EBook

The Invertabelt
System

 

 

 

 

 

 


Table of Contents


Introduction…………............................................The Invertabelt System

Chapter 1……………………….........................................…Who and Why?

Chapter 2……………………….......................................…….Classification

Chapter 3……………………........................................Art Versus Science

Chapter 4 ………………………........................................….Strengthening

Chapter 5………………………...........................................……..Stretching

Chapter 6………….............................................Posture and Maintenance

 

 

 


Introducing the Invertabelt System

The Invertabelt System is designed to effectively and efficiently treat low back pain, ranging from acute traumatic dysfunctions to chronic long-lasting pain management problems. The Invertabelt is to be used in conjunction with your physical therapist or other medical professional. Your physical therapist will help guide you through the proper exercise progressions using The Invertabelt System, allowing faster return to function.   

The Invertabelt is based on best practice guidelines and evidence based research. It is driven by tried and tested principles; that include the treatment based classification approach and MDT principles, with an emphasis on the patient response approach using the centralization phenomenon.

The Oakford Group believes that most spinal dysfunctions are based upon improper loading strategies to the spine. Poor habitual patterns cause asymmetrical loading of the spine that, in turn, may irritate/agitate the muscle, bone, ligamentous, or neural tissue in the low back. 

The first step in treating low back pain is recognizing the improper loading strategy we place on the spine through our daily habits.  As a physical therapist, I try to identify the directional preference of the spine. The directional preference is usually opposite of the habitual direction we put our spine into repetitively throughout the day.  The spine will typically have a directional preference of forward bending or backward bending.  In this eBook we will help you define your directional preference and introduce common treatment protocols to help eliminate your back pain. 

This eBook is not designed to be an all-inclusive treatment guide to low back pain.  Instead, it is to be used in conjunction with your healthcare professional to aid in the treatment and adminstration of common treatment protocols.  Remember you are to consult your medical professional prior to use or treatment of your low back symptoms–improper treatment could result in further pain or dysfunction. 

 

For decades, research has indicated that reaching end range of motion (ROM) at the spinal level allows for better outcomes and maximum function. Unfortunately, when pain occurs in the body, many times the spinal segment in which the problem is located has significant ROM deficits. These deficits slow down healing and reduce the likelihood of a full recovery.

The Invertabelt isolates the exact spinal segment and provides overpressure to that segment, allowing it to move into the required ROM. Physical therapists and chiropractors regularly perform manual therapy techniques that facilitate spinal-end ROM. The Invertabelt is a simple tool that ensures end ROM is completed with every exercise repetition multiple times a day, versus 1-3 times a week when seeing a medical professional during an office visit or physical therapy session.

Once directional preference is established and motion is regained, symptoms will begin to decrease.  The Invertabelt provides exercise progressions that follow modern pain science theories, researched core stabilization protocols, and muscle stretching/lengthening exercises.  These allow proper tonal changes for freedom of movement and pain free activity.

As pain continues to reduce, posture management is essential for continued maintenance of the spine. Research indicates a high correlation between poor posture habits and spine pain, thus improper posture may allow the spine to become irritated once again.  The Invertabelt provides posture support in any chair by creating anterior/posterior force vector at the exact spinal segment, reducing the likelihood of symptom reoccurrence.

 

 

Chapter 1 -
WHO IS APPROPRIATE FOR THE INVERTABELT SYSTEM?
 

Most individuals do not have difficulty loading the front half of the disc. This is secondary to the forward flexion activities that dominate our everyday lives versus the much less common extension activities. When individuals continually load the front end of the spine, over time it may begin to stress some of the structures on the back side of the spine causing them to become irritated. Most individuals need a little break from flexion, which is where extension and the ability to load the posterior half of the spine becomes essential for spinal health.

 


 

Loading the back half gives the front half a break, and allows structures to rest. Herein lies the problem, after continual flexion loading it can become more difficult, and possibly painful, to initiate loading the back half of the spine. When pain is experienced with extension, this triggers the individual to avoid this position. The pain related with the movement is now identified as threatening or dangerous to the patient as a result of the pain that it incurs. This reinforces bending forward and motivates individuals to avoid extension.

