Do you have Back pain with backward bending??

At Tactical Performance Physio, I understand the unique challenges faced by individuals experiencing pain with backward bending (extension-based pain). This type of discomfort often requires a nuanced approach, emphasizing stabilization exercises to improve motor control and prevent further injury. In this blog post, I will delve into the stabilization strategies I employ, particularly focusing on "anti-extension" exercises and the progression of these movements as patients develop better control.

The Initial Focus: Anti-Extension Exercises

For patients with extension-based pain, the initial emphasis is on exercises that counteract lumbar extension, known as "anti-extension" exercises. These exercises are designed to enhance stability by preventing excessive arching of the lower back. The core objective is to maintain a neutral spine, which is crucial for reducing pain and enhancing functional movement patterns.

Posterior Pelvic Tilt Control

A key aspect of this approach is developing control over the posterior pelvic tilt. This involves teaching patients to engage their lower abdominals and glutes, helping to flatten the lower back and reduce the tendency to extend excessively. Starting with simple exercises, we gradually increase the complexity and challenge as the patient gains proficiency.

Some of the foundational exercises we incorporate include:

• Dead-bugs: This exercise is excellent for promoting core stability while maintaining a neutral spine. It challenges the patient to coordinate arm and leg movements without losing control of their core.

Focus on using lower abs to “tuck pelvis” to keep lower back flat on floor throughout movement.

• Planks with Posterior Tilt: A staple in core stability training, planks help strengthen the entire core while ensuring the lumbar spine stays neutral.

• Hinging Movements: Teaching patients to hinge at the hips while maintaining a neutral spine is crucial. This movement pattern is foundational for activities like deadlifts and good mornings.

• Single Leg Hinge Movements (single leg RDL): These exercises challenge balance and stability while maintaining proper spine alignment.

• Chops and Lifts in Kneeling: These movements, performed in a kneeling position, emphasize rotational stability and can be progressed to standing positions for added challenge.

The Chop: Focus on engaging lower abs to “tuck pelvis under”

Avoiding Compensations

A critical aspect of my approach is ensuring that patients do not compensate with upper extremity movements, such as push-ups or overhead pressing, by driving into lumbar extension. This compensation can exacerbate pain and hinder progress. I emphasize maintaining a neutral spine during these activities to promote proper movement mechanics.

*If a patient does not have full overhead shoulder range of motion, they will have no choice but to excessively arch their lower back when pressing overhead thus looking at the entire body is essential. *

Incorporating Breathing and Abdominal Activation

In addition to stabilization exercises, we also integrate breathing techniques to enhance core engagement. During the early years of my career, I was heavily influenced by the Postural Restoration Institute (PRI) approach, which incorporates exhalation training with exercises. This focus on breathing helps improve diaphragmatic function and core stability, supporting overall spine health.

*All of your abdominal muscles are significantly activated when performing long or forceful exhalations*

Conclusion

At Tactical Performance Physio LLC, our approach to treating extension-based pain is comprehensive and patient-centered. By focusing on anti-extension exercises, developing posterior pelvic tilt control, and avoiding compensatory movements, I help my patients achieve better motor control and reduce pain. As patients progress, I introduce more challenging exercises, ensuring they maintain a neutral spine throughout their training. Our dedication to staying at the forefront of physical therapy techniques, including breathing and abdominal activation, ensures that our patients receive the best possible care.

References:

1. Rabin A, et al. "A clinical prediction rule to identify patients with low back pain who are likely to experience short-term success following lumbar stabilization exercises." J Orthop Sports Phys Ther. 2014.

2. Vera-Garcia FJ, et al. "Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations." J Electromyogr Kinesiol. 2007.

3. Badiuk BW, et al. "Exercises to activate the deeper abdominal wall muscles: The Lewit." J Strength Cond Res. 2014.

4. Park SH, Lee MM. "Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability." Med Sci Monit. 2019.

5. Fritz JM, et al. "Subgrouping patients with low back pain: evolution of a classification approach to physical therapy." J Orthop Sports Phys Ther. 2007.

For those looking to improve their core stability and manage extension-based pain, I am here to provide expert guidance and personalized treatment plans. Don't hesitate to reach out to me at Tactical Performance Physio LLC for more information or to schedule a consultation.

"Before implementing any exercise or rehabilitation program, it’s important to consult with a healthcare professional, especially if you are dealing with a nagging injury. They can help you tailor these principles to your unique needs and ensure you progress safely."