sábado, 19 de Julho de 2014

More exercises for lower back pain / sciatic pain

Other exercises that can relieve sciatic pain are strengthening exercises. The most important group of muscles that have a great impact in the improvement of the sciatic pain is the abdominal group.
The abdominal muscles are located between the ribs and the pelvis on the front of the body. The abdominal muscles support the trunk, allow movement and hold organs in place by regulating internal abdominal pressure.
There are four main abdominal muscle groups that combine to completely cover the internal organs:

  •  Transversus abdominus, which is the deepest muscle layer. Its main roles are to stabilize the trunk and maintain internal abdominal pressure;

  • Rectus abdominus that goes from the ribs to the pubic bone ate the front of the pelvis. This muscle has the characteristic bumps or bulges, when contracting, that are commonly called the “six pack”. The main function of the rectus abdominus is to move the body between the ribcage and the pelvis.

  •   External oblique muscles that are on each side of the rectus abdominus. The external oblique muscles allow the trunk to twist, but to the opposite side of whichever external oblique is contacting. For example, the right external oblique contracts to turn the body to the left.

  • Internal oblique muscles that flank the rectus abdominus and are located just inside the hipbones. They operate in the opposite way to the external oblique muscles. For example, twisting the trunk to the left requires the left internal oblique and the right external oblique to contract together.

Think of your core as a strong column that links the upper body and lower body together. Having a solid core creates a foundation for all activities. All our movements are powered by the torso – the abdominals and back work together to support the spine when we sit, stand, bend over, pick things up, exercise and more.
Another muscle that is involved in moving the trunk is the multifidus. This is a deep back muscle that runs along the spine. It works together with the transversus abdominus to increase spine stability and protect against back injury or strain during movement or normal posture.      

Transversus Abdominus strengthening

Transversus abdominus is the deepest of the abdominal muscles and wraps around the abdomen between the lower ribs and top of the pelvis, functioning like a corset. When transversus abdominus contracts the waist narrows slightly and the lower abdomen flattens. The function of the transversus abdominus is to stabilize the low back and pelvis before movement of the arms and/or legs occurs.
Mid or low back pain (for example, trauma, sciatic pain, lumbar herniation disc), abdominal injury/surgery and/or excessive lengthening due to pregnancy can cause a delay or absence in the anticipatory contraction of transversus abdominus. If this muscle contraction delay/absence is not corrected, this dysfunction will remain, even after your pain has subsided.
For that, you need to restore your recruitment patterns (order in which different muscles contract). The first step is to learn to isolate the muscle and train it to contract.

 Recruitment Training for Transversus Abdominis (TrA)

To activate your Transversus Abdominus, all you need to do is “suck in” your belly about 25% to 50%. To know if you are activating the desired muscle, just place your index finger slightly inwards from the left and right hip bone. The hip bones are two bony prominences in front of the waist. Breathe in and on the breath out contract the transversus abdominus.
Hold the contraction for 3 - 5 seconds and then release and breathe throughout this exercise. Repeat the contraction and hold for 3 sets of 10 repetitions 3 - 4 times per day for 4 weeks. 