 

 


TEST 1

Sitting to standing transition: The lumbar spine should have between 40 and 60 degrees of extension or back bending, depending on your age. A quick test to see if you have a loading problem is to perform extension while standing after sitting for 45 minutes. Take notice of how far backwards you can bend before you feel a restriction. Try performing 10 repetitions and assess quality and quantity of motion on your first repetition versus your tenth. If the quality or quantity improves you probably have a loading asymmetry discrepancy.

Test 2

Slump Tests: Sit in your favorite chair in your normal sitting posture.  Think about what position your spine is in.  Are you demonstrating good posture?  Probably not right?  I mean who really practices good posture?  If sitting for a period of time begins to increase your symptoms, practice placing a small towel roll in your low back just above your belt line.  Sit for another 2-3 minutes with the towel roll in place and your feet flat on the floor.  Reassess your symptoms.  If your symptoms improve it is highly likely that you have a loading asymmetry and directional preference of extension. 

According to McKenzie principles, the magic happens at end range of motion (EROM).  Symptom relief is dependent on reaching EROM at the spine. Some individuals can perform standard exercises and achieve EROM. Others need assistance, or overpressure activities. Overpressure applies gentle stretching on the joint in the limited direction of the spine.

The Invertabelt offers gentle overpressure stretching techniques that allow the spine to move into end range of motion; therefore, promoting optimal health and decreasing asymmetrical loading patterns.

 

Common Symptoms          

                                                                       

The Invertabelt System follows the progressions outlined by the McKenzie Method and MDT examination principles.  Approximately 75% of all patients with back pain exhibit a directional preference.  Patients with a directional preference may benefit from using The Invertabelt System. 

 


 
 
 These are common findings that may indicate usage of The Invertabelt:


• Variable pain-Pain that comes and goes (abolished or intensity changes), pain that moves in location
• Pain above the knee-Research indicates that pain above the knee has a much better prognosis with specific exercise progressions
• Sitting increases pain-This borrows from the dynamic disc model that indicates with sitting the disc will “creep” posteriorly and irritate the surrounding soft tissue
• Symptoms increased by repetitive bending-Again, the dynamic disc model indicates compression anteriorly on the disc (caused by spinal flexion) will manipulate the disc posterior irritating the soft tissue.
• Increase pain in the morning-When lying in a horizontal unloaded position during the night, the disc will absorb fluid.  Upon immediate standing the disc is loaded and then compressed.  Increased fluid retention in the disc causes increased intradiscal pressure and thus more pain.
• Walking feels better-Standing and walking causes proper posterior loading strategies to the disc relieving pain and irritation on surrounding soft tissue.

 

Who Should not use The Invertabelt? 

 

It may be difficult to determine what individuals would directly benefit from therapy with the Invertabelt.  In some cases, it is easier to determine who will not benefit.  The section below outlines those that are contraindicated and/or inappropriate for the use of the Invertabelt:

• Loss of bowel or bladder function
• Significant weakness in lower limb
• Loss of deep tendon reflex
• Back pain associated with severe accident

 

 

Other Red Flags include:


• History of cancer
• Unexplained weight loss
• Consistent pain at night
• Systemically unwell
• Widespread neurological deficits or findings

 


Chapter 2 -Classification

 

 


Low back Treatment Terminology!!

Low back Symptoms- Tingling, burning, pain/ache, numbness.  May manifest in low back, buttocks, thigh, calf, foot, etc.

Directional Preference- The position the spine is in when the symptoms either abolish reduce or centralize

 

 

Centralization- Movement of symptoms closer to spine


Example 1:
Pain in calf moves to buttocks
Example 2:
Pain in posterior thigh moves to low back
Example 3:
Large diameter across the entire back shrinks to small softball size pain in the center of the spine

Peripheralization- Movement of the symptoms further away from the spine


Example 1:
Symptoms move from buttocks to knee
Example 2:
Symptoms move from back to thigh
Example 3:
Small diameter directly in spine moves to watermelon size pain across the entire back or on one side

Abolished Symptoms- Symptoms that resolve as a result of specific spinal positioning or repetitive movement patterns of the spine

Extension Strategy- Refers to a loading strategy in which symptoms abolish or centralize with pure extension movements

Flexion Strategy- Refers to a loading strategy in which symptoms abolish or centralize with pure flexion movements

Lateral Component- Refers to loading strategy that requires a combination of both an extension positioning of the spine and lateral positioning of the spine

Lateral Shift- A more severe manifestation of a lateral component where a patient’s shoulders/ribcage are shifted laterally from the pelvis.  Shoulders will typically shift away from the painful side.


