In part one of this post I very simple reviewed some of the ideas behind core stability and how I questioned their relevance to a patient’s pain presentation. In this follow up post I will briefly review how people with pain have different function than those without pain and give an opinion on how core ‘stability” exercises may help with patients in pain in a manner that has nothing to do with stabilizing the spine.
Purpose: To highlight the poor link between the bogeymen found on imaging with pain or dysfunction.
Our current technology is amazing when it comes to viewing the insides of our body. The problem with this fantastic technology is that we can see something (e.g. a tear in a muscle or a joint with some osteoarthritis) and assume that there is something wrong or that this is the source of our pain. However, the link between tissue “abnormalities” on MRI, x-ray or Ultrasound is often quite poor. Many, if not most, people have “bad stuff” on their MRIs or x-rays yet have no pain. (more…)
Update: I am not the first to write about this area. I found a great post by Todd Hargrove tackling the same topic and saying much the same (he does it more succintly and I address a few other areas as well). His post is here: http://www.bettermovement.org/2011/does-excessive-sitting-shorten-the-hip-flexors/
The Tight Hip Flexor Bogeyman
We too often tell patients that their pain, dysfunction or poor performance on any movement is due to the great bogeyman of hip function – TIGHT HIP FLEXORS. It is quite a go-to explanation for all things bad. Where this idea started I don’t know but it is certainly propagated by the Lower Crossed Syndrome Theory. This theory contends that dysfunction occurs when your pelvis is tilted forward as a result of tight hip flexors, weak glutes, tight low back muscles and weak abs. At its heart, this theory assumes the body works like a puppet where we can tension and loosen our strings (aka muscles) and watch our pelvis dance into some assumed nasty or happy position. (more…)
Purpose: Info sheet for patients to learn why the SI joint can be a pain in the butt.
The sacroiliac joint (SI joint) occurs where the bottom of your spine meets your hip bones. You have two of them and they must bear all of the stress that goes from your upper body through your lower body and vice versa.
SI joint pain can be felt in the lower part of your back, into your buttock, down your thigh and even into the shin. People will often feel their leg give out and will feel a catch when walking. It is often confused with Sciatica. This pain is often preceded by simple actions like picking up a pencil. Last pain perceived to be felt in the area of the SI joint can even come cranky nerves beside the joint and from above the joint (the superior cluneal nerves). (more…)
Purpose: Exercise Sheet handout
Attached is a handout for four variations on the sidebridge. If you do not know what you are doing please speak with a professional before incorporating these into your strength and conditioning program.
Audience: Patients, Trainers & health professionals
Utility: Exercise sheet handout for basic spine “stability” training
What exercises: Bird dog, side bridge, curl up
Stability is in quotes because you can certainly debate whether these exercises actually increase “stability”. Or more accurately make the stable system more Robust. What these simple but great exercises definitely do is work the entire trunk and hip musculature without imposing a large compressive or shear load on the spine. The initial research justification for those exercises (almost 16 years ago but they have only been catching on for the past 5 or so) is that they train the spine musculature but do so in a manner that may not increase the injury risk. Many exercises can train the spine musculature (e.g. double leg raises, back hyperextensions) but do so in a manner that might increase your risk of injury. These exercises avoid this which may be ideal in a low back injured population. Athletes are a separate kettle of fish. (more…)