Sports Injuries

Today, more than ever, individuals are less physically active and sitting down for more extended periods causing the gluteus muscles to be used less and weaken. Weak, inactive, or tightening glutes can cause instability in the lower spine, the hips, and the pelvis to shift out of alignment. This leads to low back and buttock pain. The pain is constantly dull, aching, pulsating, then when moving, getting up, it throbs and stings. Gluteal strengthening exercises can strengthen the muscles and alleviate the pain.

Gluteal Strengthening

Every individual has a unique physiology. The body develops asymmetrically as the individual favors one side or area of the body over another. This can cause imbalances in the muscular system, leading to awkward positioning that causes pain. The muscle groups that support the lower back consist of the:

• Core muscles
• The gluteal muscle group includes:
• Gluteus Maximus
• Gluteus medius
• Gluteus minimus
• Pelvis muscles
• Hamstrings
• Quadriceps

In some cases, the development or lack of level of an individual's upper back strength can also affect the amount of strain on the lower back.

Gluteal Strengthening Difference

Many joints connect in this area that can have functional problems. The muscles within the lower back need:

• Exercise
• Rest
• Recovery time
• To be stretched
• Mobility training - example, foam rolling

Stretch Out

Stretching allows the body to enhance the limits of its flexibility and mobility. Most of the stretches are involve the hip joint, as this is one of the most effective ways to loosen the gluteal regions. It's essential to warm the muscles slightly with a light activity while stretching them to elongate naturally.

Seated Figure 4 Stretch

• Sitting in a chair.
• Cross the right leg over the left.
• With the right ankle resting on the left knee.
• It should resemble the number 4.
• Bend forward at the hip, placing slight pressure onto the left leg.
• Hold this stretch for ten-twenty seconds.
• Stretch the other side.
• Placing the left foot on the right knee.
• Repeat this three times.

Downward Dog

This yoga pose engages all the muscles along the back. With the glutes at the top in this position, it forces them to activate, allowing them to stretch fully.

• Hold this pose and focus the attention on the glutes.
• Arch the back slightly.
• Feel the stretch in the seat of the glutes.
• Hold for 30 seconds.

Exercises

Glute Bridge

• Lay on the back with feet flat on the floor.
• Knees bent.
• Rear-end resting on the ground.
• Engage the glutes.
• Push the rear-end up to form a bridge.
• Hold for 60 seconds.
• Repeat three times.

Swiss Exercise Stability Ball Wall Squat

Squats naturally engage the glutes. This is a variation on a squat that focuses on developing gluteal strength.

• Stand with the back facing the wall.
• Place a Swiss stability ball between the wall and the back.
• Lean back into the ball for balance.
• Lower the torso until the knees reach 90 degrees.
• Return to standing.
• Repeat for ten reps.
• Do three sets.

Body Composition

Analysis An Effective Tool

Opportunities to increase physical activity lead individuals in a positive direction. The most common reason for reducing and stopping healthy changes is a lack of motivation and feedback. Strategies that provide immediate feedback are essential to:

• Monitor progress for establishing a baseline.
• Set appropriate and attainable goals.
• Track changes over time.
• Ensure success.

Monitoring changes with a simple weight scale or Body Mass Index calculator provides limited ability to accurately track changes that only highlight weight changes and not track progress in muscle gain or fat loss. In less than 45 seconds, the InBody Test provides doctors, trainers, and physical therapists with easy-to-understand, accurate and objective measurements to evaluate body composition that includes:

• Assessing muscle distribution.
• Target areas weakened by condition or injury.
• Identify muscle and fat imbalances in each area of the body.
• Monitor changes to determine the efficacy of the treatment plan, exercise program, and diet plan to ensure long-term success.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Akuthota, Venu et al. "Core stability exercise principles." Current sports medicine reports vol. 7,1 (2008): 39-44. doi:10.1097/01.CSMR.0000308663.13278.69

Distefano, Lindsay J et al. "Gluteal muscle activation during common therapeutic exercises." The Journal of orthopedic and sports physical therapy vol. 39,7 (2009): 532-40. doi:10.2519/jospt.2009.2796

Glaviano, Neal R et al. "Gluteal muscle inhibition: Consequences of patellofemoral pain?." Medical hypotheses vol. 126 (2019): 9-14. doi:10.1016/j.mehy.2019.02.046

Jeong, Ui-Cheol et al. "The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients." Journal of physical therapy science vol. 27,12 (2015): 3813-6. doi:10.1589/jpts.27.3813

Macadam, Paul et al. "AN EXAMINATION OF THE GLUTEAL MUSCLE ACTIVITY ASSOCIATED WITH DYNAMIC HIP ABDUCTION AND HIP EXTERNAL ROTATION EXERCISE: A SYSTEMATIC REVIEW." International Journal of sports physical therapy vol. 10,5 (2015): 573-91.