Extension Exercise Indications and Progressions

Pure Extension Responders-Individuals who symptoms centralize with pure extension exercises.  Patients may experience low back pain or pain that is in buttocks or leg.

Progression:

Unloaded and Static Positioning:

 

 

 

Stomach lying with foot anchor 


• Stomach lying with resistive bands placed at chest level
• Stomach on elbows without resistive bands
• Stomach lying on elbows with resistive bands


o Positions should be maintained for 4-5 minutes at time 3-5 x a day

Unloaded and Dynamic Movement


Press up with foot strap


• Press up the foot strap and resistive bands

 

 

Loaded (Standing) and Dynamic Standing back with foot anchor

 
 10-20 repetitions every 1-3 hours
 Maintain good posture between exercise sessions


Lateral Exercise Responders

• Individuals who do not centralize with pure extension exercise
• Individuals may have a lateral shift present, where a patient’s shoulders/ribcage are shifted laterally from the pelvis.  Shoulders will typically shift away from the painful side
• Majority of lateral responders will need to side bend the spine towards the painful side

 Unloaded Static


• Lie on stomach, use foot anchor, offset hip to one side 


o Lumbar spine should be compressed on the painful side – hips shifted to opposite side of pain


• Lie on stomach, use foot anchor, offset hips to one side, use resistive bands and place hands at chest level
• Lie on stomach, use foot anchor, offset hips to one side, use resistive bands and prop oneself up on to elbows

Road Kill Positions


• Lie on stomach, use foot anchor, raise leg on the painful side up and out so that the inside of the knee is lying flush with the bed
• Lie on stomach, use foot anchor, raise leg on the painful side up, hold resistive bands to chest level
• Lie on stomach, use foot anchor, raise leg on the painful side up, move to elbows positioning


o All unloaded static positioning should be performed 3-5 minutes 3-5 x a day

Unloaded and Dynamic


• Lie on stomach, use foot anchor, offset hip to one side, perform press up
• Lie on stomach, use foot anchor, offset hip to one side, with resistive bands perform press up

Unloaded Dynamic Road Kill Positioning


• Perform road kill positioning on elbows, using your elbow move your lumbar spine further into a side bent position towards the leg that is propped up
• Perform press up in road kill position without resistive bands
• Perform road kill position with resistive bands


Loaded (Standing) Dynamic


• Use foot anchor, place strap anchor on the opposite hip of pain location, shift hips (side glide) away from the pain

 

 


 
o All dynamic exercises should be performed 10-20 repetitions every 1-3 hours
o Maintain good posture in between exercise sessions

 

FLEXION RESPONDER TREATMENT INDICATIONS


Treatment Indications:


• Pain will typically abolish or greatly diminish with sitting or sustained bending forward
• Pain typically builds in standing and peripheralizes (gets larger or moves down legs)
• Patients symptoms may include: back pain, buttocks pain, leg pain that is bilateral or unilateral


Exercises:


Supine


- Single knee to chest: With waist strap secured at waist just above back pain, lie on back, hold onto resistance bands and pull one knee to the chest


- Double knee to chest: With waist strap secured at waist just above back pain, lie on back, hold onto resistance bands and pull both knees to the chest

 

 

Seated

- Seated knee to chest:  Sit with waist strap secured at waist just above back pain, hold onto resistance bands and pull one knee to chest


- Seated piriformis stretch: Sit with waist strap secured at waist just above back pain, cross knee over leg, hold onto resistance bands and pull knee to across body to opposite chest


- Seated Flexion:  Sit with waist strap secured just above back pain, hold onto resistance bands, flex forward and grab knees with hands

Standing


• Standing flexion:  Stand with waist strap secured just above back pain, hold onto resistance bands, flex forward and reach for the floor

*** All exercises should be performed 1-3 sets with 3-5 repetitions 15-20 second holds

  

 

Chapter 3 Art Versus Science

As the Invertabelt System has continued to be developed, The Oakford Group believes that an excellent adjunct treatment program that works in conjunction with the physical therapist and their clinical expertise has been created.

