The Hip Muscles are Part of the Core

Weakness or muscle imbalance in the hips impacts the core. 
   
Continuing the discussion of the core, I am moving from the spine now onto the primary stabilizers in the extremities, this week we consider the small muscles in the hip. The hip is an integral part of the core as many of the muscles attach directly to the spine and cross the pelvis to attach to the leg. Hip weakness effects the lower extremity and spine with movement.  See the anatomy pictures below and note the attachments of the psoas, iliacus, piriformis, glutes, adductors, and obturators as they course from the pelvis and spine to the top of the femur.

 

The stabilizers are small but have important attachments in order to keep the leg stable on a moving trunk or to move the leg away from the trunk in functional movements. If these muscles become weak or imbalanced, the hip joints and lower leg joints undergo more stress than they can handle which leads to pain and injury. Hip weakness also leads to movement deficits impacting efficiency, coordination, and decreases sports performance.

So how should we incorporate the hips into core strengthening? Start adding specific hip exercises into a maintenance routine and think of them as part of your core. A good place to start is with planks, side planks as the video shows, forward and backward planks. Other great exercises include clam shells, leg lifts, bridges, bent knee fall outs, etc. Keep your core tight and limit all motion through the spine while just working into the hip. If done properly, just a couple of reps make your hips feel "on fire." This sensation is normal with proper hip strengthening. Mild soreness usually follows the day after but subsides. Soreness and muscle burning should never produce pain though.

Consult your local skilled Physical Therapist for more core strengthening exercises at www.RMSSPT.com. Follow our blog for more helpful info … 

Meredith Bremner, PT, DPT, cert DN 
Doctor of Physical Therapy 

Rocky Mountain Spine and Sport

The Core Continues … around to the Back

 Ever thought of doing back exercises to improve your core strength?

 

In the last post I talked at length about the anterior core muscles and the importance of targeting each layer when doing core strength. I defined the core as "a group of muscles that supports the axial skeleton and acts as the foundation off of which the extremities move." That said, we need to now direct our attention to the core muscles in the back.

 

Anatomy review - Just as with the anterior aspect of the spine and the abdominals, the posterior back muscles have layers as well. The outer layer consists of the erector spine or paraspinal muscles which extend from the neck down through the base of the spine and sacrum. Deep to that layer is the multifidus, the key muscle which stabilizes the spine during and prior to movement. (Sound familiar to last week's post on the abdominals?) The multifidus can become under worked, inefficient, and uncoordinated if not isolated in exercise. When this happens, the larger, outer layer muscles overpower it and cause translational forces in the spine resulting in pain with movement. However, the multifidus should create a deep contraction on each segment which unifies the entire spine into one supported column off of which the spine is able to bend forward/backward, side to side, and rotate when the paraspinals activate.

 

 

How do we train or retrain this muscle? Go back to very simple exercises that require less movement and more focus on the neuromuscular system's control. Lay on your stomach, face down. Focus on gently "lifting your tailbone as you pull your navel to your spine." This is a small movement which should feel like next to nothing. If possible, place your fingertips just to the sides of your spine and feels for a tightening down on the back muscles near midline. If you are lifting your head or working too hard, you will notice the larger side muscles start to kick in.

 

 

Once you have a good multifidus contraction, then work up to more challenging exercises such as the "superman" or alternating arm to leg lifts as seen below.

 

 

These exercises require focus and awareness but should never cause pain. If you feel back pain, stop and go back to square 1. Consult your local skilled Physical Therapist for more core strengthening exercises at www.rmsspt.com. Follow our blog rmsspt.blogspot.com for more helpful info …

 

Meredith Bremner, PT, DPT, cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport

The Core

Core strengthening gets a lot of attention these days. But what really is the "core?" Why is it so important? How do we strengthen it properly?

 

The core is a group of muscles that supports the axial skeleton and is the foundation off of which our extremities move. Let's briefly review the anatomy. In the trunk the core is made up of 3 layers of muscles: the outer, middle, and inner abdominals. The outer layer is the rectus abdominis, or "6 pack," muscle which attaches to the base of the ribs and breast bone and extends down to the pelvis. Its role is to bend the spine forward in a sit-up type motion. The middle layer is made up of the 2 diagonal muscles called the abdominal obliques which attach the rib cage to the tops of the pelvis and side bend the spine or stabilize asymmetrical movements. The innermost layer is comprised of the transversus abdominis, or TA. This muscle runs horizontally over the trunk and attaches the thick band of tissue under the naval to the back of the spine. The job of the transversus is to tighten down the abdominal contents and stabilize the spine prior to and during movement. 

 

 

It is important to understand these 3 layers of muscles when doing core exercises. Too often individuals do sit-ups and crunches but never train the deepest TA muscle to stabilize their spine; they end up with back pain and strong outer abdominals which do not adequately support the spine. Also, many people stop doing core exercises because they are unsure how to safely strengthen their abdominals without doing situps, which may be painful. 