When dealing with any kind of pain, many types of remedies can help alleviate the source of the pain. Whether muscle pain or cardiac tissue pain, the effects can be long-term if not appropriately treated. Doctors have discovered that low laser therapy can help repair injured muscles that patients have experienced. With low laser therapy, the beneficial effects can help repair injuries that the bodies’ skeletal and cardiac muscles have endured. 

When the body gets injured, many people endure the pain later or during the accident. Sometimes the pain is short-termed or long-termed, depending on how severe the injury is. Short-term pain or “acute” pain can be simple, like a sprained joint; however, long-term pain or “chronic” pain, it’s more severe to the body and can have lasting effects. Chronic pain can hinder a person’s body from doing the most straightforward task. When people deal with chronic pain, it can drastically affect the body’s musculoskeletal system and even their cardiovascular system. 

When the body’s musculoskeletal system is damaged, many complications can start affecting the joints in many different parts of the body. Chronic pain can cause inflammation throughout the body, causing a person not to have the energy to do any task they planned for the day. Sometimes the pain can be excruciating where the body just completely shuts down. When doctors see their patients, they ask them, “Where does it hurt?” meaning where the pain feels more excruciating on the person’s body. The patient will always tell their physicians that the pain is on their joints or back. So doctors would recommend low laser therapy.

With low laser therapy or phototherapy, the effects from the treatment can alleviate the pain from the body. Studies show that the application of low laser therapy in injured muscles can significantly enhance muscle regeneration in multiple and frequent applications. Low laser therapy does target the injured muscles because it uses irradiation, which targets the affected muscle while increasing the body’s natural antioxidants and cytoprotective heat shock proteins (HSP-70i). Phototherapy can even help reduce muscle fatigue in athletes when they are in a post-exercise routine.

Studies have found that physical therapists use phototherapy as another form of recovery treatment for athletes. What the laser does is that when it is placed on the affected muscle and joint pain, the infrared wavelength penetrates the skin and starts to affect the targeted area. The infrared wavelengths cause therapeutic effects by decreasing oxidative stress accumulated by the body while also reactivating oxygen species production, improving the body’s mitochondrial function, etc. Another study also shows that phototherapy can also repair cardiac tissue. The study shows that when doctors use phototherapy, it directly affects the intracellular mechanisms in the heart while also activating heat-independent tissues without causing tissue damage to the heart. The study also shows that phototherapy can be effective in various complications, such as lymphoedema and muscular trauma. 

All in all, low laser therapy has beneficial properties in preventing muscle and cardiac muscle tissue damage. Its infrared radiation can help patients go about their day without the pain and suffering that their body endures. By reducing ventricular dilatation and preserving the body’s mitochondria while elevating the HSP-70i, the body can start on the road to recovery.

References:

Leal Junior, Ernesto Cesar Pinto, et al. “Effects of Low-Level Laser Therapy (LLLT) in the Development of Exercise-Induced Skeletal Muscle Fatigue and Changes in Biochemical Markers Related to Postexercise Recovery.” Journal of Orthopaedic & Sports Physical Therapy, Aug. 2010, https://www.jospt.org/doi/10.2519/jospt.2010.3294.

Kazemi Khoo, Nooshafarin, et al. “Application of Low-Level Laser Therapy Following Coronary Artery Bypass Grafting (CABG) Surgery.” Journal of Lasers in Medical Sciences, Laser Application in Medical Sciences Research Center, 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291821/.

Oron, Uri. “Photoengineering of Tissue Repair in … – Medical Laser.” Photoengineering of Tissue Repair in Skeletal and Cardiac Muscles, 2006, http://medical.summuslaser.com/data/files/91/1585172203_ls8S6pcJwigZfZQ.pdf.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Chiropractic back pain specialist, Dr. Alexander Jimenez looks at new study on muscle activation timing in the postural muscles and the implications for lower back pain in sportsmen and women.