 

 

Did you know that during a subjective and objective examination a physical therapist will triage between 50-500 different variables to formulate a unique set of exercises for each patient?  We understand that there is no self-help book or instructions that can ever replace the evaluation and assessment skill that the physical therapist can provide for and to the patient.

Although best practice guidelines and evidence based research is at the forefront of every therapist’s treatments; knowing when to implement exercise progressions and how to manage each patient’s unique situation is sometimes more art than science.

Centralization Phenomenon vs Peripheralization Phenomenon

Centralization versus peripheralization of symptoms, is a concept or idea that has been used in physical therapy and rehab settings for years.  If you have been to a rehab specialist you may have heard these terms discussed before.  What do these terms mean?

 

 

 

Centralization and peripheralization is a theory on pain manifestation or a pain pattern originating from the spine.  In general, when loading strategies become compromised for various reasons, structures of the spine may become aggravated or irritated.  As the stress continues the pain may be experienced in the low back.  If the structures stay irritated and stress on the tissue increases the pain may become diffuse or larger in diameter.  Symptoms may even move into the buttocks or lower leg.  This is called peripheralization of symptoms.

Peripheralization of symptoms does not indicate that significant structural or tissue damage has occurred, rather the tissue is undergoing too much repetitive stress.  Peripheralization is the first line of defense to let our body know that a change in activity or pattern of movement is needed.  Many times, identifying contributing movement patterns that lead to deficiencies in spinal loading strategies can be affective in pain reduction.  Creating variability in the loading strategies can lead to centralization of symptoms.

Centralization of symptoms occurs only after symptoms have begun to peripheralize.  Centralization of symptoms is the phenomenon that occurs when the spinal tissue begins to experience less stress or strain.  When tissue stress reduces, symptoms begin to “centralize” toward the low back.  Leg pain will move to the buttocks, buttocks pain to the back and diffused pain in the back will move to the center of the spine.  Centralization indicates a good prognosis!

Unfortunately, as symptoms centralize toward the low back, many times the pain intensity can slightly increase.  This can be very misleading for patients and even medical professionals.  Human nature tells us to avoid increasing pain on one’s body, so naturally patients may gravitate away from positions or activities that cause centralization as it may increase pain levels.  Remember centralization of symptoms must occur for proper tissue stress reduction to occur.  If we avoid centralization we may never begin to improve spinal loading deficiencies, and thus eliminate the problem.

 

 

The take away message: LOCATION, LOCATION, LOCATION!!!  Where the pain is and more specifically where the pain is moving is much more important than intensity of pain!  If a specific exercise or position moves the symptoms towards the back, that position is a positive position for spinal health even if the intensity of the pain increases slightly.  Conversely, if a position or exercises increase symptoms away from your spine, then it is a negative spinal loading strategy.  Assessment of how your activities, spinal positions, and exercises affect the location of pain is essential in treatment of low back pain. 

*** Please note that intensity of symptoms should not be increasing dramatically, even if the symptoms centralize to the low back.

Simple Disc/spine Biomechanics

 

 


I. Flexion or Bending forward

A. Disc is a closed hydraulic system used for movement and axial loading
B. As the spine bends the superincumbent weight shifts anterior shifting the line of gravity anterior
C. As the weight shifts anterior it creates a larger moment arm


i. farther the reach larger moment arm
ii. greater force on spinal segments

D. The anterior annulus is loaded by the vertebral segments above and below
E. The nucleus pulposus begins a posterior displacement (80% increase in intradiscal pressure)
F. Potential for annulus mechanical breakdown


i. Mechanical or chemical nocioception occurs
ii. Pain may be local referred or radicular in nature


