Lumbo-Pelvic Stability
8 March 2013, 3:42 pm
Welcome to the first post. I'm interested in any feedback, questions or suggestions for future posts...
Over the winter a few folk mentioned to me that they’d been getting some lower back pain when doing core stability exercises – leg raises and what not. I sort of have half a mind to do an article at some point about lumbar spine/pelvic stability. Thought I’d put some stuff on here and (hopefully) get some feedback, and maybe one day put it into a more structured form. The essence of lumbo-pelvic stability is that if you can’t control the position/stability of your lumbar spine when, for example, doing leg raises/planks, you’ll transfer a LOT of shear force across the lumbar vertebrae, which will result in pain. We have a system of muscles that allows us to keep our spine still when we are moving our limbs – simple. However, during strenuous movements we tend to ‘use’ spinal movements to initiate limb movements; when we get tired, we are simply unable to stabilise our spines, leading to ‘give’, and often pain.
Therefore, there are two important aspects – decreasing the likelihood of pain/injury, and making sure we are targeting the muscles that generate movement/power, not using spinal movements to compensate.
Aims:
· Understand the anatomy of the spine, and what constitutes ‘normal’ spinal alignment.
· Understand how to alter and monitor spinal alignment.
· Understand how abnormal spinal alignment and lack of control can produce pain.
· Understand how to control spinal stability during training, to make sure we are targeting the muscles we want to actually train.
There is a bit of a caveat here: when you are trying a boulder problem, and trying to get your foot on a distant hold, the aim is NOT to concentrate on trying to keep your pelvis still – do everything you can to get that foothold. However, when you are training and doing your leg raises, by using correct form/technique, you will minimise injury risk and increase training effect on the muscles you want to train.
So, a bit of basic anatomy.Look at the three pictures below. The triangle is the pelvis, the curved line is the spine. The first picture shows lumbar neutral – the pelvis is flat, the spinal curves are smooth and natural. The lumbar and cervical spine show their natural forward curve (lordosis); the thoracic spine shows its natural backward curve (kyphosis). The second picture demonstrates a posterior pelvic tilt, which removes the lumbar lordosis, increases the thoracic kyphosis, and hugely exaggerates the cervical lordosis. The third picture is an anteriorly tilted pelvis. You can see it leads to a very tight bend at the base of the lumbar spine.
These altered curves put increased compressive and torsional stresses on the vertebrae, joints, ligaments, discs and other structures, depending on whether they are on the ‘inside’or ‘outside’ of the bend.
Most of us, when we sit – on a sofa, driving, at a computer– go into a slumped posture. This is a posteriorly tilted pelvis (picture 2), which pulls the lumbar spine out of its natural lordosis. This is why, when we stand up (after prolonged sitting) or get out of the car our lower backs feel very stiff and achy. The other problem with this posture, is that it exaggerates the thoracic spine kyphosis, which results in two things: 1) Increased tension across the thoracic spine and 2) a ‘poking chin’ posture – in order to look forwards we need an exaggerated bend in the base of our cervical spine (neck), which causes pain there too. It also alters the biomechanics of our shoulders, increasing the likelihood of shoulder instability, but that’s something for another day…
At other times, for example when lifting, or doing leg raises, we use lumbar spine extension – exaggerating the curve at the base of the lumbar spine – to initiate movement. Similarly, when doing ‘plank’ type exercises or press-ups, we allow our pelvises to tilt forwards, again exaggerating the curve at the base of the lumbar spine.
Basically, if you can’t control the position of your lumbar spine, you are likely, at the very least, to have localised pain, which will limit your training and make it less effective.
What can we do about it?
The first exercise is about teaching your brain what is actually happening back there. There is a thing called proprioception – our brain’s ability to know the position of a body part without seeing it (we know whether our elbows are bent or straight with our eyes closed, for example). However, most of us have very little proprioceptive awareness of our lumbar spine/pelvic position.