Lower back pain (LBP) is a common illness among athletes (see Box 1). However, since our understanding of the etiology of back pain has improved, so have the prevention and treatment approaches. A good instance of this has been the growing emphasis throughout the last 15 years on functional training to the postural muscles of the back -- an approach to LBP treatment/prevention that's now quite widely recognized among clinicians and coaches. But though some research has emphasized advantages of the mode of training for those who have back pain and for carrying out regular activities, less research has been done on the benefits of core training for elite athletes and how this training ought to be carried out to maximize athletic operation. Really, there are many articles in the literature which promote core training programs and exercises for performance enhancement with no solid scientific rationale of their effectiveness, particularly in the sporting context.

Core Training & Muscle Activation

Many elite athletes undertake core stability and core strength training as part of their training program, despite contradictory findings and conclusions regarding their efficacy. This is principally due to the absence of a gold standard way of measuring core stability and strength if performing everyday tasks and sporting movements. A further confounding factor is that due to the diverse demands on the core musculature during regular tasks (low load, slow movements) and sporting activities (large load, resisted, dynamic movements), study conducted in the rehabilitation sector can't be put on the sporting environment and, subsequently, data regarding core training programs and their effectiveness on athletic performance are lacking.

1 aspect of postural muscle function that has received special attention in recent years is muscle activation patterns. Understanding how a particular sort of movement triggers (or fails to trigger) postural muscles in the trunk is vital to unravelling the part of the postural muscles in trunk stabilization. Much of the initial work in this field has tended to focus mostly on the magnitude and patterns of electromyographic (EMG) activation in postural muscles, and this knowledge has proved invaluable to physiotherapists and sports physiologists looking for a better knowledge of LBP. More recently, there has been a developing interest in the timing of these action, and its connection to LBP.

The ability to rapidly modulate the timing of muscles in response to sudden postural perturbations is deemed paramount for maintaining posture and equilibrium, and thus in boosting good lower back health. The literature indicates that, in comparison with healthy controls, besides demonstrating reduced EMG activity, people with chronic LBP also demonstrate delayed activity reaction to both expected and unanticipated postural perturbations(4,5). Moreover, acute experimentally-induced LBP in healthy people has been proven to change trunk muscle activity during trunk flexion--extension, in addition to attaining and quick arm-movement tasks. Simply speaking, sufferers with acute or chronic LBP seem to be at increased risk of further injury in response to unexpected external perturbations(6,7).

Timing & Pain

One criticism of these kinds of studies was that they employed protocols aimed at approximating 'real-life' perturbations but, in reality, these protocols were not sufficiently realistic to enable meaningful conclusions to be drawn. Nonetheless, these criticisms were answered by a 2011 study by Danish scientists, which examined automatic postural reactions in the presence of experimentally induced LBP to quickly, functionally applicable, complete body perturbations(8). These perturbations were created by a computer-controlled platform which enabled movement in 3- dimensions to generate tilting or sliding perturbations closely mimicking 'tripping over an obstacle' or 'slipping on a wet surface'.

In the study, the researchers analyzed the activation of the erector spinae and external oblique muscles in response to unanticipated, bi-directional postural perturbations prior to and after the induction of acute LBP in healthy individuals. Each experimental session consisted of a baseline, control, and also an acute LBP condition. For the management and acute LBP condition, isotonic or hypertonic saline, respectively, was inserted to the ideal erector spinae muscle. In each condition, participants stumbled on a moveable platform during which 32 randomized postural perturbations were conducted. These consisted of eight repetitions of four perturbation types achieved within a period of 4-5 minutes -- 8cm anterior slides, 8cm posterior slides, 10 anterior tilts, and 10 posterior tilts. Throughout those perturbations, bilateral EMG was recorded by the erector spinae and external oblique muscles as well as the subjective pain experienced by these subjects.

The results demonstrated that compared to the 'no back pain' condition (control), back pain delayed the beginning time of both erector spinae and external obliques to the forward and backward slipping perturbations (although only the onset time of the erector spinae systematically varied with all the differing perturbation types and directions). It was also evident that in the back pain illness, the EMG amplitude was reduced bilaterally for all perturbations (see fig 1a 1d).

The findings of the aforementioned Danish study appear to be encouraged by people from a US study on modified electromyographic activation patterns in response to perturbations of standing balance, also published in 2011(9). In this study, researchers evaluated the intermuscular patterns of EMG activations from 24 individuals with and 21 people with no history of chronic and recurrent LBP in reaction to twelve directions of support surface translations. Specifically, the aim was to characterize more thoroughly the shift in muscle activation patterns of people with LBP in response to a perturbation of standing balance, and to gain insight into the influence of early versus late-phase postural responses (differentiated by quotes of voluntary response times).

