Shoulder, Spine and Hip Integration
Lifting heavy objects pulls the lumbar spine into a straight position to activate the posterior ligamentous system and shortens the distance between the shoulder and spine, which decreases the lever arm on the low back. A lordotic lifting posture is recommended for people with crap nutrition as they have weaker ligaments (and take 5 – 6 times longer to heal than other soft tissue). A straight lumbar lifting posture is required for people with good nutrition and strong ligaments (or for > 20 rep max for others).
Lumbo Pelvic Rhythm
The integration of the lumbar spine, pelvis and hips when lifting. There should be a flexion relaxation phenomenon at 45 degrees of forward bend as the ligamentous system switches on. If the pelvis goes early the low back muscles are tight and hamstring long and weak (< 50°). If the pelvis goes late the hamstring are tight and restricting the movement. The Lower back ligaments may also be lax and the lumbar discs are at greater risk of herniation (> 50°). Correlate with Waiter’s Bow Test. Which will be less than 50° if the hamstrings are tight.
Back Pain and Developmental Orders
Back pain and muscle imbalance syndromes may result from incomplete childhood development in 20% of adults today. Test reptilian and mammalian crawling patterns, squatting, lunging and brachiation to distinguish where their development ceased. Babies should brachiate at 7 months and be upright at 9 – 12 months.
Corrective Exercises for Back Pain
Pilates phase 1: no axial load
McKenzie press up, Prone cobra, Horse stance variations, Feldenkrais shoulder spine integrator / hip pelvis integrator, forward ball roll, Prone jackknife, Swiss ball side bend, SLBR back extensions (Roman chair/Swiss ball), Supine hip extension BOB/FOB and total gym exercises.
Pilates phase 2: no axial load beyond body weight, non compressive loads may be used.
Kneeling back extensions, straight-arm lat pull down, woodchop, pullover, lat pull down, 3-point single arm rows, stick training and secondary back exercises
Pilates phase 3: axial load beyond bodyweight
Squat, lunge, standing cable rows, cable push, bent over row, deadlift, low pull, reverse woodchop.
This article was written by Steve Hines who is a physiotherapist who runs Pilates classes in Wandsworth London.
Steve can be contacted through his website.