IMPORTANT NOTE
- The aim of this workshop is to increase the knowledge of fitness leaders, personal trainers and instructors in the area of injury prevention and safe exercise prescription.
- An awareness of common injuries and their physiotherapy and medical rehabilitation programs will assist the trainer in providing correct supervision of their clients whilst in the fitness centre or personal training studio.
- At no stage should fitness leaders assume the role of diagnostic practitioners or primary rehabilitation consultants without direction and assistance from the treating medical professional or physiotherapist.
- To do so will place the fitness leaders in danger of litigation and intense scrutiny by their peers as well as by the legal and medical community.
- The information presented in this workshop is to be used as a guide only and should never be used as a replacement for medical or physiotherapy intervention.
Basic Anatomy of the Lumbar Spine
Muscular Structures- Superficial and Middle Layers
Intervertebral Disc and Its Anatomy
- Nucleus Pulposus (inner part of the disc)
– Is a gel-like mass composed of water and proteoglycans held by randomly arranged fibres of collagen. With its water-attracting properties, any attempt to deform the nucleus causes the applied pressure to be dispersed into various directions, similar to a person on a waterbed.
- Annulus Fibrosus (outer part of the disc)
– consists of “lamellae” or concentric layers of collagen fibres. The fibre orientation of each layer of lamellae alternate and therefore allow effective resistance of multidirectional movements.
- Vertebral endplate
- Is a plate of cartilage that acts as a barrier between the disc and the vertebral body. They cover the superior and inferior aspects of the annulus fibrosus and the nucleus pulposus.
- Innervation
– The disc is innervated in the outer 1/3 of the annulus fibrosis
Where Does the Pain Come From???
- The spine has an abundant nerve supply and pain may thus originate from many of its musculoskeletal structures.
Pain receptor stimulation may be via…
- Mechanical Force – i.e. pressure, distraction of disruption
2. Chemical irritation – i.e. chemical substances associated with: inflammation or trauma
Pain sensitive structures include:
- Apophyseal joint capsule (facets)
- Ligaments
- Muscles
- Bone
- Blood vessels
- Disc (nerve fibres have been found in the outer third of the annulus)
- Nerves
- Whenever nerve fibres in these structures are irritated, in addition to the pain being felt locally, it may also be felt at some distance from them i.e. Referred
Referred Pain
- Referred pain can be either:
- Somatic Referred
- Arises from noxious stimulation of musculoskeletal structure (discs, capsules, synovium, ligaments, muscles)
- Nothing wrong with the nerve
- g. ice cream headache, heart attack
- Described as dull generalised ache vague
- Typically above the knee
- Nil sensation or strength or reflex loss
Radicular Pain
- Arises as a result of irritation of spinal nerves or nerve roots
- Due to disc pathology, facet OA, bone spurs, congenitally narrowed nerve exit foramen or inflammation
- Irritation of the nerve itself e.g. traction injury, trauma, tumour
- Can feel pain anywhere along the course of the nerve
- Electric, pins and needles, numbness, weakness often below knee (dermatomal dtribution)
Effects of Movements on the Lumbar Disc
Disc Pressure in Various Positions
Common Conditions & Training Considerations
Progressive levels of Disc Injury
- Disc Degeneration
- Disc Prolapse/Protrusion
- The posterior longitudinal ligament remains intact but the nucleus pulpusus impinges on the annulus fibrosi
- Disc Extrusion
– The nuclear material emerges through the annular fibers. PLL still intact
- Disc Sequestration
– The nuclear material emerges through the annular fibers and the PLL is disrupted.
A portion of the nucleus pulpulsus has protruded into the epidural space
Practical Applications for Trainers
- Maintaining Lordosis
- Remember rotation also stressed disc walls
- Can my client extend….if not they may be at risk
- What else can I do
- Stretch hamstrings and gluts
- FREE phsyio assessment for anyone with a history of back pain or
- Disc pathology
- Technique dependent exercises
- Squat, dead lift, RDL, kettle bell swing, Olympic lifting , good mornings, bent over row, low to high woodchoppers
- High Risk Exercises
- Dead ball lift, atlas stone
- Food for Thought: Deep leg press, seated rear delt, lifting DBs to prepare for DB press, weights belts
- Rehab progression trees??
