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Back and Spine Care, Gentle Stretches and Exercises, and Injury Prevention and Maintenance through Muscular Balance Dr. Wendy Hileman, Ph.D., MPH, MSW, MS My background CEO/CFO for Healthy Adventures Foundation Adjunct instructor at University of Southern California Adjunct professor for Southwestern College Education Ph.D. in Organizational Psychology Master’s degree in Organizational Psychology, Master’s degree in Public Health Master’s degree in Social Work Bachelor’s degree in Physical Education with an emphasis in Athletic Training 2 INJURY PREVENTION AND MAINTENANCE THROUGH MUSCULAR BALANCE 3 Injury prevention Muscular balance Balance between muscular strength and flexibility Push/pull/lever system Concentric/eccentric • Strength • Flexibility 4 Injury prevention Core strength Abdominals/back Core strength is your best line of defense Daily exercises • • • • Pelvic tilts Bridges Lumbar rotations Abdominals 5 Injury prevention Body mechanics Neutral and body alignment Good posture Proper lifting techniques Close to body and pushing instead of pulling Avoid repetitive motions and vibrations 6 Guidelines for Exercise with Injuries 1. Always seek the approval of a physician before starting an exercise program. 2. Follow the guidelines of your physician and/or physical therapist when starting an exercise program. 3. Listen to your body. If it hurts, don’t do it! Working through it is not the answer. 4. Exercise with a prevention approach. 7 Guidelines for Exercise with Injuries 5. Stretch daily, holding each stretch about 30 seconds. Stretch and hold; no bouncing! Do each stretch 1 – 2 times. 6. Do strengthening exercises at least 2 times per week. 7. Do functional exercises, which are designed to prevent or minimize flare ups, daily. 8. Strengthen above and below the injury to bring more stability to the area. 9. If you have arthritis, do the stretches and exercises with out causing more pain than you normally have. 8 Exercise for Older Adults It is important to follow a physical fitness plan throughout your lifetime. The plan must be modified as we age, to adjust for health problems, risks, and decreased ability, but despite this, a plan should still be in place and practiced! This is essential to minimize age-related health problems. Proper medical screening and doctor approval should always occur before starting an exercise program. 9 Exercising with Arthritis Osteoarthritis Defined: arthritis that develops with age; largely caused by weight bearing and deterioration of the joints. All of us get it to some degree Primarily occurs in knees, hips, and spine No cure, instead treat the discomfort Gentle exercise and stretching can help to reduce symptoms and flare-ups Always see a physician before starting a new exercise program 10 EXERCISE CONSIDERATIONS WITH INJURIES 11 Common Chronic Conditions Back/spine Disc degeneration / arthritis Sacroiliac joint dysfunction Sciatica or nerve Damage / pinched / bulging discs Whiplash Plantar fascitis Rotator cuff injuries Tendonitis Knees: Chondromylasia cartilage damage / arthritis ligament damage Overuse/repetitive disorders 12 Aw my achin’ back … Who has aches and pain? Everyone. 80% of all people will experience back pain at some point of our life 80% are a result of weakened abdominals You lose muscle mass as you age. When does aging start? At 30 years of age. Without exercise, you would lose 1 pound of muscle and gain 1 pound of fat. Exercise is the only known anti-aging treatment. So … how do you take care of aches and pains? Gentle stretching and exercising can decrease the intensity and frequency of most chronic aches and pains. These exercises are not intended to be specific for any one person. Instead, these are the most common exercises for the conditions only. Please seek the advice from your physician and/or physical therapist to see if they are right for you. 13 Spine – Common Conditions Neck - Common conditions: arthritis/degeneration, discs, nerve pinch, whiplash, and chronic muscle tension. Back - Disk involvement or injury, fibromyalgia, arthritis, osteoporosis, muscle weakness, tears or damage to the soft tissue, fractures, sciatica, sacroiliac joint dysfunction, spondylolysis and spondylolisthesis, stenosis, piriformis syndrome, lumbar radiculopathy (caused from diabetes), iliolumbar syndrome, sacralization of transverse process, spinal infections, tumors, car accidents (whiplash), scoliosis, stress / depression, etc (Calliet, 1995). 