On these blogs and in our courses we go on and on about the deep stabilisers of the spine. 😀And rightly so, because they are the kingpins of spinal health. However, let's assume your client is showing a bulging disk, but it is between L5 and S1..... humm, now the usual rules of strengthening interspinales are not going to have any affect here because interspinales stop at L5, so how are we going to address a problem at the final spacing area of the spine....🤔
We can't affect this gap through extending the vertebrae, so instead we have to look at the pelvis position. A pelvis that sits in an anterior position will, by definition, cause it to be elevated at the posterior element and this will reduce the spacing between the L5 and S1 .
So the way to deal with this is not through spinal stability, but rather pelvic stability. By returning the pelvis back to a neutral position, usually by loosening or stretching the Rectus Femoris etc, we will gain a temporary relief for the disk that is being squashed. But to give a permanent solution we need to get the pelvis to stay in that neutral position and for this we need the core to work. Now people view the core as many different things so for the sake of this blog, by core, I mean the Transverse Abdominis (TVA) muscle. 😀 This attaches into the thoraco lumbar fascia, as do the internal obliques, the latissimus and the erector spinae, so if we get TVA to work properly, all these other stabilisers also are able to work effectively.
So how do we do this? Well in our facebook page I recently put up a case study with the picture above asking people what this test was for... take a look, what do you reckon?
Well, it was a test for TVA strength....
The pole gives our client some proprioceptive feedback to let them know if they move their spine during the activation. Their head should be retracted, touching the pole, and stay in that position when they activate their TVA. What many people do when they activate their TVA is they flatten their lumbar curve and tip their pelvis, they also often drop their head and overly arch their thoracic spine. The TVA muscle doesn't produce any of these movements, so if they are doing this, you know they aren't actually activating their core, rather using other muscles to assist... so it is a great test, but you can also use it to strengthen your client.😀
So give it a go on your clients this week, you will be surprised by how many you thought had a good core, actually don't. 😀
If using this for CPD, try the following question:
Your client who has a disk bulge in L5-S1 is desperate to get back to their strength training regime which involves deadlifts with a heavy bar weight. You notice their pelvis is severely tilted in an anterior position. As a therapist, how might you rectify this pelvis position and get some strength back in the necessary muscles, other than the exercise above. 😉As a trainer, how could you modify their programme to solve this problem. Think about all the muscles involved in both the deadlift action and in an anteriorly positioned pelvis.
Then write it all up in your CPD logbook for reflective learning. For your FREE CPD log click here and sign up to our newsletter.🤗