 

So, let's go back to the basics and train the core from the inside out, gradually progressing from deepest layer to outermost layer as we up the challenge. Start by laying on your back and think of drawing your naval down toward your spine. Don’t hold your breath. It will help to put your hands just above the tops of your pelvic bones and feel the muscles tighten down from the inside across the stomach region. Then, once you have that contraction, try to hold it for up to 10 seconds. The next progression is to keep your spine completely stable and supported with your TA contraction and then lift one leg slightly. Alternate legs. See the video below for a more advanced exercise where both feet are held in up while still drawing the navel down toward the spine.

 

 

As you progress with the exercises, then start challenging yourself with bigger movements such as situps or planks but continue to draw in as to keep the spine supported by contracting the TA. You will notice much more support through the trunk and an increase in challenge.

 

These exercises require focus and awareness but should never cause pain. If you feel back pain, stop and go back to level 1 by drawing the navel into the spine. Consult your local skilled Physical Therapist for more core strengthening exercises at www.RMSSPT.com

 

Meredith Bremner, PT, DPT, Cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport

The Neck is Part of the Core - Chin Tuck Exercises

How do we strengthen our neck? In High Intensity Interval Training (HIIT) workouts, it's not uncommon to hear people say that their neck fatigues before anything else when they are working on core strengthening. They are limited by neck pain when doing V-ups, sit-ups, bicycles, etc.

Research has shown that the way we strengthen our core is from the inside out. Meaning, we have to address the deepest layer of muscles that stabilize the spine before we ask the bigger muscle groups to start working on movement. In my last post, I made an argument that the core includes the neck, shoulder, abdomen, and hip stabilizers. For the neck, the deep neck flexor muscles as a group should be addressed with core strengthening. The neck is very similar to the low back. Think of the low back and how the abdominals are in the front of the trunk and work to bend the spine and/or keep it stable. Now, looking at the neck, it has the same directional curve and the deep neck flexors are positioned in front to draw the chin down or keep the spine supported. Essentially, the deep neck flexors are the "abdominals" of the neck, stabilizing it prior to and during movement.

The chin tuck is a simple exercise that draws attention to the deep neck flexors. As you can see in the video, I am gently tilting my chin down as if I am making a double chin. Ideally, one would perform a chin tuck and then hold the position for up to 10 seconds for 10 repetitions every hour through the day. Note that I am not jamming my chin down but simply nodding. This puts the neck in an optimal position for the deep neck flexors to protect and support the spine as one progresses into crunches, sit-ups , V-ups, and more challenging exercises. Several peer reviewed studies have shown significant improvement in neck pain and neck strength when subjects performed chin tucks frequently through the day. If you are unable to lay down through the day, you may also perform this exercise in a sitting position. Remember again that it is a simple chin tuck taking the head back over the shoulders, not looking down and flexing your neck. If you feel like you are hardly doing anything, you are likely doing it right. The movement is subtle but important for proper head and neck positioning.

 Meredith L. Bremner, PT, DPT, Cert. DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport, LLC

For further information on neck pain and strengthening, visit our website and schedule to see a skilled physical therapist. www.rmsspt.com

5 Ways to Improve Your Overall Fitness

   

1.    Get up and get going … no matter what the exercise is, just start somewhere. "Motion is lotion" and the body was designed to move. Our joints, ligaments, muscles, and connective tissue are all at their optimal function when challenged on a daily basis. For some, this may be through high intensity interval training (HIIT) workouts and for others this might be walking 30 minutes. Just start somewhere!
 
2.    Work on your core regularly. We used to think that the core was limited to the abdominal muscles, but it pertains to the axial skeleton which includes the neck, shoulders, back, abdominals and hips. There are key exercises for each region that should be in your routine to maintain a strong foundation on which you can move. Stay tuned on our website to see an example exercise for each region.
 
3.    Vary your training and goals - Our bodies respond to change. This means that if we are doing the same exercises over and over with the same amount of load, our bodies won't respond. If you would like to get stronger or more fit, consider changing the type of exercise or vary your weight and intensity. Sometimes this can best be done through the year with the changes in season. In the summer, take the opportunity to get outside with the nice weather and take a break from lifting in the gym. You will notice a change with more cardio and your muscles and joints may thank you for the much needed break.
 
4.    Find a training buddy … Research has shown that people do much better with exercise in a social setting provided there are common goals. Find someone who will keep you honest and even push you a bit. This can really help you with your consistency and improve your overall fitness.
 
5.   See your local Physical Therapist for a precise exercise program and recommendations tailored to your body's unique needs. A Physical Therapist is trained in the evaluation and examination of human movement and function and can identify movements that will help you reach your goals.

See rmsspt.com for locations and our staff bios. 

