1. Low Back Injury
Prevention in the Gym
Brandi Smith-Young, PT
P er fect 10.0 P hysi cal T her apy
Fellow, American Academy Orthopaedic Manual Therapy
Board certified orthopedic specialist
www.perfect10physicaltherapy.com
perfect10pt@gmail.com
2. Introduction
Competitive gymnast
Two time USAG Collegiate National Champions at
TWU
Bachelors in Kinesiology at TWU
Masters in Physical Therapy at Tx St
3. Practicing for 7 years
Fellowship trained in Orthopedic manual physical
therapy
Board certified orthopedic specialist in PT
One of 300 therapist in the US with these certifications
4. My passion:
Bring sport specific quality care to gymnast
Decrease the number of injuries in gymnast
Improve performance, recovery time, decrease
time lost in the gym, and improve return to sport
status
Performance Enhancement
5. Common complaints
Pain in the front of the hip
Pain on outside of the hip
Pain in low back
Pain running down back of leg
Pain running down the inside of leg
10. Anatomy cont’d
All these muscle
provide stabilization
for the low back
If these muscles are
not functioning
properly increased
stress will eventually
lead to injury.
11. Muscle imbalance
Some muscles are strong
While opposing muscles are weak
Some muscles are stretched out
While opposing muscles are too tight.
12. Due to the stringent requirements placed on gymnast
certain muscles tend to develop stronger than others
Certain muscles get weak
Other muscles develop tighter
And some develop looser or stretched
13. Common muscle imbalances
Contribute to most injuries in gymnastics
Weak abdominals/core
Weak hip muscles
Hamstring doing to much and buttock muscle not doing
enough.
Tight hip muscles
Tight IT Band
Tight lats or shoulder muscles
14.
15. Biomechanics of bridge
Forces of arching backwards (180 deg arc) need to be
shared btw the shoulders, thoracic spine, lumbar spine,
and hips.
Pic: USA Gymnastics Junior Compulsory Program
16. Biomechanics of bridge
Poor shoulder flexibility,
poor thoracic flexibility
(extension), poor spine
control (via sling of
muscles), and/or poor hip
flexibility contribute to
forces being concentrated
typically in the low back
(L4-5, L5-S1) and/or mid
back (TL junction)
Pic: USA Gymnastics Junior Compulsory Program
18. Ways to decrease imbalances
Strengthen the core
Pelvic tilt (fig 1 & 2)
Must tighten belly button up
toward the nose and in Figure 1
toward the spine (40-50 on
blood pressure cuff)
Not straight down into the
floor Figure 2
Marching (fig 3)
Start with pelvic tilt
No motion in the hips, hips
stay level (keep at 50)
Alternate legs Figure 3
19. Core cont’d
Heel Slides (fig 4 &5)
Start with pelvic tilt (40-50
with blood pressure cuff)
Slide R leg out maintaining
the tilt Figure 4
No rocking of the hips
Monitor hips with hands
Slide L leg out back still
flat
Slide R leg in
Slide L leg in
= 1 rep
Figure 5
20. Active Straight Leg Raise
Lay on back with band
above the head.
Pull band to the floor with
straight arms & hold
Raise one leg with the
opposite straight leg
staying flat on floor.
Toes point upward, no
rolling of hips.
Slowly lower straight leg
and return arms above
head.
X15-20 fwd, X15-20 side
21. Active Lower Abdominals
Lay on back with band
above the head
Pull band to the floor with
straight arms & hold
Both knees bent to 90,
keeping the back flat to
the ground lift both knees
toward the chest
Keep back flat as lower
both legs to the ground
Return arms above head
x15
To progress begin to straighten knees
22. Obliques
Engage abs belly button up and
in, back flat
Breath in, hold as rotate the
torso towards the bent knee
Breath out and in as hold 10
sec x10
Progress to 20-30-60 sec x2-5
Keep the elbow rotating
towards on the ground.
Keep the opposite hip (leg
straight) flat on the ground
23. Trunk Stability Rotation
Lay on back hips and knees
flexed to 90, shoulder at 90
degrees arms straight out
Place ball or towel between
knees
Rotate the knees to one
side, keeping opposite
shoulder blade down. Hand
on side of rotation turns
down the opposite hand
stays turned up.
Return to starting position,
repeat on opposite side
24. Tweaking current conditioning
Gymnast are great at compensating
Make sure they remain flat back when doing core
exercises (not rounded in upper back or arched in lower
back…neutral spine)
Do not allow an arch throughout the entire exercise
Ie. V-ups on floor or from the bars, hollow holds, sit-ups,
crunches, hanging sit ups, etc
Modify by decreasing the lever arm (bend knees or bring
arms closer to the body if unable to maintain good
form. Progress as strength and control improves.