Once you can easily recruit Transversus Abdominus you can progress to the following exercises.
Lying on your back with your knees and hips flexed:
  1. Slowly let your right knee move to the right, keep your low back and pelvis level. Return to the center and repeat with the left.
  2. Lift the right foot off the floor keeping the knee bent. Don’t hold your breath and don’t bulge your lower abdomen. Return the foot to the floor and repeat with the left foot.
  3. Lift the right foot off the floor and then straighten the leg only as far as you can control your core without lifting your lower back from the floor. Slowly bend the knee and return the foot to the floor. Repeat with the left leg.
  4. Lift the right foot off the floor and then the left foot off the floor. Alternate leg extensions, exert with exhalation, breathe in to rest or hold. As always, do the leg extensions as far as you can without lifting your lower back from the floor.
In side lying:
  1. Keep your ankles together and lift your top knee (only as high as you can control without breath holding), focus on turning your inner thigh outwards. Return your knee.
  2. Keep your ankles together, lift your top knee and then lift your ankle. Return your ankle and then your knee.
With all these exercises maintain the leg lift for 10 seconds, build to 3 sets of 10 repetitions before moving on.
Once you can activate the Transversus Abdominus, you can practice recruiting it in many different positions such as sitting, standing, squatting, lifting etc.
It is not uncommon for other muscles to co-contract in an attempt to compensate for a dysfunctional core. It is critical that you take the time to focus on your technique and achieve a correct contraction before moving on to any loading through the arms or legs. Watch for the following substitution strategies:
  1. Posterior tilting of the pelvis
  2. Bulging of the abdomen
  3. Depression of the rib cage
  4. Breath holding
  5. Fingertips being pressed out by a strong muscular contraction (internal oblique)
The final step is to remember to use this muscle during regular activities. Each time you get out of the chair, lift, bend or reach, the deep muscle system should be working with and for you. The goal is to help the brain remember to use the deep system and the more you use it, the less you will be likely to lose it.
Now, if you want to, you can go to the gym and train your abdominals. But be sure to ask your physical therapist about the type of abdominal exercises you can or cannot do. For example, for people with a lumbar herniated disc it is dangerous to do all kind of exercises that require a torsion movement of your back.

Other exercises that can reduce your lower back pain are strengthening of the gluteus and stretching of the iliac psoas. The stretching of the iliac psoas should be done at least three times per day with three sessions of thirty minutes each. 


terça-feira, 17 de Junho de 2014

Age-related impairments (along with videos)

Hey everybody! I know that I have been away without giving any news (like two years), but now I am back! :) With the change of country (speaking of that, I must change my location), the adaptation that it requires and the search for new jobs (and the adaptation to the new co-workers, that was not easy at all!), I was caught up in the proccess and I honestly did not have time to sit down in front of my laptop with a nice cup of coffee and don't think about anything else than my blog. I will try to get back on track.
For the time being I work in a hospital, mainly with elderly people, and I am starting to have the perception of all the problems that elderly people have, as part of the aging proccess. I am writing this post, and showing you the videos below, because I am becoming aware that young people (even some of the hospitals staffs that take care of the elderly people and is in charge of their well-being and confort) are not sensibilized to these changes and don't have, most of the times, the endearment and affection that this situation demands.  
These two videos show the GERontologic Test suit (GERT), a german project. It's an age simulation suit that offers the opportunity to experience the impairments of older persons. Some of the the age-related impairments are opacity of the eye lens, narrowing of the visual field, high-frequency hearing loss, head mobility restrictions, joint stiffness, loss of strength, reduced grip ability and reduced coordination skills, as explained in their website: http://www.age-simulation-suit.com/
Enjoy and see you soon! :)



segunda-feira, 22 de Agosto de 2011

Patellofemural Pain Syndrome Home exercises

Before starting any of the exercises mentioned below, search advice from your physical therapist, for he is the only one that really knows your actual condition and what you shouldn’t do or should do.
In order to achieve proper rehabilitation of your injury it is important to ensure the exercises are performed with good technique, for poor practice leads to poor performance and potential strain on your injury. To avoid that, it is important the presence of a physical therapist.
If at any time you feel pain or discomfort, stop the exercises and consult your physical therapist.

Warm up

When injured it is particularly important that you warm up with a fast walk (at a pain free pace) for 3-4 minutes before you start your exercises. This increases your circulation and helps prepare your muscles. 

Quadriceps sets

1.    Sit with your affected leg straight and supported on the floor or a firm bed. Place a small, rolled-up towel under your affected knee. Your other leg should be bent, with that foot on the floor.
2.    Tighten the thigh muscles of your affected leg by pressing the back of your knee down into a towel. Hold for about 6 seconds, and then rest for up to 10 seconds.
3.    Repeat 8 to 12 times.