14 Back issues Often related to: Weak abdominals Tight hamstrings Tight hip flexors Hip pain from weak abductors and overdeveloped adductors Poor back flexibility 15 Back - Injury prevention Core strength Abdominals/back Core strength is your best line of defense Daily exercises • Pelvic tilts • Bridges • Lumbar rotations (may be contraindicated with disc problems, ask your therapist and/or orthopedic specialist) • Abdominals 16 Exercising with Back Injuries Low Back Pain Exercise can minimize low back pain symptoms, including the intensity of flare-ups and the number of flare-ups Exercise can reduce your risk of back injury Always consult with a physician before starting a new exercise program 17 ACSM & AHA 2007, HHS 2008 Physical Activity Recommendations Healthy Adults age 18-64 Aerobic Physical Activity Muscle Strengthening Activity Moderate intensity: 150 minutes/week, OR Vigorous intensity: 75 minutes/week (or a combo) 10 min at least, preferably spread throughout week 2 or more days/wk 8-10 exercises 8-12 reps (one set) Flexibility Activity Minimum of one day per week More is better Physical activity and public health: Updated recommendation for adults from the ACSM and AHA. MSSE 2007. and HHS publication October 2008. 18 Special Considerations Warm-up, Conditioning, Cool down Warm-up – should be a low level aerobic activity performed for 10 – 15 minutes prior to exercising. This helps to reduce your risk of injury. Conditioning – this would include stretching, strength training, and aerobic activities. Cool down - should be a low level aerobic activity performed for 10 minutes after exercising. This helps to reduce your risk of muscle soreness and blood pooling. 19 What should you do? Time: 30 minutes aerobics (10-min chunks OK) More is better! Type: Aerobic activity (for everyone but especially important for those under 50) Muscular strengthening activity (for everyone but especially important for those 50 and older) Flexibility activity (in elderly/sick) Balance training (if fall risky) 20 GENTLE STRETCHES AND EXERCISES 21 Back – Stretches appropriate for most back issues Stretches Finding neutral Finding good posture Worship Double or single knees to chest Sitting or laying down hamstring stretch Stretches Piriformis stretch Hip flexor stretch Quadriceps stretch Quad stretch with a pelvic tilts for hip flexor stretch Glutes stretch 22 Back – Exercises appropriate for most back issues Exercises Transverse abdominals squeeze Side crunches Clam shells Exercises Pelvic tilts Bridges Lumbar rotations Crunches Superman (stomach or alt. on all fours) 23 Neck – Stretches and Exercises Stretches Side Bends Chin Down Looking over shoulders Smiley Face Exercises Chin Tucks Rowing 24 SHOULDERS 25 Shoulders Common conditions: tendonitis, rotator cuff injuries, dislocations, and impingements. KEY POINT – Avoid overhead activities, such as shoulder press exercises! 26 Shoulders – Stretches and Exercise Stretches Anterior Shoulder Stretch Medial Shoulder Stretch Posterior Shoulder Stretch Exercises Wall Walking Stability Exercises Shoulder Girdle 27 Overuse/Repetitive Disorders – Elbows, Forearms, Wrists Common conditions: Tennis Elbow Golfer’s Elbow Tendonitis Radial Nerve Impingements (carpal tunnel) Ulnar Nerve Impingements (elbow) 28 Overuse/Repetitive Disorders – Elbows, Forearms, Wrists Stretches and Exercises Stretches Biceps Stretch Flexor Stretch Extensor Stretch Exercises Forearm curls Forearm extensions Forearm deviations Forearm supination/pronation Rolling Exercise 29 Knees Common conditions Chondromylasia Tendonitis Cartilage degeneration/arthritis Cartilage injury Ligament injuries. 30 Knees – Stretches and Exercises Stretches Standing Quad Stretch Standing Hamstring Stretch Gastrocnemius (calf) Stretch Exercises Terminal Knee Extensions Partial Squats with Ball Squeeze Stool Scooting 31 Ankles and Feet Common conditions Achilles tendon injuries Shin splints Ankle sprains Tendonitis Plantar fascitis 32 Ankles and Feet – Stretches and Exercise Stretches Gastrocnemius Stretch Soleus Stretch Big toe stretch Ball roll Exercises Balancing • One Foot • Balance boards • Rocker boards • Wobble boards • Catching a ball on a balance board Toe taps Heel raises Towel scrunch Marble Game 33 GENERAL PREVENTION 34 Exercises While Sitting Heel raises and toes raises (sitting) Hip openers Pelvic tilts Shoulder shrugs Neck half-rolls Smile (big toothy smile!) Chair dips Wall/desk pushups Hip circles Yoga you can do at your desk 35 Resistance Training Examples of resistance training without equipment Squats or lunges or wall sits (2 minutes is the goal!) Heel Raise Toe taps Push-ups (wall, modified, regular) Dips Pelvic tilts Transverse abdominals (stomach squeeze, flatten it out) 36 Flexibility Training Examples of stretches Look over your shoulder Shoulder rolls or 4-point shoulder rolls with step 4 chin down and stretch Chin tucks Mad cat Reach Tricep stretch Posterior should stretch Check stretch Hamstring stretch Double knee squeeze Cross legged lean 37 Benefits of Fitness Weight management Increased ability to perform a wide variety of activities throughout your life Improves your immune system More efficient body systems Reduces risk of preventable diseases Slows aging process 38 Benefits of Fitness Increase longevity Improved endurance, flexibility, and strength Builds self-confidence Boosts the metabolism Regulates appetite Decrease anxiety with balance exercises Improve mood http://www.mayoclinic.com/health/depression-and-exercise/MH00043 39 Conclusion If you have aches and pains, gentle stretching and exercises can help to: Keep you active Manage your health Decrease the intensity and frequency of flare-ups Improve your overall quality of your life 40 Any questions? 41