16 min
Episode 1692 - Multi-planar approach to loading the lumbar spine #PTonICE Daily Show
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- Fitness
Dr. Brian Melrose // #ClinicalTuesday // www.ptonice.com
In today's episode of the PT on ICE Daily Show, Spine Division lead faculty member Brian Melrose discusses loading the lumbar spine in all planes as part of a judicious rehab plan, including anti-flexion, anti-rotation, and anti-sidebending exercises. Brian shares a progression sequence beginning with plank-based loading that advances to using external resistance, and culminates in intentionally loading the spine in suboptimal positions.
Take a listen or check out our full show notes on our blog at www.ptonice.com/blog.
If you're looking to learn more about our Lumbar Spine Management course, our Cervical Spine Management course, or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
BRIAN MELROSE
All right. Good morning, PT on Ice Daily Show. My name is Brian Melrose. I'm one of the lead faculty in the spine division, teaching both cervical and lumbar courses. I'm really stoked to be back here on a clinical Tuesday to talk about loading the lumbar spine in multiple planes. And where that really comes from is I was back in Windsor, Colorado. I was at the extremity management course. And I was listening to Lindsey Hughey talk about loading the rotator cuff. She was kind of discussing the idea of loading in different positions, loading in different speeds, and varying loads. And as I'm sitting there and I'm kind of marinating on the idea of loading in different planes and speeds, I thought to myself, why would the lumbar spine be any different? And what if we approached kind of loading the spine through that lens?
SPINE RESILIENCE IS MULTI-PLANAR
And so when you begin to think about how to make a comprehensive exercise program for individuals where you're building resiliency in the spine, we have to consider that multi-planar approach. So something that would stress the spine into flexion, something that would stress the spine into extension, something for side bend, and then something for rotation. And so a full comprehensive exercise program would look like at least four exercises. And after that course, that's really when I started messing with this concept in the clinic. And it's been really helpful for a couple different populations. Number one is individuals that have had more chronic pain and you're just trying to introduce exercise overall. I think jumping to things like, you know, the deadlift or a squat with a barbell can be a bit much for them. And so it's a great way to start with some exercises and kind of progress them towards using weights and resistance. The other place where this is helpful, though, is when irritability is high. If you've been to any of our courses, we talk about how your interventions need to mirror the patient's irritability. When the irritability is high, it may not be appropriate to have them using external resistance. It may not be appropriate for them to be loading at heavier loads. And so usually I like to start things, again, in a multi-planar sense with body weight and then move more towards dynamic movements. And the last population, where I think this concept helps a lot, is for individuals that are higher-end athletes, or folks that are already kind of squatting or deadlifting multiple times a week. I know for me, that's a big issue with my powerlifting patient population and other skilled Olympic lifters and crossfitters. When they come into the clinic with back pain and I want to offer them some exercises that make their spine more resilient, they're already loading the spine with the deadlift and with the squat a couple of times a week, my window of opportunity really begins to shrink just in terms of the type of
Dr. Brian Melrose // #ClinicalTuesday // www.ptonice.com
In today's episode of the PT on ICE Daily Show, Spine Division lead faculty member Brian Melrose discusses loading the lumbar spine in all planes as part of a judicious rehab plan, including anti-flexion, anti-rotation, and anti-sidebending exercises. Brian shares a progression sequence beginning with plank-based loading that advances to using external resistance, and culminates in intentionally loading the spine in suboptimal positions.
Take a listen or check out our full show notes on our blog at www.ptonice.com/blog.
If you're looking to learn more about our Lumbar Spine Management course, our Cervical Spine Management course, or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
BRIAN MELROSE
All right. Good morning, PT on Ice Daily Show. My name is Brian Melrose. I'm one of the lead faculty in the spine division, teaching both cervical and lumbar courses. I'm really stoked to be back here on a clinical Tuesday to talk about loading the lumbar spine in multiple planes. And where that really comes from is I was back in Windsor, Colorado. I was at the extremity management course. And I was listening to Lindsey Hughey talk about loading the rotator cuff. She was kind of discussing the idea of loading in different positions, loading in different speeds, and varying loads. And as I'm sitting there and I'm kind of marinating on the idea of loading in different planes and speeds, I thought to myself, why would the lumbar spine be any different? And what if we approached kind of loading the spine through that lens?
SPINE RESILIENCE IS MULTI-PLANAR
And so when you begin to think about how to make a comprehensive exercise program for individuals where you're building resiliency in the spine, we have to consider that multi-planar approach. So something that would stress the spine into flexion, something that would stress the spine into extension, something for side bend, and then something for rotation. And so a full comprehensive exercise program would look like at least four exercises. And after that course, that's really when I started messing with this concept in the clinic. And it's been really helpful for a couple different populations. Number one is individuals that have had more chronic pain and you're just trying to introduce exercise overall. I think jumping to things like, you know, the deadlift or a squat with a barbell can be a bit much for them. And so it's a great way to start with some exercises and kind of progress them towards using weights and resistance. The other place where this is helpful, though, is when irritability is high. If you've been to any of our courses, we talk about how your interventions need to mirror the patient's irritability. When the irritability is high, it may not be appropriate to have them using external resistance. It may not be appropriate for them to be loading at heavier loads. And so usually I like to start things, again, in a multi-planar sense with body weight and then move more towards dynamic movements. And the last population, where I think this concept helps a lot, is for individuals that are higher-end athletes, or folks that are already kind of squatting or deadlifting multiple times a week. I know for me, that's a big issue with my powerlifting patient population and other skilled Olympic lifters and crossfitters. When they come into the clinic with back pain and I want to offer them some exercises that make their spine more resilient, they're already loading the spine with the deadlift and with the squat a couple of times a week, my window of opportunity really begins to shrink just in terms of the type of
16 min