25. Hand Heel Rocks
Place a stick horizontally
across the hips/low back
Tighten abs
Do not let the stick
move as rock back
Rock back and forward
as far as you can with
control
26. Bird Dog with Band
Start with stick
across low back
Tighten abs
Ph I alternating
arms
Ph II alternating legs
Ph III alternating
opposite leg with
opposite arm
No motion at hips,
no movement of
stick
28. Hip strength
Strengthen the hip
muscles
Clam progression
Phase I (fig 6)
Sidelying, roll hip
forward.
Tighten abs, tighten
buttock
Keep heels together and
lift one knee up Figure 6
Monitor hips, no motion
Hold 10 sec x10
29. Hip External & Internal
Rotation Quadreped & Prone
In the same position; move
Start on all 4s, knees
the band to the opposite
under hips and hands
foot.
under shoulders.
Theraband attached to Rotate the hip so the foot
ankle pulling away from moves outward (IR)
the band
Engage abdominals Repeat laying flat on the
stomach.
Gently squeeze bottom
with no hip flexor May need a towel or pillow
activation under the belly button.
Rotate the hip so the
foot moves inward (ER) Make sure abs engaged belly
button moves up and in.
31. Strength Iliopsoas
Seated Iliopsoas (fig 9)
Sitting tall, back straight
Tighten abs
Lift one leg as high as possible
to chest with no motion in back
Grab under the leg and lift all
the way to chest, no motion bk
Let go with hands and hold 5 sec
Lower 5 sec Figure 9
x10
32. Iliospoas strength cont’d
Laying iliopsoas (fig 10)
Laying with one leg bent
1 knee
and other straight at an bent
angle
Tighten abs
Lift the straight leg with
foot turned out
No motion at hips
Hold 10 sec, lower slow
X10
Monitor hips with hands figure 10
33. Buttock muscles
Get the buttock muscles to
work instead of the
hamstrings
Prone knee bend (fig 11)
May need a pillow under belly
button
Squeeze belly so back is flat
(tighten from 70-60 using the
blood pressure cuff) Figure 11
Slowly bend knee to buttock
without motion in hips or
arching at the low back (keep at
60 using the blood pressure
cuff)
34. Buttock strength cont’d
Prone knee bend lift (fig 12)
Start in with prone knee
bend, turn 1 foot inward in
figure 4 position (tighten
from 70-60 using the blood
pressure cuff)
Keep abs tight and no motion
in low back or hips slowly lift
knee up of the ground
(keeping the cuff btw 80-100)
Figure 12
Hold 10 sec x10
NO ARCHING
35. Leg Lock Bridge
Lie on back and hold one
knee to chest, place a ball
or towel between your thigh
and chest.
Bend other knee and place
the foot on the floor.
Lift the hips off the floor
form a straight line from
shoulder through the hip to
the knee.
Progress with the ground
knee straight
37. Squat, Jump, landing mechanics
Squat with T-band and
stick
Place the crossed band
behind the lower thigh
or knee
Stand feet shoulder
width apart with slight
turnout
Press down on the stick
as sit like going to sit in
a chair.
Knees must stay in line
with the 2nd toes and
drop over the forefoot,
not passed the toes *May place a small lift under the heels to start
for athletes who have trouble or limited DF.
X20
38. Assisted Squat
Use the band to teach
the athlete to shift COG
backward.
Feet shoulder width
apart with slight turnout
Abs engaged as sit like
sitting in a chair.
Knees stay inline with 2nd
toe and over the
forefoot, DO NOT let
them go forward past
the toes.
*May place a small lift under the heels to start
x20 for athletes who have trouble or limited DF.
39. Quadruped T spine rotation
Get on all fours (hips &
shoulders at 90)
Place on hand on low
back, palm facing away
from back.
Look toward & rotate
that shoulder toward the
ceiling. Return to start
Rotate the shoulder toward
the floor. Repeat x15
Repeat with the hand palm
down on the neck. x15
Repeat on opposite side
40. Stretch hip muscles
Stretch the hip flexors
(fig 12)
Pull one knee to chest
Tighten abs
Slowly slide the other
leg out without any
motion in hips or low
back
Gently Squeeze bottom
Trying to gently Figure 12
straighten the leg and
push down into the
floor
Hold 30 sec
41. Stretch hip and Quad muscles
Hip/Quad stretch (fig
13)
Off the edge of a block
Pull one knee to chest with
flat back
Let the other leg hang down
Can add 2 pound weight to
hanging leg
Follow with gymnast
squeezing her bottom and
pushing down into coaches
hand through her thigh (no
arch in back)
Make sure hip flexors DO NOT
contract
Hold 30 sec-1 min and repeat figure 13
3-4 times going lower each
time
42. Stretching Pecs
Pec stretch (fig 14)
Have the gymnast partner
up.
One gymnast lays flat
The other gymnast either
puts on hand on the hip and
the other on the opposite
shoulder
Or standing at their head
press down on both
shoulders Figure 14
Hold 1 min switch partners
Repeat 2-3 times
43. Stretch Lats
Lat Stretch (Robots) (fig 15)
Keeping belly tight with
the back flat
Elbows stay shoulder
width apart (may
require a partner to
keep them there)
Reach back toward the
floor and slowly try to Figure 15
straighten the arms
NO ARCHING
Hold 1 min repeat 2-3
time
44. UE Elevation with T Band
Lay face up with T band
under both feet, knees
bent
Engage abdominals keeping
rib cage and spine in
neutral and chin tucked in.