G. Disruption of annulus causes nuclear material to become further displaced

II. Extension or backward bending

A. Disc is a closed hydraulic system used for movement and axial loading
B. As the spine extends the superincumbent weight shifts posteriorly
C. As the weight shifts posteriorly the annulus is compressed by the vertebral bodies above and below


i. May experience mechanical pain secondary to compression of posterior nucleus innervations


D. Compression of the posterior annulus by the superincumbent begins anterior displacement of the nucleus

Uneven Spinal Loading

Did you know that the average person will flex or bend forward 3,500 times per day?  In contrast to bending forward the average person will only extend or bend backwards 100 times a day.  That is a 35 to 1 ratio of forward bending to backward bending.  This creates a large discrepancy between the two motions.  The real question is, does this matter?  The short answer is yes; it does matter, but let’s look a little closer!

For simplistic purposes, let’s look at the spine from a lateral view and let’s split it into two halves - the front half and the back half.  Now, we can correlate these two halves to each designated motion.  Bending forward loads the front half, and bending backwards loads the back half of the disc.
 

 


 
   
As we load the front half by sitting, bending forward, or tying our shoes (think of all the ways our spine bends forward throughout the day) we are unloading the back side of the spine.  The repetitive flexion unloads the back side of the disc over and over and over again. 

 


  
    

Over time, when the back half of the spine is consistently unloaded, it becomes difficult or even painful to begin to load the back end of the spine.

 


 
 
What happens if an individual has difficulty or pain with backward bending?  That individual will typically avoid the motion altogether.  Avoidance, thus, creates a larger discrepancy between bending forward and backward and promotes further asymmetries.  The good news is, these asymmetries are reversible.  Asymmetries, such as the one described above, promotes poor spinal health.  The spine operates and is in its healthiest state when it is able to load the front half and the back half equally!

The solution to the asymmetries is extending or backwards bending more, achieving end range of motion by extending.  Individuals must monitor the amount of forward bending versus back bending through activity modification and posture awareness.  The goal I tell my patients is to try and lower the ratio of forward bending to back ward bending to 5:1 (versus 35:1).  This loading ratio should create better spinal biomechanics, thus creating less pain.

The Oakford Group has been established with an objective to promote a healthy spine through education and innovative therapy products.  The Invertabelt was created to promote proper spinal loading strategies, to improve spinal biomechanics, reduce asymmetries, and promote proper spine health.

 

Why End Range of Motion?


If you have been to therapy before you have probably already gotten sick and tired of hearing your therapist say, “try to go farther, push further, try and get to END RANGE”, regarding low back pain and your exercises.  Why do therapists obsess so much about moving further into the end range of motion during lumbar spine exercises?
There are many theories and reasons why end range of motion is the goal.  We will discuss some main points in this article, but know there are other rationalizations/justifications of why end range of motion is targeted.

 


 

The first reason for focusing on end range of motion is the dynamic disc model.  This was a theory that was popularized by Robin McKenzie, and through decades of research has for the most part held up fairly well.  This approach is known also as MDT principals, or the McKenzie Method.  The concept is simple (and one we have discussed to a certain extent), as the spine flexes forward the anterior portion of the disc is compressed and pushes the nucleus of the disc posterior.  Over a period of time the disc can begin to have structural changes on the posterior or back side of the disc and can cause either a physical or chemical irritation of the soft tissue/nerves.

The dynamic disc model suggests that if the disc is compressed posteriorly by back bending or extending, then the disc and its contents will then shift forward and thus relieve the irritation or compression of the nerve.  The majority of the research conducted thus far, indicates end range of motion is more affective and assumes all patients reach end range of motion.

End range of motion makes biomechanical sense, to believe that the more compression achieved during end range of motion will shift the disc forward more quickly creating quicker and better outcomes.  Thus, the dynamic disc model promotes end range of motion at the spine, and explains part of the therapist’s obsession with end range of motion.

 

Chapter 5 Strengthening


Strengthening Versus Stabilization

 

 


Core strengthening is a vital part of spine recovery and spine maintenance.  Patients often get excited about beginning core strengthening.  They feel empowered by being able to become an active participant in therapy and taking control of their symptoms.  Unfortunately, that excitement leads to disappointment once the strengthening exercises are revealed.  Early foundation strengthening is many times described as boring or mundane by patients, but it is important to understand what the goals are. 