Exercise no 1: The Pelvic Tilt
The easiest position to try this exercise is in ‘crook lying’ – see the video. Basically, you are trying to tilt your ‘hip bones’(iliac crests) backwards and forwards. You shouldn’t feel that your abdominals need to work. It should feel very easy in terms of effort. At first, you may feel you need to concentrate quite hard! When you can do this in crook lying, try it in sitting – on a dining room chair or something flat and solid. The aim is to do it without moving your shoulders/thoracic spine. Either holding your iliac crests or placing a hand in your abdomen and lumbar spine (see video) will allow you to monitor the movement.
Just doing this periodically when you are driving or sitting at your computer can be very soothing and prevent that all-encompassing ache when you finally get up.
There is also a thing called ‘lumbar neutral’, which is kind of the ‘optimal’ position for your lumbar spine, (There is no ‘optimal’position really, it is a very dynamic, complex set of joints which actually need to be kept fairly mobile) and it is the position that you’ll need to be able to control when doing the core stability exercises. To find lumbar neutral, tilt your pelvis forwards (sit up) as far as you can comfortably, and then backwards (slump down) as far as you can. Do this a few times, and then stop in the position that is about a third to a half of the way down.
Again, once you have it mastered in sitting, try it in standing. It looks a bit creepy, but if you have a job where you do a lot of standing, it can help to relieve low back pain. Again it is essential that you can find and maintain pelvic neutral in standing for many of the core exercises. If you do any weight training, it is the position you need to maintain to protect your back, and to ensure you are using the muscles you want to use. Cyclists, it is a good habit to practice pelvic tilts on long bike rides, to ease lumbar spine stiffness.
Muddying the water.
Unfortunately, it’s not as simple as all that. There are a few muscles attached to the lumbar spine and pelvis, and over time these will have adapted their lengths to your normal resting postures, so you need to do some stretching as well! The main culprits are the hip flexors and the hamstrings.
A habitual anteriorly tilted pelvic position will result in shortened hip flexors, so you need to stretch them. They attach directly to the lumbar spine, so if they are short they will put direct tension on the lumbar vertebrae. This is why many people get back pain when they lie flat. It is also why activation of the hip flexors, when doing leg raises, causes lumbar spine pain if their action is not countered by good core stability. See the stretch below – it incorporates a pelvic tilt, so you need to know how to do it.
The hamstrings are connected to the pelvis. If they are tight, they will pull the pelvis into posterior tilt, particularly with the legs straight out in front. Doing L-sits for example – the hip flexors are working overtime to keep the legs up, and they’re pulling the lumbar spine one way; the hamstrings are on tension and are therefore pulling the lumbar spine the other way. A recipe for pain. Again, make sure you stretch them.
OK, where are we? We can control our pelvic position, our hip flexors and hamstrings are nicely stretched. Now for a few very simple (not easy) exercises to help understand the concept of core stability.
It is not:
· About working your abdominals, getting a six pack and doing front levers (although it may help with that)
· About working yourself HARD.
It is about:
· Learning to control the position of your lumbar spine while you move other parts of your body, lift things, hold positions.
· Gradually increasing that level of control, so that ultimately, you can do very strenuous core work without having a negative impact on your spinal well-being.
Exercise no 2: Single leg lift-outs
This is really to demonstrate the mechanics of lumbar control, and to teach your brain the concept of maintaining spinal position while carrying out another task.
· Lie down on the floor in the crook lying position;
· Find lumbar neutral – flatten your back against the floor;
· Lift both feet off the floor – you should feel that this would cause your lumbar spine to arch away from the floor if you didn’t counter it – do so. Keep your back flat against the floor.
· Slowly, extend one leg – keep that back flat on the floor. If you feel your back arching, bring the leg back.
· Once the leg is fully extended, bring it back and do the same with the other leg.
· If you found this easy, do the same thing with both legs together, but don’t allow your back to arch.
· Hold the extended position for a count of 5, return and repeat.
· Stop before failure, only go as far as you can without your back arching.
Exercise no 3: standing single leg lift
This, again, is about demonstrating how we usually use spinal movements to initiate limb movements, and is about teaching your brain how not to do this. It will also give you the movement pattern for controlling lumbar spine position when doing leg raises.
