Getting Better...Better - Part 9 - The Spine - Part II
Last time we discussed the components of injury at the spine, the importance of breathing mechanics and how intra-abdominal pressure(IAP) affects the integrated spinal stabilizing system(ISSS).
Summed up - diaphragmatic breathing is the cornerstone of any low back rehabilitation program and key to longevity in training. It promotes proper IAP which positively influences active stability strategies at the spine. Chest or “paradoxical” breathing can reduce the diaphragm’s ability to regulate IAP, resulting in poor or compensatory stabilization strategies at the spine.
After we improve IAP and control with diaphragmatic breathing, we must learn to create active stability strategies that are appropriate to the task. The phrase I use repetitively with athletes and patients is:
ORGANIZE. STABILIZE. MOVE.
In order to create postural centration or active stability strategies along the trunk, we must first establish “neutral.” As we discussed last week in Part 8, most common respiratory faults result in the rib cage lifting, compromising diaphragm function and IAP regulation. They also contribute to the the common Lower Crossed Syndrome(Part 5). In order to ensure optimal function of the ISSS, these postural compensations must first be corrected.
In most individuals, the trunk can be “ORGANIZED” by squeezing the gluteals, returning the pelvis to a neutral position and fully exhaling, allowing the ribs to depress and return to their resting position. This typically resolves the lower crossed or “open scissor” postural loading strategy and results in a “stacked” torso, or the diaphragm and pelvic floor mirroring each other. This position best allows for the appropriate co-contractions needed to create active stability.
Once the the trunk has been organized, the individual “STABILIZES” through what McGill calls bracing or a circumferential co-contraction of all abdominal and extensor musculature. These co-contractions not only provide segmental stability, but also create a “superstiffness” or level of trunk stability greater than the sum of the individual muscle stiffnesses. This superstiffness needs to be tuned to the activity/load, similar to how one might control the volume of the radio. Low load activities such as standing and walking require a much different level of stability than a max-effort squat or deadlift.
Interestingly, the body creates these circumferential contractions automatically when periods of higher stability are needed, such as when one coughs, sneezes, laughs, etc. Often times I will use the cough as a tool to teach bracing to individuals who struggle to create stability inherently.
Once the individual can Organize and Stabilize, the goal is to be able to create this actively stable position unloaded, then loaded, then loaded dynamically, adding load, speed and dynamic positional control as their skill improves.
Now obviously, life and sports do not always occur in a “stacked” or neutral position. But the goal is to learn to create joint or postural centration, when under load. Remember:
Joint Centration = Actively Stabilized Positions = Increased Power and Strength and Decreased Stress and Injury.
In Part 5 we unpacked Charlie Weingroff’s Core Pendulum Concept. To sum up, Joint Centration within a joint's ROM, can be compared to a pendulum that finds it's center, based off of its fixed point. If a joint's ROM is compromised, it changes what the brain interprets as it's "fixed point," also changing how the joint finds its center, resulting in poorly "centrated" joint.
Our goal with Organizing and Stabilizing, is to help the individual to to be able to find and establish joint centration, or the center of the pendulum. This is position where the spine is best able to absorb and adapt to stress/load. However once an individual is pain free and/or can properly manage load, the goal then become to gradually learn to create stability and control throughout the spectrum of the “pendulum”(AROM), specific to the demand. Any athlete will tell you- throwing a ball, swinging a bat, gymnastics are all examples of activities that cannot happen at “neutral.” But these positions can still be “owned” or actively stable, provided that the individual is properly equipped to control the full range of their “pendulum.”
Again, as always - it depends on the context - different people have different goals, different anatomy, and different medical histories. If you are having pain, please, PLEASE go talk to a qualified medical professional who can evaluate YOUR problem. In part 10 we will “unpack” the shoulder complex with the goal to help make you better. Better.
Special thanks to Chris Duffin, for allowing me to steal the picture from their fantastic video illustrating common postural faults vs neutral posture. The video can be found here- https://youtu.be/kl_-VmyiQ3w
If there is any specific topic you would like to see addressed or if you have any questions feel free to reach out to me(Jon) directly at firstname.lastname@example.org or contact our clinic at 816-554-6003.
Thanks for reading!!
Frank C, Kobesova A, Kolar P. DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. International Journal of Sports Physical Therapy 2013;8(1):62-73.
McGill, S. (2009). Ultimate Back Fitness and Performance (2nd ed., p. 116). Backfitpro Incorporated.
Weingroff, C. (2010, October 02). A quick explanation to the Core Pendulum Theory. Retrieved October 31, 2017, from http://charlieweingroff.com/2010/10/a-quick-explanation-to-the-core-pendulum-theory/
Page, P., Frank, C., & Lardner, R. (2010). Sensorimotor Training Progression. In Assessment and Treatment of Muscle Imbalances: The Janda Approach(pp. 163-164). Champaign, IL: Human Kinetics.
McGill, S. (n.d.). Superstiffness. Retrieved October 31, 2017, from http://www.backfitpro.com/pdf/Enhancing_back_performance_with_super_stiffness.pdf