Strength is defined as a muscle that has the ability exert or withstand a force.  Regarding the spine, strength is the active control of the spine stability which is achieved through the control of the forces in surrounding muscles. When the spine is unstable, the musculature does not have the ability to apply enough force to stabilize the spine during normal movements.  Conversely, a stable spine has core musculature that can support the spine during normal activity. This helps us conclude, we perform core strengthening to achieve core stabilization.

So why are patients not excited about the core strengthening/stabilization exercises?  The muscles can be categorized as local systems or global systems.  The local muscles are where most strengthen protocols begin.  These muscles are deep endurance based and require 30-40% maximum contraction.  In other words, they take very little movements to activate them and they must be performed over a period of time to improve endurance.

The muscles targeted early are the transverse abdominal and the multifidus.  Stabilization begins with these muscles.  Movements are basic and simple.  Unfortunately, many patients are unimpressed with the introduction of these exercises.  The spine must be able to maintain rigidity during static positioning and during dynamic activities, and local muscles are the foundation for spinal rigidity.

Strength TEST
First stand flat footed.  Go up onto your toes and quickly drop back down on your heels.  Does it reproduce your pain?  If yes, perform the same activity but this time tight your belly 25-50%.  If your symptoms are less with your belly tightened, then you could benefit from core strengthening! 

 

 


Strengthening exercises

 

 


Transverse Abdominals


- Place waist strap securely around waist
-Firmly grasp resistance bands and hold arms outstretched from body
-Draw the abdominals in as if trying to tighten a belt that is to small
-Do not allow pelvis to rotate
-Performed circular motions arms extended 3 x 30 seconds
-Performed up/down motions with arms extended 3 x 30 seconds
-Performed in/out motion with arms extended 3 x 30 seconds
-Perform diagonal motions with arms extended 3 x 30 seconds

Planks


-Place waist strap securely around waist
-Firmly grasp resistance bands and move into your elbows
-Lift stomach off of ground developing a straight line from knees to shoulders

Intermediate I


-Place waist strap securely around waist
-Firmly grasp resistance bands and move into your elbows
-Lift stomach and knees off of ground developing a straight line from toes to shoulders

Intermediate II


-Place waist strap securely around waist
-Firmly grasp resistance bands and move into a pushup position
-Push up and lift stomach and knees off of ground developing a straight line from toes to shoulders

Advanced


-Place waist strap securely around waist
-Firmly grasp resistance bands and move into a pushup position
-Push up and lift stomach and knees off of ground developing a straight line from toes to shoulders
-Walk hands side to side
-Walk hands up and down

Multifidis Strengthening

Lying Down
-Place waist strap securely around waist
-Lie prone
-Secure hand grips in hands
-Cross arms and place hands under chest creating tension through the resistive bands
-Unilaterally lift one side of your anterior pelvis off the floor tightening of the muscles above belt line and close to the spine
-Alternate and Repeat

Standing


-Secure belt around waist firmly
-Firmly grasp resistance bands and hold arms outstretched from body
-Slowly rotate pelvis posteriorly unilateral until tightening of the muscles above belt line and close to the spine
-Alternate and repeat

Planks + Multifidis


-Place waist strap securely around waist
-Firmly grasp resistance bands and move into a pushup position
-Push up and lift stomach and knees off of ground developing a straight line from toes to shoulders
-Slowly rotate pelvis posteriorly unilateral until tightening of the muscles above belt line and close to the spine
-Alternate and repeat

Stretching

 

 

Stretching is vital to restoring proper muscle balance.  Stretching can be used for neuro tissue and muscle tissue.  Musculature and neuro tissue can both be mobilized and lengthened. 

Early in the rehab process tissue should be mobilized first.  Establishing normal movement or pain free motion helps to reduce pain and nervous system excitability.  After pain levels have reduced stretching can be more aggressive and focused on tissue lengthening.  If tissue lengthening occurs to quickly for both nerves and musculature an adverse reaction can occur and pain can increase. 

