Low Back Pain Julia Del Nero Sara Seidman

+ Low Back Pain Julia Del. Nero & Sara Seidman

+ Anatomy of the lower back ■ Consist of L 1 -L 5 in the lumbar region ■ Support the weight of the entire torso ■ In-between each of L 1 -L 5 are discs ■ ■ ■ Discs act as shock absorbers L 5 meets with the sacrum to allow considerable rotation so pelvis and hips are able to swing when walking and running 31 nerves are rooted to the spinal cord in itself

+ Risk Factors ■ Age ■ ■ Diet ■ ■ The more weight you carry the more stress you place on your back, therefore a healthy diet is key Sedentary lifestyle ■ ■ ■ The older you get the more wear and tear goes on your back Desk jobs Not active Mental health factors ■ ■ Stress Anxiety

+ Muscle Involvelemt ■ Rectus abdominis ■ Transverse abdominis ■ Internal oblique ■ External oblique

+ Cont. ■ Latissumus Dorsi ■ Quadratus Lumborum ■ Gleuteus Medius

+ Latissumus Dorsi

+ Quadratus Lumborum

+ Gleuteus Medius

+ Causes & Daily reasons for pain ■ ■ Muscle imbalances ■ Training one side of the body more then the other ■ Focusing more on dominate sides Sedentary lifestyle ■ ■ Trauma ■ ■ If you are not exercising and sitting at a desk all day Car accidents Manual Labor ■ Lifting with your back instead of your legs

+ Mechanisms of Dysfunction ■ Gait ■ Postural Analysis ■ Biomechanics of stress ■ Flexibility

+ Gait ■ Studying the motion and mechanics of how a person moves. ■ Used to assess, plan, and treat people with conditions that are hindering their ability to walk

+ Postural Analysis ■ Locates if a person has any form of scoliosis, reduced lordorsis, kyphosis, etc

+ Loads acting on the lower back ■ Sitting at a 90 degree angle has no advantage for anyone ■ This shows the loads acting on the spine with different backrest angles showing that the load is the minimum when backrest is around 120 degrees.

+ Spin in relation to standing upright ■ Spine in relation to standing upright: ■ The more weight you carry the more stress it puts on ones back

+ How to asses the client ■ See if there is pain, how intense it is and how long it lasts ■ Physical examination, check posture, check for anatomical abnormalities such as scoliosis or kyphosis ■ Palpation/percussion of spine to check for soft tissue or vertebral tenderness ■ Straight leg raise ■ Neurological exam if needed ■ Get client history ■ If pain is severe they should not exercise but there are some exercises client can do to help relieve them of lower back pain

+ Sample exercise program Since the core is constantly supporting the lower back we will place a heavy emphasis on training core specific muscles

+ Reverse crunch- NO counterweight 1 - Crunch teaches people to properly tilt their pelvis 2 - When performing this exercise think about curling your belly button to the top of your ribcage 3 -When unrolling think about unrolling from the top position one vertebra at a time 6 rounds of 6

+ Dragonfly ■ This exercise comes into play once the reverse crunch becomes too easy ■ Teaches you to posteriorly tilt your pelvis but also hold that position throughout a range of motion ■ Essentially it’s a great antiextension challenge ■ Get as tight as possible ■ Squeeze butt and core hard and maintain a straight line from ankles to hips to shoulders 4 rounds of 5

+ Split stance-Cable shop • Standing, in a split stance with inside foot forward, back foot directly in line with the front foot and knees slightly bent • Trains body to avoid rotation and reinforces good breathing patterns • Working your chest, arms and hips as well as challenging your stability • Holding rope handle with both hands from high cable position 6 rounds of 6 (each side)

+ Wide stance-anti rotation chop 6 rounds of 6 (each side)

+ ■ Helps to avoid rotation ■ Get tight and don’t let anything out of place’ ■ Assume extra-wide stance with a cable machine to your right. Hold the rope attachment in front of your chest with your arms extended ■ Rotate your upper body to the right as far as your range of motion allows. Keep your arms directly in front of your chest —do not move your lower body ■ Reverse the movement and rotate your upper body toward the left as far as you can, pulling rope attachment with you as you move. Keep your arms directly in front of your chest and do not move your lower body ■ Continue rotating your torso in each direction

+ Core assisted push-up • With a resistance band under the core this will help to correct proper form • Work on lightening up resistance to eventually not have to use the band for help • The band will allow you to load the upper body while doing your push up without compromising your form. 6 rounds of 6

+ Butterfly sit-ups • Brace and squeeze core while sitting up • Hands should point toward or past toes 6 rounds of 12

+ Elevated pushups • Use lowest height and least resistance while maintaining form • Elbows aimed backwards hands facing forward • Keep head, neck, back, and hips all in a straight line 6 rounds of 6

+ Side planks 3 rounds of 15 second hold on each side

+ ■ Assume a plank position, then slowly drop your hips to the ground and pull back into proper alignment ■ Align shoulders, hips, and knees ■ For an easier/assisted use one of your legs as a “kick stand”

+ Leg raises • Start lying on the ground, you may use hands placed under glutes to help brace lower back. Once you begin each set do not set the feet down in-between reps • The leg raise is the perfect exercise for the somewhat neglected lower abdominals and hip flexors 4 round of 8

+ How can this program be used? ■ Gain and maintain normal range of motion ■ Reduce risk of injury by staying healthy ■ Stabilized core which helps stabilize spine ■ Improves posture so there is less stress on your spine ■ Helps maintain flexibility ■ Effective for mobilizing hips to increase stabilization

+ What are short and long term goals of this program? ■ Short term pain relief ■ Improve ability to achieve self sedation ■ Abdominal and lumbar muscle strengthening ■ Increase hip and lumbar spine mobility ■ Improve lumber and pelvic priori overprice sensibility ■ Intervertebral joint stabilization ■ Lumbar posture modification ■ Improved general fitness

+ Resources ■ http: //www. ninds. nih. gov/disorders/backpain/detail_backpain. htm#290513102 ■ http: //www. healthline. com/symptom/low-back-pain ■ http: //www. aahf. info/pdf/SN_Training_clients_with_Low_Back_Pain. pdf ■ http: //www. spine-health. com/wellness/exercise ■ http: //www. agape-biblia. org/plugins/pract-ministries/Lect 502. htm ■ http: //www. nismat. org/services/orthopedic-surgery/therapeutic-exercise-programs/low-back-exerciseprogram ■ Web MD ■ http: //www. spine-health. com/conditions/spine-anatomy/lumbar-spine-anatomy-and-pain