Meredith L. Bremner, PT, DPT, Cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport, LLC

Finding a Quality Physical Therapist: How Do Americans Evaluate Quality

I recently read a report based on a survey, conducted by the Associated Press-NORC Center for Public Affairs Research, that Americans do not think that information about the quality of health care providers is easy to come by, and they lack trust in information sources that tend to produce such indicators. It also revealed that when it comes to what being a quality health care provider means, there is a disconnect between how experts and consumers define it. The survey found that most Americans focus on the doctor-patient relationship and interactions in the doctor's office, with fewer thinking about the effectiveness of treatments or their own health outcomes. Further, individuals report that they value provider quality over cost and are willing to pay more for higher-quality doctors, but when asked directly in the survey, few report having done so.

http://www.apnorc.org/PDFs/Finding%20Quality%20Doctors/Finding%20Quality%20Doctors%20Research%20Highlights.pdf

 "When Americans are asked to volunteer what they think is the most important factor that makes a high-quality doctor, responses vary widely but mostly focus on doctor-patient relationships and personality (59 percent), rather than on the delivery of care or the patient's own health outcomes (29 percent). Most frequently, Americans say that a quality doctor listens, is attentive, or shows interest in them (18 percent). Other top responses focus on doctor-patient interactions and their traits, including that the doctor has a caring attitude (8 percent), good bedside manner (8 percent), various other positive personality traits (7 percent), and time spent with patients (5 percent). Relating to the delivery of care or patients' own health outcomes, 11 percent values most a doctor's ability t accurately diagnose and fix their health problem, and percent mention a knowledgeable doctor".

So this got me thinking, would the same survey given to Americans who have had #physicaltherapy have the same findings. I tend to think that it would, however I also think that the number for patients/clients who relate positive outcomes to quality #pt would be higher than with physicians.

Patient's come to physical therapy expecting pain relief and functional improvement, however the power of listening, being attentive and showing interest in a patient both personally and clinically is very powerful. Over the years I have had many patients who have failed physical therapy due to more severe underlying pathology, had surgery, and then returned rather happily to PT with me. I attribute this to a strong trusting relationship that was built during our treatment sessions which happen through active attentive listening and a caring attitude.

Physical therapists' have the opportunity and advantage as compared to other health care professionals when it comes to building a trusting relationship. First of all, we typically spend at least 30 minutes with our patients giving us plenty of time to first listen and then counsel and treat. Secondly, we have more frequent follow up visits to implement our plan of care. Unfortunately insurance and reimbursement constraints have led to the practice of "volume scheduling" leaving less time for attentive listening.

Every human being wants to feel important and heard, especially when dealing with a health issue. #Physicaltherapists are by training, as are physicians, good listener's, however projecting a caring attitude and good bedside manners are traits that generally cannot be taught, they are innate.

Eric W. Krell, PT, DPT, BScPT, MTC
Co-owner Rocky Mountain Spine and Sport, LLC
follow @EKrellDPT

The Benefits of Physical Therapy

"I have often said, and I see it becoming more true with each passing year especially now with the increase of life expectancy and the desire on the part of many to stay engaged during those years, that while medicine and surgery may save lives, no profession speaks to the quality of those lives better than does physical therapy."

                                                                                                                                             

- Stanley V. Paris PT, PhD, FAPTA

                                                                                              (Mildred Elson Award, Acceptance

Speech, Amsterdam, 2011)

Many people do not know all of the ways that physical therapy can help them, if you find that you cannot do certain things because of pain, then it might be time to talk to your doctor or call Rocky Mountain Spine and Sport to see if physical therapy can help you.

There are certain signs that you may benefit from physical therapy. These signs can include:

• Inability to stand or sit comfortably for long periods of time

• Back, neck or joint pain

• Limited movement at any joint or in your neck/back

• Difficulty getting in and out of bed

• Trouble sleeping

• Inability to walk for at least 20 minutes

• Trouble with balance or unsteadiness

• Unable to enjoy leisure or recreational activities

• Unable to interact with children or grandchildren

• Limited ability to exercise

• Unable to work

• Difficulty going up and down steps or curbs

• Regular headaches

• Pain with chewing, or a painful clicking in your jaw

If you find yourself in pain or discomfort from the most basic daily activity, alleviating this could be found in physical therapy treatment. Physical therapy doesn't involve medication and it doesn't mask the pain or discomfort. Physical therapy is intended to resolve the issue. To get you back to normal and allow you to enjoy the things you love to do.

The key benefits of physical therapy are to evaluate physical problems, increase and maintain muscle strength and endurance, restore and increase joint range of motion, increase coordination, decrease pain, decrease muscle spasms, decrease swelling and inflammation of joints, promote healing of soft tissue injuries, correct walking problems, educate patients and family, decrease stress and many more too numerous to mention.

The American Physical Therapy Association (APTA) has defined physical therapy as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to the manipulation/mobilization, used to diagnose and treat soft tissues and joint structures for the purpose of modulating pain and improving function.

At Rocky Mountain Spine and Sport Physical Therapy it is our goal to get every one of our patients back to work.... play.... life!  We have highly trained physical therapists at five convenient locations ready to help you. There is no need to wait any longer, physical therapy can help you regain full use of your body and put you on the road to recovery. Call one of our locations today to get started.

Eric Krell  - PT, DPT, BScPT, MTC

Follow @EKrellDPT