Preventative Strategies for Lower Back Strains in Pilates There is now some evidence that increases in core strength can be useful in both the prevention and treatment of various forms of back pain and injury. There is also some interesting recent research showing that improvement in hamstring flexibility will result in better movement strategies and reduced risk of back strain in daily life. In this post, we are going to examine how to combine both of these approaches. First, we will look at the effects of hamstring inflexibility on the lumber spine, including how stiff hamstrings may alter the biomechanical functioning of the pelvis and lumbar spine. We will then have a look at how to stretch the hamstrings effectively on the Pilates Reformer, with a simple exercise that is totally safe on the lumbar spine. Finally, we will also revisit some key Pilates exercises used to teach the correct movement patterns that greater hamstring flexibility will enable.
Two recent studies looked at what is
called “lumbo-pelvic-rhythm.” The first looked at lumbo-pelvic-rhythm in relation to forward bending, the second in relation to lifting. Lumbo-pelvic rhythm is essentially how the pelvis and lumbar spine move in relation to each other. We, i.e. the body, usually employ one of two patterns, particularly when forward bending and lifting—lumbar dominant and pelvis dominant. In lumbar dominance, a forward bend is achieved through flexion of the lumbar spine. In pelvis dominance, a forward bend is achieved through pelvic rotation i.e. increased hip flexion, with less loss of neutral spine position.
Here's a link to the research papers: http://goo.gl/IixTFF http://goo.gl/HNZvZq
What the research found: The results of both studies were interesting, but unsurprising: “After hamstring stretching exercises, there was a significant increase in hip flexion and decreases in both lumbar flexion and the lumbar/hip flexion ratio during the preparation phase of stoop lifting.” To re-iterate: in flexible subjects, pelvis movement/rotation, the preferred means of movement, was dominant. In conclusion, improving tight hamstrings may reduce lumbar loading/ flexion thereby reducing low back pain. The meaning of this research- tight hamstrings can have a negative effect on spinal biomechanics. Movement of the pelvis on the hips should be equal to or greater than movement of the lumbar spine in relation to the pelvis, otherwise flexion is concentrated in the lower back.
The take home lessons from this research: 1) Stretch the hamstrings 2) Teach all of the correct movement patterns that you already teach so well in your Pilates studio. Emphasize the usual objectives like hip disassociation and lumbo-pelvic stability. Here’s an exercise that would be useful:
Stretching the Hamstrings Here’s a safe, simple and effective hamstring stretch that you can use with anyone suffering low back strain, or as a preventative strategy.
It’s a very brief descrition taken from our Innovations in Pilates reformer book. 1 Step one: Using medium spring resistance allow the carriage to take your leg to the point of tension in the hamstrings i.e. about 5 or 6 out of ten in terms of intensity. 2 Step two: contract the hamstrings isometrically using about 30% of your maximum strength. To do this, hold the strap and simply press your leg toward the floor, without allowing the leg to move. Do this for five seconds. 3 Step Three: Take a breath in and on a breath out allow the carriage to slide in toward the foot bar a little more, to take up the slack created in the hamstrings by the contraction. Hold this final position for 20 deep breaths.
Try teaching your client some hip circles. Why? Although the hip circles do not replicate the pelvic on femoral rotation discussed above, they do teach a client about hip dissociation- that is, moving the trunk somewhat independently from the legs, or vice versa. When bending forward or lifting as described in the studies above, this same dissociation principle applies-the lower back is less likely to strain if the trunk and pelvis rotate on the femurs. If they don’t rotate on the femurs, the low back will flex instead. Once your client experiences the idea of dissociation in their bodies in an easier setting like lying on the reformer, you can stand them up and teach the actual skill of bending and lifting from the hips.
Why not use the Roll up?
Teaching Hip Dissociation The roll up may in fact re-inforce the same negative movement strategy discussed above, depending on how it’s taught. (Note that the BASI exercise photos are quite different to the video, and much safer.) If the hamstrings are tight, watch the video and see what happens! It’s an exact replica of the standing movement pattern in people with stiff hamstrings-the movement occurs at the path of least resistance-the lumbar spine. Try teaching your client some hip circles. Why?
Here’s the video link: https://www.youtube.com/watch?v=n78PS4zq3D8
Why not use the Elephant, after all, it more closely resembles the lifting technique described in the research? Mostly because it requires a high degree of hamstring flexibility to begin with! If a client does not have this degree of flexibility, here’s what you’ll see………
You will be reinforcing the same lumbar dominant movement pattern associated with low back strain! Compare our client above to this better performance below, with correct hip dissociation.
Conclusion The hamstrings are often implicated in low back pain but the relationship is unclear. The research above helps to demystify the cause and effect relationship. Use it to do what you were already doing in your studios-teaching effective movement strategies and stretching-but now with greater certainty.
www.innovationsinpilates.com.au Fb Page Innovations in Pilates Books Workshops Certifications Classes Retreats www.pilatesretretas.com.au
For a discussion of the Elephant, follow this link: www.anthonylett.com.au/index.php?q=playingwith-the-dog.html