Lower back pain and pelvic tilt during biking

I was always wondering what it the correct position for all my joints during biking. What can be the most energy efficient and at the same time anatomically less stressful position I should have.

Here is a wonderful website that gives nice detailed guidelines and rules of thumb for proper body position during biking.

I found very relevant to my problem the following information:

Lower Back Pain and Pelvic Tilt

This image shows two cyclists, with the one on the right in a far lower, more aggressive position. One might imagine that of the two, he might suffer more back pain. But this was not the case, with the cyclist on the left suffering debilitating pain, very quickly into a ride. The clue is in the angle of the pelvis. The rider on the left has a noticeable hinge point in his lower back as his pelvis is reluctant to lean forwards and the lower lumbar vertebrae appear to be immobile. The rider on the right meanwhile has a smooth transition from pelvis to lumbar region and along the whole spine. In the left hand case, the saddle was too low and the rider had a very stiff right hip joint. The excessive upwards movement of the knee and lack of mobility in the hip combined to push the pelvis back.

Backpack safety for kids

A simple and nice video on how kids should put their backpack by moveforwardpt.com. This is an extremely important issue for the healthy development of the whole musculoskeletal system of a kid and especially its spine.

Major points:

1. Do not use one strap backpacks
2. Put both straps around the shoulders and adjust them so that the kid feels comfortable with it
3. Do not allow the backpack to fall below the low back of the kid
4. Put in the backpack only the necessary items and do not make it heavy

Good luck to all the kids with their new school year!!

Proper bike posture

With biking becoming more and more famous all over Europe, it is extremely important to know how to properly set your posture.

Read this very interesting article at livestrong.com.

Iliotibial band syndrome

Tensor fasciae latae muscle

Origin: Spina iliaca anterior superior

Insertion: iliotibial band

Actions: Hip > ABD, FLEX, INT ROT

Gluteus maximus muscle

Origin: Dorsal surface of the sacrum and facies glutea of the ilium

Insertion: Upper fibers > iliotibial band, lower fibers > tuberositas glutea of the femur

Actions: Hip > EXT, EXT ROT, upper fibers > ABD, lower fibers > ADD

Iliotibial band insertion: lateral tubercle of the tibia (tuberculum of Gerdy, after French surgeon Pierre Nicolas Gerdy [1797–1856]).

Iliotibial band syndrome is a common overuse syndrome especially in long distance athletes. There are a lot of factors that can cause this syndrome, both biomechanical and training, but the exact cause is not completely understood.

When an athlete is running his foot touches the ground about 3000 times per mile. After running for 10 times he has touched the ground 30000 times. The force required to lift his body weight while running is about 3 times this weight. So, if someone weight 70 kg he will need to exert force to lift 210 kg. This means that his leg joints and muscles are loaded with extreme forces during exercise.

Biomechanics

The iliotibial band (ITB) provides the knee with stability. When the knee is in flexion over 30 degrees, the ITB is moving dorsally behind the lateral epicondyle of the femur. When the knee is extended, the ITB is moving ventrally in frond of the lateral epicondyle of the femur. This movement irritates the ITB and the bursa that lies under the insertion of it and attaching on the periosteum of the lateral epicondyle of the femur (Running News, Margaritis, 2008).

       

Research has shown that the joint capsule of the knee is folding at the point of attachment of the ITB and it is this structure that is inflamed in the ITB syndrome and not the ITB itself (Running News, Margaritis, 2008).

Causes

The ITB syndrome is an overuse syndrome which appears when the body's natural healing mechanism do not have enought time to heal the micro-damages at the point. However, there are a lot of risk factors that can increase the chances of it to appear. Here are some major causes (Running News, Margaritis, 2008):

1. Uneven leg lenght > causes variations in the function and position of the hip abductors and the pelvis bone increasing tension on the ITB

2. Genu varum > increases tension on the ITB

3. Foot overpronation > causes tibial internal rotation and hip adduction increasing tension on the ITB

4. Week hip abductors > causes increased hip adduction and internal rotation increasing tension on the ITB

5. Myofascial limitations > tight hip flexors and/or extensors and rotators increase tension on the ITB

Assessment

The pain is located at the lateral side of the knee, but it may also appear in the hip. Pain increases with running, hip and knee active flexion, hip active or passive adduction. Palpating the region can also reproduce the symptoms.

Special tests to reproduce the symptom:

Ober test > positive if the hip remains abducted.

Thomas test > positive if the knee off the bed is not flexed more than 70 degrees or hip cannot be adducted more than 15 degrees.