The authors concluded that a history of LBP is related to higher baseline muscle activation and also that EMG responses are modulated by the activated state, rather than exhibiting acute burst activity from a quiescent state (perhaps to circumvent trunk displacements) as is true in areas without LBP.

Late Onset Muscle Activation In Athletes

The research above looked at start activation instances in (differently) healthy but sedentary individuals. But what are the consequences for athletes? Unfortunately, the literature in this regard is very thin on the ground. However, a brand new study published in 2013 has looked in the reflex reaction of shallow trunk musculature in athletes with chronic low back pain(10) to check whether similar patterns of delayed muscle activation onset exist within the athletic body. In particular, the investigators sought to compare long latency reflex response (happening between approximately within 40ms to 100ms) in athletes with chronic LBP against asymptomatic athletes.

To do this, 24 athletes with chronic LBP were compared with 25 hepatitis athletes. At the position rankings, perturbations were introduced equally expectedly and unexpectedly while the surface EMG of the rectus abdominis and erector spinae muscles were listed. The latency of the onset of muscle activation and the root mean square (RMS) amplitudes within the response length were compared between the two groups.

In comparison with the asymptomatic athletes, the latency of onset has been postponed from the LBP athletes when the athlete underwent unexpected perturbations. However, during the anticipated perturbations, no modification was observed. The investigators went on to conclude that 'chronic LBP athletes exhibit a delay in onset latency to unexpected perturbations and decreased long latency response amplitudes to perturbation tasks compared to asymptomatic athletes. These modifications can induce athletes to recurrent low back pain and further injury.'

Questions

If muscle activation time is a significant element in LBP, an obvious question to ask at this stage is if a core training program (which often creates the staple of many a lower back injury rehabilitation program) can help normalize muscle activation patterns. There is a paucity of research in this area but a study published in 2012 is revealing(11). In this study, researchers sought to investigate feed- forward activation or timing of abdominal muscle activation in response to rapid spinal flexion following an eight-week plan of core stability exercises, sling exercises, or overall exercises.

Of specific interest was the effect on muscle activation onset (listed bilaterally from m-mode ultrasound imaging) at the deep abdominal muscles in response to quick shoulder flexion in the chronic nonspecific LBP patients.

In the conclusion of the eight-week instruction period, there were only insignificant or very modest improvements in the LBP subjects. The baseline-adjusted 'between group' differences showed a 15 millisecond advancement with sling training relative to core stability training, and a 19 millisecond advancement relative to general exercise training. To put it differently, eight months of core stability training produced hardly any advancement in the start of abdominal muscle contractions.

Conclusion & Conclusion

Despite our growth in understanding along with the widespread take-up of core training work, low back pain is still a significant issue among athletes. Recent study on muscle activation patterns suggests that the late onset of stimulation in postural muscles is likely to be a contributing factor in the etiology of chronic low back pain and rehabilitation/ prevention programs relying only on core activation could be insufficient to help normalize postural muscle activity.

References
1. Spine (Phila Pa 1976). 2004 Feb 15;29(4): 449-54
2. Neurosurg Focus. 2006 Oct 15;21(4):E7
3. Br J Sports Med. 2003 Jun;37(3):263-6
4. Brain Res 2001; 141:261–266
5. Spine 2000; (Phila Pa 1976) 25:947–954
6. Exp Brain Res 2003; 151:262–271
7. Spine 2007; (Phila Pa 1976) 32:E801–E808
8. Exp Brain Res 2011; 210:259–267
9. J Neurophysiol. 2011 Nov;106(5):2506-14
10. J Back Musculoskelet Rehabil. 2013 Apr 29. [Epub ahead of print]
11. Spine (Phila Pa 1976). 2012 Jun 1;37(13): 1101-8

The body is a connected whole and more than just separate parts and regions. When back pain presents, it might not be the back muscles or spine but could be tense, tight hips, and hamstrings causing low back pain. How it happens, how to stretch and loosen up, and target these areas could help alleviate the pain.

The Hips and Hamstrings

When the hip flexors and hamstrings become tense, the tightness can alter the pelvic alignment. This affects spinal alignment leading to discomfort and low back pain. The hip flexors are a group of muscles around the front of the hips, and they activate when moving the leg and knee upward. The hamstrings are the muscles in the back of the thighs that allow for flexion of the knees and hip extension. Muscle tightness in the hips and/or hip joint stiffness can also contribute to low back pain. Not being able to rotate, flex, or extend the hip forward or backward can affect:

• Walking
• Running
• Swinging
• Twisting movements
• This increases mechanical strain on the lower back.

