Medical & Rehabilitation

Lower Back Pain

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One of the most common ailments of people of all ages (athletes or the general
population) is low back pain. It is so common and causes so many issues that there
is an entire specialty (Chiropractic) that is dedicated to this condition. The reasons
is because of the severity of what could happen if low back pain continues without
treatment – pinched nerves, degenerative discs, arthritis, ruptured discs, etc.
Many of the most common treatments are – spinal adjustments, modalities,
increasing flexibility/mobility of the hips, strengthening, etc. Some of these can be
very expensive – in addition to the degree of uncertainty that may arise when trying
to choose a specialist that fits your situation.
In terms of treatment, some of the most basic and effective forms of correcting
dysfunction are ISOMETRIC STRENGTHENING. This goes well above and beyond
traditional strengthening of the trunk/spine (like crunches or planks). This can be a
very systematic approach to providing great stability across the various spinal levels
by ensuring that the muscles that attach to these levels are contracting properly.
In the pictures below, 4 key exercises will be demonstrated that strengthen the
muscles that are involved in the 4 key motions of the spine: FLEXION, EXTENSION,
LATERAL FLEXION, and ROTATION.
Usually low back pain and the onset of any type of condition in the trunk/spine
arises because the spine is inefficient at contracting muscles that are involved in one
or more of these motions. If one side is inefficient, the spine becomes unstable at
that level and many problems could arise. To combat this, it’s always a good idea to
train the motions from an isometric standpoint in every motion:

FLEXION

FLEXION

EXTENSION

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LATERAL FLEXION

LATERAL_FLEXION

ROTATION

ROTATION

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Sets/Time: Depending on the severity of your pain and your fitness level – can be
2-5 sets of 15 to 60 second holds
Advanced: There are dozens of variation of these isometrics – standing, kneeling,
split stance, squat stance, performing these band exercises while lifting, etc.
Also, different band tension and/or different force angles (how high or low your
partner/trainer puts the band) will dictate the emphasis being placed on various
muscles.
The great thing about these exercises is that they can be done with bands – which
are inexpensive and don’t take up space. And, they can be done from anywhere,
even at home. To be very specific about the cause of your low back pain – getting
evaluated by a specialist can dictate which variations of these exercises should
be assigned along with a progressive plan that can really aid in the reduction of
common low back ailments – with a plan for the future to keep from reoccurring.

Combating Knee Pain/Tendonitis

One of the most common areas of issues for adults is knee pain/tendonitits. The easiest way to combat these ailments – and build a program to supplement your current activity level – involves a 3-step process:
  1. STABIILTY. The most efficient way to ensure the knee is stable, and the structure of the joint is supported properly by the muscles that cross it, is to perform isometrics. Isometrics involves contracting a muscle at a specific range without moving; as opposed to moving the joint like traditional exercise. Looking at the muscles of the thigh the cross the knee joint (and/or are involved in function of the knee), there is the 4 primary groups:  muscles in the front (quads and hip flexors); in the back (hamstrings); on the inside (adductors); and outside (abductors). Progressions can begin at 3 seconds and progress up to 30 seconds for advanced adults.
    1. Advanced tipHaving a fitness professional assess any asymmetries (an imbalance) in the ranges of motion at the knee joint can help make the stability isometric program even more specific to your body.
  2. STRENGTH. Don’t be scared off by the term strength. This is not the typical term that people think of that means “how much weight can you lift.” This is simply just progressing the 4 main exercise listed above from isometrics to motion. Using the same 4 machines (or bands for advanced), a person can start to implement basic motions. The range of motion can start very small (just what a person can control), and start to increase as the knee becomes more stable through the isometrics. This style of progression can be specific to anyone.  We’ve had a lot of success with this protocol from anyone like an older person that just needs to combat various levels of knee pain to get back to the active lifestyle that they enjoy; to the 25-year old advanced fitness enthusiast that wants to get the knee stronger in order to train more aggressively. The key to finding what will work for your goals is to control two major factors: the range of motion and the speed (tempo) of the motion.
    1. Advanced tip:  If you are experienced with training, and already implement exercise such as squats and lunges – these exercise can still be for you – and lead to a lot more success (and less pain!) during the advanced training you are performing.  Just complex (superset) the single joint exercises listed above into your current routine.
  3. ENDURANCE. This is the key to long term health! Once the joint is stable, and you have provide the necessary strength at all of the required ranges of motion – ensure the knee joint can now handle your chosen activity. Doing exercises like backward and forward marches at various speeds and distances can greatly enhance all of the necessary muscles from an endurance component. Note the key word MARCH. Endurance training can be simplified for joint integrity and reducing pain; as opposed to the typical form of “endurance” that people think is cardiovascular. The marching can just focus on local muscular endurance, which is necessary for continued pain management.
    1. Advanced tip:  the use of resisted devices such as sleds, and pulley machines (outside) and the Keiser (inside) can make these exercises a lot more beneficial.

By: Pete Bommarito