Network Magazine Spring 2020 | Page 22

THE QUICK READ • Back pain is the leading cause of disability, with 80% of people experiencing lower back pain at some point in their lives • Restrictions in the more mobile structures of the body typically result in the spine taking up the slack, resulting in overuse, pain and injury to the lower back • PTs can help clients overcome lower back pain through corrective exercise programming that facilitates movement and mobility in the feet, ankles, hips, thoracic spine and shoulder girdle • By appreciating how the entire body needs to work as an integrated system, trainers can design corrective exercises that reduce stress to the lower back, as well as risk of future injuries. Corrective exercise strategies for lower back pain Before attempting to gain mobility in the feet, ankles, hips, thoracic spine and shoulders with the following exercises, you should perform self-myofascial release techniques on the muscles that cross those joints (i.e., the calves, quadriceps, hamstrings, hip flexors, glutes, obliques, and shoulder musculature) (Rolf, 1989). Once the tissues in these areas have been warmed up with SMR exercises, you can progress your client to the gentle stretching/mobilisation exercises outlined below (Price, 2018; Myers, 2001). Corrective exercises for the feet and ankles Calf stretch (with straight leg) This stretch will help promote flexibility in the ankle when the knee is straight and the hip is extended, such as during walking. Flexibility in this area will ensure the leg can travel behind the hip correctly without the lower back having to overarch excessively to keep the torso upright. Stand with one leg back and feet pointed straight ahead. Ensure that the back leg is straight and the heel remains in contact with the floor. Tuck the hips under until a stretch is felt in the calf of the straight leg. Perform for 20-30 seconds each side at least once a day. Calf stretch (with bent leg) This stretch will help promote flexibility in the ankle when the knee is bent, such as during squatting or bending down to pick something off the ground. This will ensure the ankles, knees, and hips can bend effectively so the lower back does not experience excessive stress when lowering the torso. Stand in a split stance on a BOSU Balance Trainer with hands on a wall or desk to assist with balance. Push the heel of the back foot down and bend the knee of that leg to feel a stretch in calf muscles. Do not overpronate the foot as the knee bends. Perform on each leg for 20-30 seconds once a day. Calf stretch (with bent leg) Calf stretch (with straight leg) Corrective exercises for the hips Glute stretch This stretch will help promote flexibility in the hip, so the leg can rotate effectively in the hip socket, such as during walking and running. This will help prevent excessive rotational stress to the lumbar spine. Sit on the ground with the left leg straight and the right knee bent. Place the right foot on the outside side of the left leg while keeping the right knee bent and sit up tall. Hug the right knee toward the left shoulder to feel the stretch in the glutes. Perform for 20-30 seconds each side at least once a day. 22 | NETWORK SPRING 2020