Hamstring tightness can be a side effect of:

• Low back pain
• Pelvic positioning
• Muscle guarding
• Weakness
• All can contribute to the hamstrings feeling tight.

Tense Hips and Hamstrings

The factors creating this tightness can come from:

• A sedentary lifestyle
• Little to no physical activity
• Sitting too long with no stretching or movement.
• Injury
• Intense workout

Losing the ability to function through the entire length of motion can also indicate muscle weakness and a lack of joint movement where the joint around the muscle becomes stiff. This can be caused by:

• A lack of movement
• Arthritis
• Age-related changes

Stretching and Treatment

Stretching exercises can be the first line of treatment. It is recommended to start with gentle stretches targeting these areas. What works best for the individual is the stretch they are comfortable repeating enough to make a difference. Warming up the muscles first will generate the best results. An easy place to begin is a gentle forward fold stretch.

• Stand up straight, or sit with the legs extended out in front.
• Then, reach with the fingers toward the toes. Don’t worry if you can’t reach them.
• Don’t bounce.
• Hold the position for a few seconds.
• Repeat five to 10 times.

For the hip flexors, stretches include:

• High lunge
• Low lunge
• Warrior 1 pose

If the stretching does not bring relief, it is recommended to progress to a personalized treatment and stretching program with a chiropractor or physical therapist. Chiropractic and physical therapy can relieve the problems without medication, injections, or surgery and provide lifelong techniques for maintaining optimal flexibility, mobility, and strength. The hands-on treatment loosens and relieves the tense tightness, reinforcing the flexibility and range of motion. Treatment includes:

• Joint mobilization to the hips and spine.
• Soft tissue mobilization.
• A personalized strengthening program with stretches and exercises that target the specific muscles.
• Health coaching.
• Anti-inflammatory diet recommendations.

Body Composition

Monounsaturated Fats

Monounsaturated fat is considered healthy fat. This type of fat makes up a significant component of the Mediterranean diet. Studies have shown monounsaturated fats like extra-virgin olive oil can help prevent adverse events related to cardiovascular disease. A meta-analysis evaluating diets high in monounsaturated fats indicated a significant reduction in:

• Triglycerides
• Bodyweight
• Systolic blood pressure in individuals with type II diabetes.
• A significant increase in HDL or good cholesterol.

Another study showed the protective effects of monounsaturated fatty acids reduced the risk factors associated with metabolic syndrome and cardiovascular disease. Monounsaturated fats can have a positive impact on overall health. Monounsaturated fat sources include:

• Olive, peanut, and canola oil
• Avocados
• Almonds
• Pecans
• Hazelnuts
• Sesame and pumpkin seeds

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Estruch, Ramón et al. “Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90.” The New England journal of medicine vol. 378,25 (2018): 2441-2442. doi:10.1056/NEJMc1806491

Gillingham, Leah G et al. “Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.” Lipids vol. 46,3 (2011): 209-28. doi:10.1007/s11745-010-3524-y

American College of Physicians. (February 2017) “American College of Physicians issues guideline for treating non-radicular low back pain” https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain

MedlinePlus. (2019) Hip flexor strain – aftercare https://medlineplus.gov/ency/patientinstructions/000682.htm

NCBI. (2021) Hamstring Injury https://www.ncbi.nlm.nih.gov/books/NBK558936/

Belly dancing has been found to be an effective way to help individuals managing low back pain. It could be utilized as a part of a chiropractic treatment plan. The dancing is beneficial for improving posture and allows an individual to improve their fitness with a light form of aerobic exercise.

Regular physical activity/exercise and a healthy lifestyle go hand in hand. For individuals with spinal issues, the right stretches and exercises can make a difference in their quality of life. It increases:

• Strength
• Flexibility
• Helps with pain management
• Improves posture
• Maintains spinal alignment

Belly dancing can help with injury recovery, as well as overall health. For most the trouble with exercising regularly is that it becomes routine and boring. Individuals want to live healthily, but it can be a challenge to maintain interest and motivation. An alternative form of physical activity that qualifies as exercise could be the answer.

