#8 Top 3 Informative Tips - 2nd Clinical Wrap Up

     Hello again. This post wraps up my 2nd clinical rotation. I hope you have enjoyed them thus far. I have now started my 3rd and final rotation, where I hope to share with you my experience with industrial physical therapy and the world of corporate wellness.

     For my final post of internship II, I wanted to share the top 3 informative tips that I provided to my patients over the 8 weeks. As you may notice, all three of them correlate to the treatment and prevention of low back pain, but they apply to most healthy individuals.

     Towel Roll in Sitting – The use of towel roll in sitting is an excellent way to maintain the natural curvature of your spine, which is necessary to properly disperse forces or stress.  The lumbar spine, five segments of vertebrae found between the thoracic spine and sacrum, has a natural lordotic curve. A lordotic curve is one the turns inward towards the front of your body. Simply take a standard bathroom towel, fold it in half long ways, and roll it up. You can even duct tape it together so that it is always quickly available. When sitting, place the towel roll at the small of the back, where the natural curvature is found. Maintaining this force-dispersing curve will aid in preventing unnecessary stress and pull on ligaments and muscles of the back, as well as other structures of the spine.

     Supine-to-Sit – Supine-to-sit is a transition where you adjust your body from lying on flat your back to sitting up on the edge of the bed. I was astonished at the many different ways I observed patients come into a sitting position, most of which caused me some of my own back pain.  Due to changes in spinal column stress at different positions, the most appropriate way to go from supine-to-sit is first to roll onto your side, towards the edge of the bed you will be sitting. Once in a sideline position, fully lying on the side of your body with knees bent, you will move into a sort of pendulum motion. As you bring your feet forward and off the edge of the bed, you will push your body up and away from the surface. You should then be in sitting. A typical response I received from patients was, “this is how I get out of bed when I hurt.” This statement should show you that your body knows the best way to move, and you should always utilize this maneuver.

     Core Musculature Activation – Some professionals do not like to use the term “core” and I can agree with them when the term is used incorrectly. When I say core musculature, I’m specifically identifying those muscles responsible for direct stabilization your spinal column. Now in order to provide direct stabilization, the muscle needs to be anatomically attached to the vertebral bodies of the spinal column. I’m sorry to inform you, but the superficial rectus abdominis muscles, those 6-pack abs, are not attached to your vertebral bodies. The three main direct stabilizers of the spine include transverse abdominis, internal oblique, and multifidus. Now even though research is currently on the fence about whether or not local or global musculature strengthening improves back pain. I believe local activation yields the best results. Now in order to isolate these muscles, specifically the transverse abdominis, you need to draw in your stomach. Think about bringing in your stomach as if you were putting on a tight pair of pants or about to absorb a punch in the gut. An excellent way to check yourself and whether you are activating the correct muscles is to put your fingers on the front part of your hip bones and slide off the bone towards your belly. At rest, your fingers should sink in, but with activation you should feel the muscle push into your fingers. Activation of these muscles will provide stability of the spinal column and should be performed during all movements, especially lifting, whether from the ground or overhead.  

As always, seek the help of a licensed healthcare professional.  

- Patrick Berner, SPT