Here are a few facts that you should be aware of and what you can suggest.

1) The spinal discs rehydrate during a night’s sleep. In other words, fluid is passed back into the intervertebral discs filling them up like a tire. When this happens the connective tissue and the surrounding ligaments become taut. Upon rising in the morning, this fluid starts to migrate out of the discs throughout the day. Research has shown up to 90% of this new fluid is gone out of the disc after the first two hours. This is what makes bending over in the morning more difficult versus at night.

So, what to do with this info?

- Educate your clients/patients that bending excessively from the waist in the morning can put the discs and ligaments at risk of injury.

- When training your client first thing in the morning be aware of exercises that involve heavy loads.

- If they have a stretching routine that they perform in the morning have them get out of bed and move around normally first. Be aware of stretches that involve lumbar flexion such as both knees to the chest while lying on back. With an individual that has a spinal disc issue this stretch and others like it would be contraindicated at any time of the day, especially in the morning.

Things that you can have them do in the morning:

- Prone press ups – lie on your stomach and press your upper body off the floor while keeping the hips on the floor. Only press up to a range that is comfortable and pain free.

- Gentle hamstring stretches with spine in neutral position while standing (no flexing from the spine).

- Gentle hip flexor stretching with both hands over head while standing.

- When stretching or strengthening make sure the motion comes from the hips and the thoracic spine not the lumbar spine.

]]> http://mtspecialist.com/2009/07/low-back/feed/ 0 http://mtspecialist.com/2009/03/tip-of-the-week/ http://mtspecialist.com/2009/03/tip-of-the-week/#comments Sun, 15 Mar 2009 16:55:27 +0000 jenpoljacik http://mts.romkey.com/?p=49 Often times mild chronic lower back pain can be traced to the lack of hip extension one may have. This could be a muscular and/or joint limitation. Both of these can be addressed at the same time and three dimensionally.

The lower back pain is likely to be caused by compensatory hyper-extension of the lumbar spine to make up for the lack of hip extension. A number of activities can cause this pain such as rising from a seated position, walking or anything that requires hip extension (mostly everything).

First step is to stretch the hipflexor group three dimensionally. If we were to stretch the right hip it would look like this: (written in vertical logic)

LWI(R) L knee flexed at 30degrees R knee at O degrees

Pelvis

anterior->R lateral L lateral-> R rotational L rotational

drive (push)

LWI(R)

Or written the long way:

stride stance wider then hip width apart right leg back with foot turned in, L knee bent and R leg straight

The pelvis is what you are driving with to get the stretch

first drive anteriorly then R/L laterally and third R rotational/L rotational

Now you know why we use vertical logic

If one of these motions reproduce the discomfort then you have effectively assessed a limitation. Do not continue to drive in that plane instead choose the other two that are comfortable. Remember progressively tweak the stretch until you are able to stretch in all three without pain.

Strengthening: Which follows every good 3D stretch

XXX

R leg

Posterior lateral w/internal rotation @ R150

lunge

XXX

Chris Poljacik