Dancing has grown in popularity because of its fitness, flexibility, and spinal benefits. This form of belly dancing exercise does not require any special outfit or plenty of space. This utilizes the movements as a form of stretching and keeping the body moving in an aerobic fashion. They can be done at home with video instruction or an online class. Although the majority are women, men can and do belly dance.

Belly Dance

Information on the history of belly dancing. The dance has gone through various transformations since its inception. It was once considered burlesque entertainment, is now recognized as an important cultural expression, and today has been found to be a respected form of dance exercise.

Exercise

Belly dancing as physical exercise involves:

• Isometrics
• Dance posture
• Muscle control

Isometric exercises are contract specific muscles or groups of muscles. These types of exercise help with strength and stability enhancement. Both are vital for individuals recovering from back injuries or back pain management.

Posture

Dance posture is different than normal standing or sitting posture. Dance posture refers to the way an individual prepares/maintains their body to perform specific movements so that the motions are fluid, graceful, and with no presentation of pain. Belly dance posture maintains proper spinal alignment, which encourages reduced stress/pressure on the joints. This is beneficial for individuals managing back problems. The keys to spinal success are:

• Maintaining proper position/posture
• Keeping joints in alignment
• Pelvis stays straight in a neutral position
• The knees should be slightly bent and not stiff so as not to pull/strain the lower back muscles

When the abdominal and back muscles maintain/support a straight spine, this alleviates stress on the low back. Lower back issues have shown a positive response to a belly dance exercise therapy program. A study looked at the effects of belly dancing on pain and function in women with chronic lower back pain. The study found that belly dancing made movements of the trunk and pelvis that are known to influence low back pain much easier.

A belly dance program in conjunction with a chiropractic or physical therapy treatment plan can help alleviate pain and improve function. A 45-minute belly dance routine/session promotes aerobic benefits, improves flexibility and core strength.

Core Strength

These are movements that train the muscles in the:

• Pelvis
• Abdomen
• Hips
• Low back

They help build strength, generate stability, protect against back pain, poor posture, and muscle injuries. Having core strength is crucial for individuals with back issues, as it increases the stabilization of the spine. Core strengthening is highly recommended and often prescribed for individuals recovering from lumbar issues.

Depression/Anxiety Improvement

Individuals with back pain also tend to experience psychological issues like depression and anxiety. Back pain can affect:

• Mood
• Tiredness
• Sleep problems
• Self-esteem problems

Belly dancing as part of a treatment/therapy program can help an individual experience benefits that improve mental health and well-being. These include:

• Regaining mobility
• Having a positive body image
• Social interaction is enhanced

For All Ages

Belly dancing is a fantastic creative outlet and a great way to exercise. Anyone that is able can participate. Children, seniors, and everyone in between can get into belly dancing. It enhances health and strengthens the body and mind. When the body is in the proper position/posture there are no joint issues or pain. In-person classes, at home with online instruction, DVDs, or video meeting apps can benefit the body and especially the spine.

Eliminate Back Pain 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Most of us will experience it at some point, but how does it influence on athletic performance? Chiropractic injury specialist, Dr. Alexander Jimenez investigates.

Research postulates that 80 percent of the populace will undergo an acute onset of back pain at least once in their lifetimes. This adds a considerable financial burden not just on the medical system (physician consultations, prescribed drugs, physiotherapy) but also the financing of the workforce in lost employee hours and loss in productivity.

The types of lower back pain that an individual may experience include (but are not limited to):

The focus for this paper will be on the previous group -- that the bone injuries. This may be simply postural (slow onset repetitive trauma) or related to sports; for instance, gymnastics.

The two demographic groups that tend to endure the most extension-related low back pain are:

1. People who endure all day, for instance, retailers, army, security guards etc.. Prolonged position will obviously force the pelvis to start to migrate to an anterior tilt management. This may begin to place compressive pressure on the facet joints of the spinal column as they also change towards an expansion position since they accompany the pelvic tilt.

Pathomechanics

It would be unlikely that a bone stress response or even a stress fracture could be brought on by an isolated expansion injury. It would be more likely that a sudden forced extension injury may damage an already pre-existing bone strain reaction.

Similarly, if an individual stands daily and the pelvis migrates into lateral tilt, then the aspects will be placed under low load compression but for extensive intervals.

With ongoing uncontrolled loading, stress is then transferred from the facet joint to the bone below (pars interarticularis). This originally will manifest as a pressure reaction on the bone. This bone strain may advance to a stress fracture throughout the pars if uncorrected. This fracture is also referred to as a "pars flaw", or spondylolysis.