So, remember gentle pain free activities first, then push more aggressively to increase tissue length.  Below is a list of common nerve and musculature mobilization and stretching techniques that can be utilized using The Invertabelt System. 


Hamstring Stretch


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Hold 30 seconds x 3

Sciatic Nerve Glide Bias with Ankle Emphasis


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Pump ankle 10 times with 3-5 seconds holds

Sciatic Nerve Glide with Knee Emphasis


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Keep ankle pulled towards your nose
-With the hip at 90 degrees, slowly extend and flex the knee

Sciatic Nerve Glide with Hip Emphasis


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Keep the ankle pulled towards your nose
-Keep knee straight and slowly lift leg with movement only occurring at the hip

Sciatic Nerve Glide with Hip Emphasis and Internal Rotation


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Keep the ankle pulled towards your nose
-Keep knee straight and slowly lift leg with movement only occurring at the hip
-Draw the leg up as far as you can and turn toes in and out (like a windshield wiper)

Sciatic Nerve Glide with Hip Emphasis and Adduction


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Keep the ankle pulled towards your nose
-Keep knee straight and slowly lift leg with movement only occurring at the hip
-Draw the leg up as far as you can tolerate and bring foot across midline towards belly button

Quad Stretch


-Lie on stomach
-Place foot in foot strap
-Use tendon in strap to slowly pull knee into a flexed position

Femoral Nerve Glide


-Lie on stomach
-Place foot in foot strap
-Use tendon in strap to slowly pull knee into a flexed position
-Pump ankle 10 times 10 second holds

Femoral Nerve Glide Knee Emphasis


-Lie on stomach
-Place foot in foot strap
-Use tendon in strap to slowly pull knee into a flexed position
-Keep toes pointed towards knee
-Extend and flex the knee slowly 5-10 x

Femoral Nerve Glide Hip Emphasis


-Lie on stomach
-Place foot in foot strap
-Use tendon in strap to slowly pull knee into a flexed position
-Keep toes pointed towards knee
-Let hip rotate side to side (motion of lower limb should resemble a windshield wiper)
-Complete 5-10 repetitions

Quad and Hip Flexor Stretch


-Lie on stomach
-Place foot in foot strap
-Use tendon in strap to slowly pull knee into a flexed position
-Use strap to pull ankle in such a manner that lifts front of thigh off bed

IT Band Stretch


-Lie on back
-Place foot in foot strap
-Wrap the strap around and behind calf supporting the lower leg
-Keep knee straight and slowly lift leg with movement only occurring at the hip
-Draw the leg up as far as you can tolerate and bring foot across midline towards belly button

Piriformis Stretch


- Place foot strap around foot.
- Pull on strap to bend the knee and hip
- Keep the strap placed around the outside of the knee and pull the strap across the body

Chapter 6 Posture Maintenance


Seated Posture - Why Should We Care?


We are going to look at the importance of posture while sitting and its relationship to low back pain. I think most people understand that poor postural patterns can lead to low back/neck pain and there is significant research that supports these claims. In this chapter, will discuss in laymen’s terms why posture has such an impact on back/spine pain.

The average person bends forward 3,500 times a day and only over extends or bends backwards 100 times a day. That's a staggering 35:1 ratio of forward bending to backward bending. This large ratio of forward bending to backward bending creates spinal loading asymmetries. As expected, these asymmetries lead to increase strain on the soft tissue and eventual pain manifestation.

 

 

 

Many people ask, do we really bend forward 3,500 times a day? Yes, we do! Most forward bending will occur when we are in a seated position. Unfortunately, 86% of full-time working Americans sit for the majority of their working day.  When we sit in a poorly supported chair or let our posture "slouch" we are actually flexing the spine forward. To make matters worse, when we sit in a forward bent position for a long period of time, the static positioning causes a phenomenon called "creep" to occur to the disc. "Creep" is exactly what it sounds like - the disc material moves posteriorly as a result of the flexed spinal positioning.  "Creep" causes an asymmetry and increases tissue strain.