Before you start this exercise, try this: In standing, without thinking about the movement, lift one knee up towards your chest. Now do it again, in the same way, but thinking about what your lumbar spine is doing. I imagine you flexed forwards when lifting your leg up, and extended when you brought your leg down.
Here’s how to do it while maintain lumbo-pelvic stability:
· Find lumbar neutral in standing.
· Slowly lift one knee towards your chest, concentrating on keeping your lumbar spine still. Only lift as far as you can without flexing forwards.
· Make sure you maintain the lumbar spine position all the way down – do not arch your back as you lower your leg.
· Repeat with the other leg.
· If you found this east, try with a straight leg.
Next time you do leg raises, whether on a pull up or dips bar, try to think about keeping your lumbar spine still.
Exercise no 4: Waiter’s Bow
This is a ‘warm-up’ exercise for the plank. Forgive me for being boring, but it is about learning to control the position in a ‘non-strenuous’situation, and converting it to a strenuous situation. It is surprisingly difficult, for such a conceptually simple movement.
· Find lumbar neutral in standing.
· Simply bend forwards from the hips, i.e. keeping the lumbar spine still.
· Make sure you do not extend the lumbar spine as you straighten up – this is the most difficult part!
· Again, only go down as far as you can, before you ‘lose’ the stability.
Exercise no5: The Plank/press-ups
OK, you’re ready for the plank. It’s an idea to do some press-ups, again to get your proprioceptive system firing. Just get in the press-up position, and do some press-ups without letting your lumbar spine move.
Now try a plank – do some pelvic tilts in the plank position– and find pelvic neutral. Make sure you maintain this position, and don’t allow yourself to drift into anterior pelvic tilt (increased lumbar spine lordosis). A good way to do this is to actively contract the muscles in your buttocks.
That’s probably enough for now. Practice the pelvic tilts, and think about your pelvic position when you’re driving, sitting at your computer or watching TV. Think about your lumbar spine position when you’re doing any core exercises. It should improve pain, if you get any, and allow you to work the muscles you want to more effectively.I’ll try and put some progression exercises up if people are interested. Any feedback gratefully received (yes, I know, the videos are awful!)
Source: Physiotherapy for Climbers
8 March 2013, 3:42 pm
Welcome to the first post. I'm interested in any feedback, questions or suggestions for future posts...
Over the winter a few folk mentioned to me that they’d been getting some lower back pain when doing core stability exercises – leg raises and what not. I sort of have half a mind to do an article at some point about lumbar spine/pelvic stability. Thought I’d put some stuff on here and (hopefully) get some feedback, and maybe one day put it into a more structured form. The essence of lumbo-pelvic stability is that if you can’t control the position/stability of your lumbar spine when, for example, doing leg raises/planks, you’ll transfer a LOT of shear force across the lumbar vertebrae, which will result in pain. We have a system of muscles that allows us to keep our spine still when we are moving our limbs – simple. However, during strenuous movements we tend to ‘use’ spinal movements to initiate limb movements; when we get tired, we are simply unable to stabilise our spines, leading to ‘give’, and often pain.
Therefore, there are two important aspects – decreasing the likelihood of pain/injury, and making sure we are targeting the muscles that generate movement/power, not using spinal movements to compensate.
Aims:
· Understand the anatomy of the spine, and what constitutes ‘normal’ spinal alignment.
· Understand how to alter and monitor spinal alignment.
· Understand how abnormal spinal alignment and lack of control can produce pain.
· Understand how to control spinal stability during training, to make sure we are targeting the muscles we want to actually train.
There is a bit of a caveat here: when you are trying a boulder problem, and trying to get your foot on a distant hold, the aim is NOT to concentrate on trying to keep your pelvis still – do everything you can to get that foothold. However, when you are training and doing your leg raises, by using correct form/technique, you will minimise injury risk and increase training effect on the muscles you want to train.
So, a bit of basic anatomy.Look at the three pictures below. The triangle is the pelvis, the curved line is the spine. The first picture shows lumbar neutral – the pelvis is flat, the spinal curves are smooth and natural. The lumbar and cervical spine show their natural forward curve (lordosis); the thoracic spine shows its natural backward curve (kyphosis). The second picture demonstrates a posterior pelvic tilt, which removes the lumbar lordosis, increases the thoracic kyphosis, and hugely exaggerates the cervical lordosis. The third picture is an anteriorly tilted pelvis. You can see it leads to a very tight bend at the base of the lumbar spine.