It was initially considered that stress fractures of the pars was a congenital defect that introduced itself at the teenage years. However, it is now agreed that it is probably obtained through years of overuse into extension positions, especially in young sportspeople involved with expansion sports. What's more, one-sided pars defects often occur more commonly in sport which also included a rotational component such as tennis serving or fast bowling in cricket.

The stress fracture can then advance to impact the opposite side, causing a bilateral strain fracture, with anxiety subsequently being transferred to the disk in between both levels.

Spondylolisthesis features bilateral pars defects which could possibly be a result of repetitive stress into the bilateral pars in extension athletics, but more likely it is an independent pathology that manifests in the early growing stages (9-14) as this pathology is often viewed in this age category. If they become symptomatic in later years because of involvement in expansion sports, it is exceedingly likely that the defects were there by a young age but presented asymptomatically. As a result of rapid growth spurts in teenage years and the high-volume training experienced by teenaged athletes, it is possible that these dormant spondylolisthesis then pose as 'acute onset' back pain in teenage years.

In summary, the progression of this bone stress reactions tends to follow the following continuum:

The vast majority of spondylolysis and sponylolisthesis accidents are Type II -- the isthmic variety.

For the purposes of this paper, we will refer to the above stages as the posterior arch bone stress injuries (PABSI).

Epidemiology

It is a lot more widespread at the L5 level (85-90 percent). It's a high asymptomatic prevalence in the general population and is often found unintentionally on x ray imaging. Nonetheless, in athletes, particularly young athletes, it is a common reason for persistent low back pain. From the young athlete, the problem is often referred to as 'active spondylolysis'.

Active spondylolysis is normal in virtually every gamenevertheless, sports such as gymnastics and diving and cricket pose a much greater danger due to the extension and turning character of the sport. The progression from an active spondylolysis into a non-union type spondylolisthesis has been associated with a greater prevalence of spinal disk degeneration.

Early detection through screening and imaging, therefore, will highlight those early at the bone stress phase and if caught early enough and managed, the progression to the larger and more complicated pathologies are avoided as a result of therapeutic capacity of the pars interarticularis in the early stages.

It is more common to find teens and young adults afflicted by PABSI. This will highlight the rapid growth of the spine through growth spurts that is also characterized by a delay in the motor control of the muscle system during this period. Furthermore, it's thought that the neural arch actually gets stronger in the fourth decade hence possibly explaining the low incidence of bone stress reactions in mid ages.

Tennis

The tennis serve generates excessive extension and rotation force. In addition, the forehand shot may also produce elevated levels of spinning/ extension. The more traditional forehand shot demanded a great deal of weight shift through the legs to the torso and arms. However, a more favorite forehand shot is to currently face the ball and also generate the force of this shot utilizing hip rotation and lumbar spine extension. This action does increase ball speed but also puts more extension and compressive loads on the spine potentially resulting in a greater degree of stress on the bone components.

Golf

The most likely skill component involved in golf that may cause a PABSI are the tee shot with a 1 wood when forcing for distance. The follow-through of this shot entails a significant quantity of spine rotation with maybe a level of spine expansion.

Cricket

Fast bowlers in cricket are the most susceptible to PABSI. This will occur on the opposite side to the bowling arm. As the front foot engages on plant stage, the pelvis abruptly stops moving but the spine and chest continue to proceed. With the wind-up of this bowling action (rotation), when coupled with expansion this can place large forces on the anterior arch of the thoracic. More than 50% of fast bowlers will create a pars stress fracture. Young players (up to 25) are most vulnerable. Cricket governments have implemented training and competition guidelines to avoid such injuries by restricting the number of meals in training/games.

Field Events

The more common field events to cause a PABSI would be high leap followed by javelin. Both these sports create enormous ranges of backbone extension and under significant load.

Contact Sports

Sports like NFL, rugby and AFL all require skill components that need backbone expansion under load.

Gymnastics/Dancers

It goes without saying that gymnastics and dancing involves a substantial amount of repetitive spine expansion, particularly backflips and arabesques. It has been suggested that nearly all Olympic degree gymnasts could have suffered from a pars defect. Many organizing bodies now put limits on the number of hours young gymnasts can instruct to prevent the repetitive loading on the spine.

Diving

Spine extension injuries occur mostly off the spring board and on water entrance.

