ilitate re>uired movements and

mus3le a3tivations.

Toe Touches !ith Pushdo!n

he lumbar erector spinae muscles that lie on either

side of the lumbar spine are largel, responsible for

arching the lower back. *s such+ these muscles

become tight and restricted in clients that have

excessive lumbar lordosis. he opposing muscle

group of the erector spinae is the rectus abdominus

which is responsible for exing the spine. =ontracting

the rectus abdominus while stretching the lumbar

erectors facilitates the lower back muscles to release.

3oveent Directions*

tand behind the BTand reach down so that both hands are flat on the dome surface. Bend knees if you or your client has

trouble reaching down that far. )ently push down into the BT dome. This engages the rectus abdominus muscle and releases
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the antagonist muscles of the erector spinae. $old stretch for ' to * seconds, return to starting position and repeat.

About the Author*

8ustin Pri3e is 3o-o1ner of The io#e3hani3s9 a private trainin2 fa3ilit7lo3ated in San Die2o9 CA9 that spe3iali6es in providin2 e4er3ise alternativesfor sufferers of 3hroni3 pain. e is also the 3o-3reator of The io#e3hani3s#ethod 1hi3h is a method for pain redu3tion that 3om5ines stru3turalassessment9 movement anal7sis9 3orre3tive e4er3ise and life 3oa3hin2 thattea3hes trainers ho1 to help 3lients alleviate 3hroni3 pain and improve theirfun3tion. e 1as named %nternational Personal Trainer of the ear in +

57 the 1orlds leadin2 or2ani6ation of health and fitness professionals9%DEA ealth and itness Asso3iation9 and has helped thousands of peoplearound the 1orld over3ome pain and inuerin2 Athleti3 %n


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Lordoisis Test