These altered curves put increased compressive and torsional stresses on the vertebrae, joints, ligaments, discs and other structures, depending on whether they are on the ‘inside’or ‘outside’ of the bend.
Most of us, when we sit – on a sofa, driving, at a computer– go into a slumped posture. This is a posteriorly tilted pelvis (picture 2), which pulls the lumbar spine out of its natural lordosis. This is why, when we stand up (after prolonged sitting) or get out of the car our lower backs feel very stiff and achy. The other problem with this posture, is that it exaggerates the thoracic spine kyphosis, which results in two things: 1) Increased tension across the thoracic spine and 2) a ‘poking chin’ posture – in order to look forwards we need an exaggerated bend in the base of our cervical spine (neck), which causes pain there too. It also alters the biomechanics of our shoulders, increasing the likelihood of shoulder instability, but that’s something for another day…
At other times, for example when lifting, or doing leg raises, we use lumbar spine extension – exaggerating the curve at the base of the lumbar spine – to initiate movement. Similarly, when doing ‘plank’ type exercises or press-ups, we allow our pelvises to tilt forwards, again exaggerating the curve at the base of the lumbar spine.
Basically, if you can’t control the position of your lumbar spine, you are likely, at the very least, to have localised pain, which will limit your training and make it less effective.
What can we do about it?
The first exercise is about teaching your brain what is actually happening back there. There is a thing called proprioception – our brain’s ability to know the position of a body part without seeing it (we know whether our elbows are bent or straight with our eyes closed, for example). However, most of us have very little proprioceptive awareness of our lumbar spine/pelvic position.
Exercise no 1: The Pelvic Tilt
The easiest position to try this exercise is in ‘crook lying’ – see the video. Basically, you are trying to tilt your ‘hip bones’(iliac crests) backwards and forwards. You shouldn’t feel that your abdominals need to work. It should feel very easy in terms of effort. At first, you may feel you need to concentrate quite hard! When you can do this in crook lying, try it in sitting – on a dining room chair or something flat and solid. The aim is to do it without moving your shoulders/thoracic spine. Either holding your iliac crests or placing a hand in your abdomen and lumbar spine (see video) will allow you to monitor the movement.
Just doing this periodically when you are driving or sitting at your computer can be very soothing and prevent that all-encompassing ache when you finally get up.
There is also a thing called ‘lumbar neutral’, which is kind of the ‘optimal’ position for your lumbar spine, (There is no ‘optimal’position really, it is a very dynamic, complex set of joints which actually need to be kept fairly mobile) and it is the position that you’ll need to be able to control when doing the core stability exercises. To find lumbar neutral, tilt your pelvis forwards (sit up) as far as you can comfortably, and then backwards (slump down) as far as you can. Do this a few times, and then stop in the position that is about a third to a half of the way down.
Again, once you have it mastered in sitting, try it in standing. It looks a bit creepy, but if you have a job where you do a lot of standing, it can help to relieve low back pain. Again it is essential that you can find and maintain pelvic neutral in standing for many of the core exercises. If you do any weight training, it is the position you need to maintain to protect your back, and to ensure you are using the muscles you want to use. Cyclists, it is a good habit to practice pelvic tilts on long bike rides, to ease lumbar spine stiffness.
Muddying the water.
Unfortunately, it’s not as simple as all that. There are a few muscles attached to the lumbar spine and pelvis, and over time these will have adapted their lengths to your normal resting postures, so you need to do some stretching as well! The main culprits are the hip flexors and the hamstrings.
A habitual anteriorly tilted pelvic position will result in shortened hip flexors, so you need to stretch them. They attach directly to the lumbar spine, so if they are short they will put direct tension on the lumbar vertebrae. This is why many people get back pain when they lie flat. It is also why activation of the hip flexors, when doing leg raises, causes lumbar spine pain if their action is not countered by good core stability. See the stretch below – it incorporates a pelvic tilt, so you need to know how to do it.
