Injury Prevention:
Developing the Strong Back
Angie Beisner MA, ATC
Athletic Trainer
The Ohio State University
Picture: http://web.uaccb.edu/AcademicDivisions/MathScience/Science/BWheeler/Ess/figs/06_16Figureb-U.jpg
• Incidence
• Sport Specific
• Types of Injuries
Flexibility
Core Stabilization Exercises
Postural Training
•
Local Muscle Stabilization programs
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Pilates, Yoga programs
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Functional Movement Screenings
Global Abdominal Muscles
Local Abdominal Muscles
• Rectus Abdominis
• External Oblique
Rectus Abdominis
• Iliocostalis (thoracic portion)
http://home1.gte.net/imagine/rectus%20abdominis.jpg
External Oblique
http://www.mystomachexercises.com/wpcontent/uploads/2008/04/external-oblique.jpg
Iliocostalis (thoracic portion)
http://www.pro-motionphysicaltherapy.com/images/evidence/5il.jpg
•
Large Muscles
•
Act on the Spine (no attachment)
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Provide Trunk Stabilization (no influence on the spine)
•
Global Stabilization Muscles include:
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Rectus Abdominis
External Oblique
Iliocostalis (thoracic portion)
• Lumbar Multifidus
• Transverse Abdominis
• Post. Fibers of Int. Obliques
Posterior fibers of
Internal Obliques
http://www.teachpe.com/images/muscles/internal_oblique200.jpg
https/://hvelink.saintlukeshealthsystem.org/library/healthguide/en-us/images/media/medical/hw/h9991417_001.jpg
• Direct attachment to lumbar vertebrae
• Control lumbar segments
• Dynamic stability of the spine
• Intra-abdominal pressure
• Local Stabilization Muscles include:
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Lumbar Multifidus
Transverse Abdominis
Posterior Fibers of Internal Oblique
• Global Muscles:
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Typical focus of back rehab
Substitute/Dominate local
muscles in people with CLBP
 Local Muscles provide:
•
dynamic stability
•
control of the spine
Increased evidence showing LBP is influenced by local muscle weakness
 Lumbar spine problems
 Studies have shown specific exercises directed at
local muscles are effective in reducing pain
•
This is due to the dysfunction in parts of lumbar spine in
people with chronic/symptomatic back problems
(i.e. spondys)
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Training Local Stabilization Muscles
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May compensate for forces on the spine during ADL
 Leads to increased stability=decreased pain/disability
http://www.lower-back-pain-answers.com/images/Pelvic-tilt-arching-elbows.jpg
 Train for a contraction of deep abdominal muscles/LM
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Must be specific
Minimal activation of global muscles
Patient must be compliant
 Goal:
•
Teach contraction of LM and TrA independent of Global Muscle
Firing
 TrA
•
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2 fingers medial and distal
to ASIS
Slowly draw in abdominal
wall
 LM
•
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Fingers side of spinous
process
“Make fingers expand”
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Sides may have unequal firing
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May be unable to maintain for 10s
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May need to incorporate tactile stimulation
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May have weak contraction
•
Once achieved, add to
standing/dynamic tasks
•
Add Global exercises (core
program) to rehab
•
Perform exercise
throughout the day
•
Continued compliance is
needed to reinforce motor
programming
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1999-2000
•
•
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2000-2001
•
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0 back injuries
2003-2004
•
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2 spondylosis
1 lamina fracture
2002-2003
•
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1 spondylosis
2001-2002
•
•
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1 spondylolisthesis
1 spondylosis
1 spondylosis (freshman)
2004-2007
 Increase number of
athletes using jump serve
 New athletes
 No changes in:
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Floor
Lifting program
Practice
Equipment
 Random check of previous athlete with LBP
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Symptomatic
Asymptomatic
 Given instructions to begin exercise
•
Once achieved mastery, must incorporate into ADL
•
Two things were implemented as prevention techniques
with this team:
•
•
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Local muscle screening
Addition of Pilates focused exercises
While a formal study was not initiated, results were
noticed.