Press the upper extremities
flat to the floor.
Keeping everything flat on
the floor, slide the arms
upward toward the head.
Repeat x10-15
45. WHEN DO I STRETCH?
The end of workout when the tissue has been heated through
the workout which increased core temperature.
This is when you will get your greatest changes.
You must stretch within 24 hours to maintain the changes or
the tissue will creep back to prior length.
Latest research is showing greatest changes with static
stretching with vibration at 30 Hz (ie. Massager) Showing that
stretching tolerance is the key to increased flexibility.
The vibration tricks the nerves that feel pain into relaxing and
allows for a stretch without the defensive muscle contraction.
46. Contact Information
P er fect 10.0 P hysi cal T herapy
& P er for mance T rai ni ng
www.perfect10physicaltherapy.com
perfect10pt@gmail.com
512-426-6593
Follow: PERFECT10PT on
47. All information from:
The Manual Therapy Institute
www.themanualtherapyinstitute.com
Shirley Sahrmann.
Diagnosis and Treatment of
Movement Impairment Syndrome.
Gray Cook
Editor's Notes
Before we get going if you write doewn the website: perfect10physicaltherapy.com you can view the power point and videos later for more details. I should have them up by the end of next week, if not sooner.
Cervical spine, Thoracic Spine, Lumbar spine Normal curves with transition points at Cervical Thoracic junction and Thoracolumbar (TL) junction
lats, gluteus maximus, gluteus medius and under that the hip external rotators.
internal, external obliques. Underneath not pictured the transverse abdominus. The rectus abdominus (6 pack muscle) which does not attach to the lumbar spine or offer stability. It looks pretty and supports the internal organs.
Iliopsoas attaches to the low back which can offer stability when the core is strong or create abnormal stress to the low back when the hip flexor is tighter than the core is strong.
----- Meeting Notes (6/28/12 18:28) ----- Before we move on. The most important thing in injury care for gymnast is they receive early treatment before the injury progresses or causes other problems. Research has shown that pt recover faster and to a higher level if treated within 16 days of onset of the pain or injury. CAN I HAVE A VOLUNTEER
----- Meeting Notes (6/28/12 18:28) ----- We utilize a manual blood pressure cuff for feedback for the athlete to see they are using the proper muscles. Research was done using the cuff and they found from 40-50 mmHg the internal, external obliques and transverse abdominus fire. While from 60 above the rectus abdominus fires. (which remember earlier the rectus or 6 pack muscle do NOT offer stability to the low back). TEACH CUFF
I recommend that all athletes become proficient in the blood pressur cuff exercises before moving on to the rest of the exercises we will discuss.
This gets the athlete to engage their abdominals before they engage the hip flexors. Gymnast tend to let the hip flexors fire first which dumps the pelvis forward. This puts stress on the low back and will limit how high they can kick. Engage the abdominals, keeping back flat 1 st , then pull down with the band. Be sure the athlete is breathing during the exercise.
This is a great exercise to functionally work on those lower abdominals (internal and external obliques and transverse abdominus). But you have to be careful they don’ t over power with their hip flexors. Have the gymnast hold something between their knees. This gets the adductors firing while engaging the abdominals. Firing parts of the supportive sling around the spine.
Obliques tend to get underworked in gymnast with the 6 pack muscles doing everything.
This is a great abdominal stability exercise working transverse abdominus, internal, and external obliques while mobilizing the thoracic spine.
----- Meeting Notes (6/29/12 10:49) ----- When do we do this stuff? Spend some time up front to teach form and technique. Incorporate it in to stations at each event. Pick 2-3 exercises at a time and then change every 3-4 weeks. In force technique and form consistently.
----- Meeting Notes (6/28/12 18:44) ----- TEST PGM BEFORE AND AFTER
Test Seated Iliopsoas hold 90 s….Did i make her stronger? recruit the muscle better so she can utilize them throughout her workouts more effectively.
glut max one of the largest muscles in the body, so progress to 30 sec hold to get irradiation of all the muscle fibers
perfect for those athletes who when doing handstands their shoulder angle stays closed and then you ask to push through their shoulders and then their rib cage pokes out.
Dynamic stretching should be done during warm-up or throughout practice. However static stretching is still the best way to get tissue change over time.
Dynamic stretching should be done during warm-up or throughout practice. However static stretching is still the best way to get tissue change over time.
----- Meeting Notes (6/29/12 11:12) ----- This concludes the lecture today. Videos using the blood pressure cuff for core recruitment are available. And just remember it's quality of movement not quantity. Focus on technique and form of the exercises to retrain muscle firing patterns and decreased muscle imbalances to achieve optimal muscle function and peak performance. Feel free to contact me if you have any questions as you return to the gym to implement these exercises.