Saturday, September 12, 2009

Working Around Low Back Injuries Part 4; Maryland Personal Trainer

In the last part of this series, I will discuss working around the SI joint in the gym.


The sacroiliac joint, as depicted above, is where the sacrum attaches to the ilia.

Just like the lower back, SI joint can hurt for a variety of reasons. Some SIs hurt with compression while some hurt with extension. Some injuries will hurt with rotational forces as well. For example, if only the right side of the SI joint hurts, single leg work on the right side might actually cause more pain than a bilateral movement like a squat. You will need to experiment at first and figure out the nature of your injury and choose exercises accordingly.

With that said, with SI injuries, make sure you avoid putting excess pressure directly on the SI itself. When doing a seated exercise, make sure your spine is neutral and your pelvis is not in a posterior tilt. When bench pressing, make sure that your arch is not causing extra pressure on the top of your butt.

Additionally, since the glutes have attachments on the sacrum and illium, sometimes glute and hamstring heavy exercises are not appropriate. If your injury hurts with glute contraction, your options become more limited.

The safest bet (as I have frequently mentioned before, I know) is the trap-bar deadlift (assuming the injury is not recent and you can handle the compression). The trap-bar deadlift results in less compression than a typical back squat or deadlift, and since the weight is held by at the sides, hyper-extending the spine is hard to do.

Glute-ham raises are also another option, assuming they are pain free. This is a great bilateral exercise that hits the hamstrings and glutes hard while minimizing compressive force and rotational torque.

When all is said and done, figure out whether your injury is related to compression, extension, or rotational forces about the SI. For compression related injuries, an approach similar to working around flexion-related low back pain is appropriate. For extension injuries, an approach similar to working around facet joint injuries is appropriate. And for pain with rotational torque, stick to bilateral work and limit your single leg exercise choices to those that are pain free.

Conclusion

Just because you have a back injury does not mean you have to stay out of the gym. Figure out what type of movement causes your back pain and act accordingly. One thing to consider is that you do not need to have a current back injury to apply these strategies. If you have a history of recurring back pain associated with flexion or extension, you can follow the tips outlined in this series to avoid recurring injury. Building muscle, losing weight, increasing strength - these are all life-long pursuits. You only get one spine, take care of it.

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