Straight-leg raises to the front

1.    Lie on your back with your good knee bent so that your foot rests flat on the floor. Your affected leg should be straight. Make sure that your low back has a normal curve. You should be able to slip your hand in between the floor and your back, with your palm touching the floor and the back of your hand touching your back.
2.    Tighten the thigh muscles in your affected leg by pressing the back of your knee flat down to the floor. Hold your knee straight.
3.    Keeping the thigh muscles thigh and your leg straight, lift your affected leg up so that your heel is about 12 inches off the floor.
4.    Hold for about 6 seconds, and then lower your leg slowly. Rest for up to 10 seconds between repetitions.
5.    Repeat 8 to 12 times.

Wall slide with ball squeeze

1.    Stand with your back against a wall and with your feet about shoulder-width apart. Your feet should be about 12 inches away from the wall.
2.    Put a ball about the size of a soccer ball between your knees. Then slowly slide down the wall until your knees are bent about 20 to 30 degrees.
3.    Tighten your thigh muscles by squeezing the ball between your knees. Hold that position for about 10 seconds, and then stop squeezing. Rest for up to 10 seconds between repetitions.
4.    Repeat 8 to 12 times.

After being able to perform well the exercises mentioned above (not only being able to do the exercise, but to do it correctly, with appropriate control), there is an exercise program to stretch thigh muscles, strengthen the quadriceps and correct lower limb alignment in order to improve the tracking of your patella. 
     Static squat against wall.

2.    Mini-squat on both legs with support (on a chair, for example)

3.    Mini-squat on both legs without support

4.    Mini-squat on both legs with weights (start with 0.5 Kg in each hand)

5.    One leg mini-squat with support

6.    One leg mini-squat without support

7.    One leg mini-squat with weight (start with 0.5 Kg in each hand)

8.    Step up

9.    Step up with weight (start with 0.5 Kg in each hand)
1   Step down

11. Step down with weight (start with 0.5 Kg in each hand)

12. Step to (side-side)

13. Hop

Calf wall stretch

1.    Stand facing a wall with your hands on the wall at about eye level. Put your affected leg about a step behind your other leg.
2.    Keeping your back leg straight and your back heel on the floor bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg.
3.    Hold the stretch for at least 15 to 30 seconds.
4.    Repeat 2 to 4 times.
5.    Repeat steps 1 through 4, but this time keep your back knee bent.

Quadriceps stretch

1.    If you are not steady on your feet, hold on to a chair, counter, or wall.
2.    Bend your affected leg, and reach behind you to grab the front of your foot or ankle with the hand on the same side. For example, if you are stretching your right leg, use your right hand.
3.    Keeping your knees next to each other, pull your foot toward your buttocks until you feel a gentle stretch across the front of your hip and down the front of your thigh. Your knee should be pointed directly to the ground, and not out to the side.
4.    Hold the stretch for at least 15 to 30 seconds.
5.    Repeat 2 to 4 times.

Hamstring wall stretch

1.    Lie on your back in a doorway, with your good leg through the open door.
2.    Slide your affected leg up the wall to straighten your knee. You should feel a gentle stretch down the back of your leg.
a.    Do not arch your back.
b.    Do not bend the knee.
c.    Keep one heel touching the floor and the other heel touching the wall. Do not point your toes.
3.    Hold the stretch for at least 1 minute. Then over time, try to lengthen the time you hold the stretch to as long as 6 minutes.
4.    Repeat 2 to 4 times.

Iliotibial muscle stretch

1.    Stand side on to a wall with the affected leg closest to the wall.
2.    Place your arm on the wall for support and cross the affected leg behind the other.
3.    Lean your hips towards the wall. Keep your spine and pelvis in a neutral position.
4.    Hold the stretch for at least 1 minute.
5.    Repeat 2 to 4 times.