Clinical investigation

These can pose as preventable injuries. Research shows that the incidence was emphasized from the general population that have nil indicators of back pain. But, individuals will typically complain of back ache that is deep and generally unilateral (one side). This may radiate into the buttock area. The most offending movements tend to be described as expansion moves or backward bending movements. This may be a slow progression of pain or might be initiated by one acute episode of back pain in a competitive extension motion.

On clinical examination:

The one-legged hyperextension test (stork test) was suggested to be pathognomonic for busy spondylolysis. A negative evaluation was stated to effectively exclude the diagnosis of a bone stress-type injury, thus creating radiological investigations unnecessary.

But, Masci et al (2006) examined the connection between the one-legged hyperextension test and gold standard bone scintigraphy and MRI. They discovered that the one-legged hyperextension test was neither sensitive nor specific for active spondylolysis. Moreover, its negative predictive value was so poor. Thus, a negative test can't exclude energetic spondylolysis as a possible cause.

Masci et al (2006) go on to indicate that the bad relationship between imaging and the one-legged test may be because of a number of factors. The extension test would be expected to move a significant extension force on to the lower back spine. In addition to putting substantial strain on the pars interarticularis, it might also stress different regions of the spinal column like facet joints as well as posterior lumbar disks, and this may subsequently induce pain in the existence of other pathology such as facet joint arthropathy and spinal disc disease. This will explain the poor specificity of the test. Conversely, the inadequate sensitivity of the test may be related to the subjective reporting of pain by issues performing the maneuvre, which may vary based on individual pain tolerance. Additionally, this evaluation can preferentially load the fifth cervical vertebra, and so bone stress located in the upper lumbar spine may not test positive.

Grade 1 spondylolisthesis are normally asymptomatic; nonetheless, grade 2+ lesions often present with leg pain, either with or without leg pain. On examination, a palpable slip could be evident.

Imaging

Clinical assessment of active spondylolysis and the more severe pars defects and spondylolisthesis can be notoriously non-specific; this is, not all patients suffering PABSI will present with favorable abstract features or positive signs on analyzing. Thus, radiological visualization is important for diagnosis. The imaging methods available in the diagnosis of bone stress injury are:

1. Conventional radiology. This test is not very sensitive but is highly unique. Its limits are partially because of the cognitive orientation of the pars defect. The oblique 45-degree films may show the timeless 'Scotty Dog' appearance. Spondylolisthesis can be looked at simply on a lateral movie x-ray.

2. Planar bone scintigraphy (PBS) and single photon emission computed tomography (SPECT). SPECT enhances sensitivity in addition to specificity of PBS than straightforward radiographic study. Comparative research between PBS and conventional radiology have shown that scintigraphy is more sensitive. Patients with positive SPECT scan must then undergo a reverse gantry CT scan to assess whether the lesion is active or old.

3. Computed tomography (CT). The CT scan is considered to be more sensitive than conventional radiology and with higher specificity than SPECT. Regardless of the type of cross-sectional image utilized, the CT scan provides information on the state of the flaw (intense fracture, unconsolidated flaw with geodes and sclerosis, pars in procedure for consolidation or repair). The "inverse gantry" perspective can evaluate this condition better. Repeat CT scan can be used to track progress and recovery of the pars defect.

4. Magnetic resonance imaging (MRI). This technique shows pronounced changes in the signal in the amount of the pars. This is recognized as "stress response" and can be classified into five different degrees of action. MRI can be helpful for evaluating elements that stabilize isthmic lesions, for example intervertebral disc, common anterior ligament, and related lesions. The MRI isn't as specific or sensitive as SPECT and CT combination.

MRI has many advantages over bone scintigraphy, for instance, noninvasive nature of the imaging along with the absence of ionizing radiation. MRI changes in active spondylolysis include bone marrow edema, visualized as increased signal in the pars interarticularis on edema-sensitive sequences, and fracture, visualized as reduced signal in the pars interarticularis on T1 and T2 weighted sequences.

However, there is greater difficulty in detecting the changes of busy spondylolysis from MRI. Detecting pathology from MRI relies on the interpretation of distinct contrasts of signals compared with normal tissue. Unlike stress fractures in different parts of the body, the little region of the pars interarticularis may make detection of those changes harder.

However, unlike MRI, computed tomography has the capability to differentiate between acute and chronic fractures, and this differentiation might be an important determinant of fracture healing. Accordingly, in areas using pars interarticularis fractures discovered by MRI, it might nonetheless be necessary to execute thin computed tomography slices to determine whether or not a fracture is severe or chronic -- an important factor in fracture resolution.