During assessment, the iliopsoas, the rectus femoris, the gastrocnemius and the soleus muscles should be also assessed for tightness or weakness.

How to protect yourself against the ITB syndrome

• Avoid running on hard surfaces
• Avoid running in descending surfaces
• Avoid extreme increases in your training session
• Have proper running shoes and buy new ones every 300-400 miles of training
• Stretch your legs during and after your training
• Increase knee, hip and pelvis muscle strength

Physical therapy for ITB syndrome

Acute phase - inflammation (2-5 days):

- reduce inflammation putting ice at the region for 10-15 minutes, 2 times per day

- avoid movements that reproduce the symptoms and take some rest

- add light stretching of the ITB to avoid contractures during the healing process

Later phase - proliferation (up to 6 weeks):

- facilitate fibers' normal alignemnt and prevent abnormal activation to become habitual

- increase blood flow to the region through passive activation, static stretching, gentle isometric activation with very minimum or no loading and open chain exercises, massage, and electrotherapy

- strengthen the hip abductors and external rotators, the quadriceps and the cuff muscles

- stretch the ITB and the hip adductors, extensors and internal rotators

Remodelling phase (up to 1 year):

- rebuild all locomotive properties and put the patient back to his/her daily life as functionally as possible

- use passive, active and isometric activation

- work with coordination, proprioception and functional activation

- suggested methods: ballistic stretching, PNF, dynamic stretching, weights in closed chain

- strengthen the hip abductors and external rotators, the quadriceps and the cuff muscles

- stretch the ITB and the hip adductors, extensors and internal rotators

References:

• Brody TL, Carrie MH. Therapeutic Exercise: Moving Toward, Function. 3rd ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2011.
• Running News. The iliotibial band syndrome. Anastasios Margaritis. c2008 [cited 2008 November 28]. URL: http://www.runningnews.gr/item.php?id=4930.
• Schuenke M, Schutle E, Schumacher U. Thieme Atlas of Anatomy: General Anatomy of the Musculoskeletal System. New York: Thieme Medical Publishers, Inc.; 2006.

Always visit your personal GP, Orthopedic MD or PT before trying anything yourself that may worsen the situation.

Change in load on L3 disc

Within the lumbar spine, different postures can increase the pressure on the intervertebral discs. Studies of intervertebral pressure changes in the L3 disc with changes in posture were performed and concluded in a table similar to the above one. The pressure in the standing posture is classified as the norm, and the values given are increases or decreases above or below this norm that occur with the change in posture (Magee DJ. Orthopedic physical assessment, 5th ed. Alberta: Saunders Elsevier; 2007).

Upper cross syndrome - anatomy

After presenting you my file for the lower cross syndrome, I am now presenting you a similar file for the upper cross syndrome.

A syndrome very common in students that study a lot :-))

Here is the file.

Lower cross syndrome - anatomy

Ok, we all know this diagram. What I was interested in doing, though, was to find the exact muscles that are important in this syndrome. So, I am presenting them with origin, insertion, action and innervation:

Go to this link.

Lumbar spine assessment - a complete guideline

One of the most complete online guidelines for the lumbar spine assessment, broad to us by 3 ESP students of the Hogeschool van Amsterdam - Julie and her two Sara’s.

"The goal of the website is to guide students during the assessment of certain lumbar spine conditions. Therefore, we advise you to first take a look at the anatomy of the lower back to understand the conditions and gain sufficient knowledge on the subject.

The examination page talks about the general examination of the low back, including general patient history, observation as well as active and passive range of motion (ROM) and neurological testing.  This page insures you get the general knowledge you will need to assess a patient with low back problems.

Next to a-specific low back pain and malingering, the website includes lumbar spinal stenosis (LSS), disc herniation, lower crossed syndrome, lumbar instability and scoliosis as low back pathologies. All these conditions are described and subdivided into the different examination parts: patient history, assessment and treatment. The first two subcategories tell you what you should look for/what you might find in a patient with that specific pathology; questions you should ask, what tests to do and what the findings might be. Also in the assessment parts, different assessment tests will be mentioned. When clicking on the test, a link will forward you to the video of the test. The video will show how to perform the test with explanations. The treatment part is only a treatment suggestion and should only be taken as an orientation".

source: http://lumbarspineassessment.wordpress.com

Do you have a correct posture in your ADLs?

With a correct posture can prevent physical symptoms. In this website you will find instructions for the correct posture at work in the nursing care and home care.

You have to use google.translate because it is in Dutch, but you can understand everything since it has many many pictures in it.