 Potential Benefits:
•
Focus is on “local” muscle group
such as transverse abdominis,
multifidus, and pelvic floor
muscles
•
Emphasizes proper technique
•
Aid for postural control
 Pilates intervention has shown:
•
Pain relief and improved weight distribution in those with
LBP
 daFonseca J, Magini M, and de Freitas T. Laboratory gait analysis in patients with low back pain
before and after a pilates intervention. Journal of Sport Rehabilitation. 2009; 18:269-282
•
Increase Transverse Abdominis firing
 Endleman I, and Critchley D. Transverse Abdominis and Obliqus Internus Activity during pilates
exercises: measurement with ultrasound scanning. Arch Phy Med Rehabilitation 2008; 89:2205-2212.
 Proper technique
•
Muscle thickness (firing) is only increased if performed
correctly
 Reformer based exercises vs. mat based
•
Exercises used were mat 100s, leg circles
Endleman I, and Critchley D. Transverse Abdominis and Obliqus Internus Activity during pilates exercises:
measurement with ultrasound scanning. Arch Phy Med Rehabilitation. 2008; 89:2205-2212
 New area of injury prevention focus
 Limited research to show effectiveness with low
back pain prevention
•
Some research support effective tool for LBP prevention in
certain rigorous occupations (i.e. fire fighters)
 Theory:
•
Program focus on flexibility, muscle balance may have a
link to decrease LBP
 First step of rehab
 Make it a challenge
 Random checks
 Awareness
 Missing Link in low back rehab programs
 Extra step to break the cycle of CLBP
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daFonseca J, Magini M, and de Freitas T. Laboratory gait analysis in patients with low back pain before and after a pilates
intervention. Journal of Sport Rehabilitation. 2009; 18:269-282
Endleman I, and Critchley D. Transverse Abdominis and Obliqus Internus Activity during pilates exercises: measurement
with ultrasound scanning. Arch Phy Med Rehabilitation. 2008; 89:2205-2212
Gladwell V, Head S, Hagger M, and Beneke R. Does a Program of Pilates Improve Chronic Non-Specific Low Back Pain.
Journal of Sports Rehabilitation. 2006; 15:338-350
McCook D, Vicenzino B, and Hodges P, Activity of deep abdominal muscles increases during submaximal flexion and
extension efforts but antagonist co-contraction remains unchanged. Journal of Electromyography and Kinesiology. 2009; 19:754762
Wallwork T, Stanton W, Freke M, and Hides J. The effects of chronic low back pain on size and contraction of the lumbar
multifidus muscle. Manual Therapy. 2009; 14:496-500
Hall L, Tsao H, MacDonald D, Coppieters M, and Hodges P. Immediate Effects of co-contraction training on motor control
of the trunk muscles in people with recurrent low back pain. Journal of Electromyography and Kinesiology. 2009; 19:763-773
Peate W, Bates G, Lunda K, Francis S, and Bellamy K. Core Strength: A new model for injury prevention and prediction.
Journal of Occupational Medicine and Toxicology. 2007; 2:3 1-9
Hicks G, Fritz J, Delitto A, and McGill S. Preliminary Development of a Clinical Prediction Rule for Determining Which
patients with low back pain will respond to a stabilization exercise program. Arch Phy Med Rehabilitation. 2005; 86:1753-1761
Sapsford R, Hodges P, Richardson C, Cooper D, Markwell S, and Jull G. Co-activation of the abdominal and pelvic floor
muscles during voluntary exercises. Neurology and Urodynamics. 2001; 20:31-42
O’Sullivan P, Phyty G, Twomey L, and Allison G. Evaluation of Specific Stabilizing Exercises in the Treatment of chronic low
back pain with radiologic diagnosis of spondylolysis and spondylolisthesis. Spine. 1997; 24:2959-2967
Hodges P. Changes in motor planning of feed forward postural responses of the trunk muscles in low back pain. Exp Brain
Research. 2001; 141:261-266
Hodges P, Cressswell, A and Thorstenson A. Preparatory trunk motion accompanies rapid upper limb movement. Exp
Brain Research. 1999; 124: 69-79
Hides J, Scott Q, Jull G, and Richardson C. A clinical palpation test to check the activation of the deep stabilizing muscles of
the lumbar spine. International SportsMed Journal. 2000; 1:4
Hides J, Jull G, and Richardson C. Long term effects of specific stabilizing exercises for first episode low back pain. Spine.
2001; 11:E243-E248