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| Very tonic posterior chain |
I had the great opportunity of networking with a personal trainer who is FMS certified and follows a lot of the same philosophies I do. I was psyched to find him last year, but unfortunately he moved out of state shortly afterward.
However, being entrepreneurial, he kept most of his clients in Buffalo NY and does their training sessions via facetime or skype. I still get referrals from him every once in a while and they are always great and very motivated to return to training. The recent client I saw for re-evaluation last week had to be convinced to see me again (he saw me last year for UQ pain which resolved but has a long standing history of LBP).
His current complaints are only moderate stiffness and discomfort, but no pain in his lumbar spine, felt lower and bilaterally. These Sx are felt upon rising after prolonged sitting, with deadlifts, and squats. They are relieved with prolonged flexion against a table or walking in a flexed position until he can walk upright.
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| initial pre-test for functional squat, hands supposed to be touching the floor, maintaining posterior pelvic tilt |
A hunch told me he would not be an extension or loading rapid responder as all the postural education from last year carried over, he was still very compliant with sitting upright, avoiding prolonged sitting, and use of a lumbar roll. I decided to use some tests from PRI's Pelvic Course as he seemed liked the typical PEC classification.
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initial pre-test for standing reach, about 6-7" from the floor, no rounding of lumbar spine
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Essentially, he was stuck in a lordotic position, with increased tone in his lumbar and thoracic paraspinals. While this is a safe position to squat and deadlift, imagine not being able to round out your lumbar spine once you're not doing those exercises. Cortically, the lumbar spine would lose definition and the perception of it would be to move as one, instead of healthy and segmentally. No wonder the main complaint is perception of "aching and stiffness."
Treatment - 20 minutes of
- pain science education on threat and movement
- his main question was, "How can I hike, play tennis, and strength train, yet still have this pain?"
- the education was that he can do all those things because he can, and his years of LBP have made his CNS a bit overprotective of that area
- breathing education - he had no idea how to exhale, even though he could breathe diaphragmatically, he only exhaled about 30% of maximum prior to inhalation
- this was worked on in hooklying as I gave him cues for posterior tilt by placing my hand under his lumbar spine
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| my hand under his lumbar spine - "roll your pelvis toward 12 o'clock during exhale and feel my hand" |
- after about 7 minutes of practice, and rolling back and forth from 6 to 12 with some PNF agonist reversals, he was able to posterior tilt
- we then progressed to posterior tilt while blowing up a balloon for some diaphragm activation via resistance
- this was very difficult, and I told him it may take 1-2 weeks to be able to blow it up after 4-5 breaths
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| you can't see the EDGE Rehab and Sport Science logo if you can't blow up the balloon, advertising fail! |
- after 7-8 more minutes of practice of pelvic tilt, diaphragmatic activation, we did some re-test of standing toe touch and functional squat
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| He had to externally rotate his feet, but he could maintain posterior tilt until almost hand touching the ground |
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| his lumbar spine now reverses, and upon practicing diaphragmatic breathing at end range, he was able to touch his toes for the first time in years |
- just think of all the healthy input of non-threatening movement the lumbar spine received during this short treatment
- all perceptions of stiffness during bending, after rising from sitting, and during deadlift and squats were gone after this session
- as a regression, I told his trainer to have him deadlift and squat heels elevated 2" or so and progress as he is able to easily touch his toes and pass the functional squat test
- patient = glad he came, and psyched his training will be more comfortable
- trainer = glad he referred, and psyched about having a happy client
- clinicians: The takeaway is find a good trainer for some great back and forth synergy!
Keeping it Eclectic...
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