The hamstrings are connected to the pelvis. If they are tight, they will pull the pelvis into posterior tilt, particularly with the legs straight out in front. Doing L-sits for example – the hip flexors are working overtime to keep the legs up, and they’re pulling the lumbar spine one way; the hamstrings are on tension and are therefore pulling the lumbar spine the other way. A recipe for pain. Again, make sure you stretch them.
OK, where are we? We can control our pelvic position, our hip flexors and hamstrings are nicely stretched. Now for a few very simple (not easy) exercises to help understand the concept of core stability.
It is not:
· About working your abdominals, getting a six pack and doing front levers (although it may help with that)
· About working yourself HARD.
It is about:
· Learning to control the position of your lumbar spine while you move other parts of your body, lift things, hold positions.
· Gradually increasing that level of control, so that ultimately, you can do very strenuous core work without having a negative impact on your spinal well-being.
Exercise no 2: Single leg lift-outs
This is really to demonstrate the mechanics of lumbar control, and to teach your brain the concept of maintaining spinal position while carrying out another task.
· Lie down on the floor in the crook lying position;
· Find lumbar neutral – flatten your back against the floor;
· Lift both feet off the floor – you should feel that this would cause your lumbar spine to arch away from the floor if you didn’t counter it – do so. Keep your back flat against the floor.
· Slowly, extend one leg – keep that back flat on the floor. If you feel your back arching, bring the leg back.
· Once the leg is fully extended, bring it back and do the same with the other leg.
· If you found this easy, do the same thing with both legs together, but don’t allow your back to arch.
· Hold the extended position for a count of 5, return and repeat.
· Stop before failure, only go as far as you can without your back arching.
Exercise no 3: standing single leg lift
This, again, is about demonstrating how we usually use spinal movements to initiate limb movements, and is about teaching your brain how not to do this. It will also give you the movement pattern for controlling lumbar spine position when doing leg raises.
Before you start this exercise, try this: In standing, without thinking about the movement, lift one knee up towards your chest. Now do it again, in the same way, but thinking about what your lumbar spine is doing. I imagine you flexed forwards when lifting your leg up, and extended when you brought your leg down.
Here’s how to do it while maintain lumbo-pelvic stability:
· Find lumbar neutral in standing.
· Slowly lift one knee towards your chest, concentrating on keeping your lumbar spine still. Only lift as far as you can without flexing forwards.
· Make sure you maintain the lumbar spine position all the way down – do not arch your back as you lower your leg.
· Repeat with the other leg.
· If you found this east, try with a straight leg.
Next time you do leg raises, whether on a pull up or dips bar, try to think about keeping your lumbar spine still.
Exercise no 4: Waiter’s Bow
This is a ‘warm-up’ exercise for the plank. Forgive me for being boring, but it is about learning to control the position in a ‘non-strenuous’situation, and converting it to a strenuous situation. It is surprisingly difficult, for such a conceptually simple movement.
· Find lumbar neutral in standing.
· Simply bend forwards from the hips, i.e. keeping the lumbar spine still.
· Make sure you do not extend the lumbar spine as you straighten up – this is the most difficult part!
· Again, only go down as far as you can, before you ‘lose’ the stability.
Exercise no5: The Plank/press-ups
OK, you’re ready for the plank. It’s an idea to do some press-ups, again to get your proprioceptive system firing. Just get in the press-up position, and do some press-ups without letting your lumbar spine move.
Now try a plank – do some pelvic tilts in the plank position– and find pelvic neutral. Make sure you maintain this position, and don’t allow yourself to drift into anterior pelvic tilt (increased lumbar spine lordosis). A good way to do this is to actively contract the muscles in your buttocks.
That’s probably enough for now. Practice the pelvic tilts, and think about your pelvic position when you’re driving, sitting at your computer or watching TV. Think about your lumbar spine position when you’re doing any core exercises. It should improve pain, if you get any, and allow you to work the muscles you want to more effectively.I’ll try and put some progression exercises up if people are interested. Any feedback gratefully received (yes, I know, the videos are awful!)
Source: Physiotherapy for Climbers
