& REHAB
BUNS OF STEEL! 10 TIPS TO STRONG
GLUTES FOLLOWING LOW BACK INJURY
Lower back pain can be the result of a vicious cycle of instability,
spasm and inhibition. The key to prevention is right behind you…
WORDS: MERRIN MARTIN
s health and fitness professionals
we have a duty to observe our
clients’ movement patterns and
identify the key muscles for prevention of
injuries in the future.
As a physiotherapist, I am witnessing
an increasing amount of recurring low back
pain in otherwise fit, healthy and strong
clients. I have had patients in need of
treatment for lumbar disc injury who haven’t
been prescribed a single exercise for the key
preventer muscles, such as core and pelvic
floor activation. Others come in with shoulder
bicep tendon pain, yet not one rotator cuff
exercise (key preventer muscle) has been
advised to offload the biceps tendon.
We must remember to look at the whole
body when designing exercise programs
for our clients, and to closely observe their
bodies when they’re working out in order
to prevent injuries and keep them fit and
moving!
A
Knowledge gaps
A client experiencing chronic lumbar pain
recently showed me her prescribed program
of lunges and squats, hip flexor stretches
and mid-back strengthening exercises
to help reduce her lumbar lordosis and
address her lower back pain. On paper
this would have been a good program,
addressing leg strengthening, stretching
tight hip flexors and strengthening the mid
back. Problematically, however, the client
was arching and extending her lower back
with each exercise, increasing her low back
pain. She had not been taught to activate
her core and pelvic floor, or to activate her
gluteus maximus during her functional squat
and lunge exercises. She was frustrated and
ready to give up the gym even though she
loved it.
Let’s take a look at one common problem
that many clients have following lumbar
injury – and then learn some tricks and tips
to rehabilitate your client and help them
prevent recurring back pain.
Gluteus maximus – pay attention!
Gluteus maximus needs special attention
to ensure it is actually being activated and
used during an exercise program. As a hip
extensor, it brings a flexed thigh in line with
the trunk, prevents the forward momentum
of the trunk in standing and supports the
hip during gait. It is active in functional
movements such as walking, cycling,
running, sit to stand, rising
from a stooped position
and in climbing stairs. It
is continuously active in
strong lateral rotation,
extension and abduction
of the thigh. The inferior
gluteal nerve that supplies
the
gluteus
maximus
muscle originates at the
lower lumbar and sacral
areas L5/S1/S2. Damage to
the lumbar spine structures at
these levels can therefore affect
the gluteus maximus function.
Gluteal atrophy can be
caused by poor neural
activation as a result
of nerve damage,
stenosis (narrowing
of the spinal canal) or
NETWORK WINTER 2016 | 49