One can connect the dots that posture and our positioning has a huge influence on spine pain. Increased asymmetries cause increased strain and when done consistently will eventually overload the tissues and cause pain. A simple change in postural habits can have a huge impact on back pain.

If you have back pain, think about how many times your back flexes forward. I challenge you to lower your ratio of 35:1 (forward bending: backward bending), which is the first and easiest step to controlling your pain.

Posture and Muscle Pain

Let’s look more closely at how poor posture can affect our muscles - specifically muscle pain.  The neck and its musculature create a prime example of posture influencing muscle pain. 

The head weight accounts for approximately 7% of your body weight.  As the head moves forward, it activates the neck musculature.  Lack of blood flow to the muscles is called muscle ischemia and is major cause of pain in musculature.  Blood flow is directly related to the amount of contraction occurring in a muscle.  When a muscle consistently contracts there is a decrease in blood flow and the muscle becomes ischemic.

Muscle ischemia or decrease blood flow to the muscle creates anaerobic reaction and lactic acid.  Lactic acid creates muscle soreness and pain.  The chart below indicates the pain cycle/spasm, that increases muscle tone.

 

 

 
Posture Monitoring

 

 


1. Secure belt around waist at desired spinal level
2. Place feet evenly on the floor with toes underneath the knees
3. Pull resistant bands around knees well below knee cap
 

 

Additional Exercises


Please see patient information section regarding exercise theories and treatment indications


-Static Exercises should be performed 2-5 minutes 3-5 times daily
-Dynamic exercises should be performed 5-20 repetitions every 1-4 hours
-Posture should be monitored in between exercises sections
***Some exercises are available in video page

General Directions
1. Secure belt tightly around waist
2. Place foot inside the foot strap and place blue belt at midline
3. Provide significant tension on the blue belt using the clip fastener
4. Begin with low tension stretch, slowly progressing to desired intensity stretch level

Lying on Stomach
1. Secure the belt with desired tension levels per instructions
2. Place foot inside the foot strap and extend leg backward maintaining tension on the blue strap
3. Lower yourself down on the bed while maintaining tension on the black strap

Stomach Decompression
1. Adjust tension levels for desired intensity level
2. Lie on stomach
3. Pump ankle up and down to adjust intensity level

Progression:
1. Hold onto the resistance bands and bring arms towards head for desired pressure
2. Inhale and exhale with deep breaths
 

Stomach on Elbows
1. Adjust tension levels for desired intensity level
2. Lie on stomach and prop body onto elbows
3. Pump ankle up and down to adjust intensity level
4. Inhale and exhale with deep breaths
 

Progression:
1. Hold onto the resistance bands and bring arms towards head for desired pressure
 

Press Up
1. Adjust belt tension for desired intensity level
2. Lie on stomach
3. Place both hands flat on surface next to head
4. Use arms to lift upper body off surface
5. Return to starting position
 

Progression:
1. Hold onto resistant bands and place both hands flat on surface next to head
2. Use arms to lift upper body off surface
 

Standing Back Bend
1. Adjust belt tension for desired intensity level
2. Stand with feet shoulder width apart and hands on hips
3. Slowly lean backward arching back
 

Standing Side Glides
1. Adjust belt tension for desired intensity level
2. Stand with feet shoulder width apart and hands on hips
3. Slide blue strap to the hip
4. Slowly glide hips to the side of the blue strap
 

Side Glides with Extensions
1. Adjust belt tension for desired intensity level
2. Stand with feet shoulder width apart and hands on hips
3. Slide blue strap to the hip
4. Slowly glide hips to the side of the blue belt
5. Bend backwards
 

Centralization Phenomenon
1. Poor Low back health is characterized by larger area of pain, symptoms moving into the buttocks, or symptoms moving into the lower limb
2. As low back health improves, pain will begin to “centralize” or move towards the low back
3. Location of pain is more important to back health then intensity of pain
4. Assess low back health by location of pain, not pain intensity

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Source:
Core Strength: Stabilization the Confusion
Strength and conditioning journal April 2007
Mark D. Faries and Mike greenwood
Copyright: <a href='http://www.123rf.com/profile_samotrebizan'>samotrebizan / 123RF Stock Photo</a>