Essential Back Rehab Strategies – Category A – Neutral, Bracing and Static Strength Endurance
Essential Back Rehab Strategies
Category A
Essentially, the muscle (groups) that stabilize the torso and protect our spine encompass all of the musculature from the armpits to the knees. In Phase 1 of our back rehab strategies we will be trying to re-establish our ability to brace our torso effectively. This will be a difficult task because after a back injury you will be in pain. And when your body senses pain, it shuts down and inhibits muscle contraction. You will find it very hard to tense the muscles close to and surrounding the injury. This means we are even more susceptible to injury in an injured state. Makes sense, right?
After the doctor clears you to engage in physical activity again, you need to start at the very basic level of recovery. For our back rehab protocol, this means we need to understand what neutral posture is and how to brace effectively in this position. Once we do this, we can begin to activate and strengthen again. Not only strengthen, but build muscular endurance. That is how we are going to lay the foundation and get back to normal movement; which ultimately means getting back into the gym.
As you will see with our simple strategy, the application will be progressive.
Progressive Strategy
1. Find and Understand Neutral Posture
2. Feel Bracing and Understand Tension
3. Build Static Strength Endurance While Utilizing Neutral Posture and Bracing
Neutral Posture
Neutral posture affects everything we do in an out of the gym. When trying to develop our ability to load correctly for strength training movements, absorb impact or transfer forces, a neutral posture is essential. It means the alignment of the “back of our head, the upper back/t-spine and the sacrum/buttocks.” (1) If you can consciously=>sub-consciously (from drilling and patterned reinforcement) move into this position when lifting weights or anything you do during the day, you will be at your strongest and you will be less likely to get injured.
I teach a neutral posture a few different ways. One of which is in the quadruped (all fours) position. This allows the lifter/athlete to adjust their positioning until they “feel” where neutral is. I cue them until they reach the posture and have them stay there for a timed period.
Another way I cue a neutral posture is taking advantage of how our body moves. Movement (and tension) is coordinated diagonally across the posterior chain from the hip to the opposite shoulder (called the serape effect). If we can understand this position and pull the lifter into a compensation (with the elastic band), when they resist movement they will reinforce a neutral posture. Heavier bands can be used as proficiency grows. The lifter should attempt to stay in this posture for approximately 60-90 seconds or throughout a workout.
Side Note: Notice the athlete is contracting his quads, glutes, lats and squeezing his fist, i.e. bracing.
Many times when we coach neutral, the lifter / athlete finds it a very difficult posture to achieve due to tightness or inflexibility. The majority of the time, tight hip flexors (from too much sitting) and a tight upper (thoracic) back (from too much time at the computer or sitting with bad posture), are the issue. Working on hip mobility and opening up the upper back, will be very important. You should make it a priority in every workout to address these restrictions.
Bracing
Not that we’ve obtained a neutral posture, we need to start creating tension. After a back injury, tension without movement (or static/isometric strength) is the first priority. Pain inhibits muscle contraction and once the pain is gone, we need to get everything firing again (motor unit recruitment). Think about the atrophy that occurs when your arm is in a cast for an extended length of time. It becomes much weaker and smaller. This “use it or lose it” analogy is the same after an injury. The worse thing you can do is to remain sedentary for and extended length of time.
For more advanced applications like strength training, bracing plays a significant role in how much strength we can display, how much impact we can absorb, how much power we can transfer and how susceptible we are to injury. Remember our body acts as a single kinetic chain and we must coordinate the muscular contractions across many muscle groups (intermuscular coordination) when we engage in strength training or real-world movements.
When athletes are just starting in the program and begin utilizing compound movements, I use a simple elastic band to teach them bracing. I have them wear the band while performing squats, clean & press, deadlifts (and others). The goal is to not let tension off the band, but to keep it tight throughout the duration of the exercise.
Many fitness professionals coach “bracing” as if you were protecting yourself from a punch. This couldn’t be further from the truth. Remember, the “core” involves everything from the armpits to the knees, and we must brace each kinetic segment across this distance. Radiant tension (or co-contraction) (2) involves the summation of the tension of multiple muscle groups to coordinate movement, resist or prevent movement and / or create more strength / power.
Static Strength Endurance
Remember, for Phase I of our back rehab program, we will start at the beginning. Starting over means we forgot everything we know and work on the basics. The first base we covered was “finding neutral”. The second base was once we found neutral, we created tension. Understanding what it means to create real tension across the torso and into the trunk will carry over into everything we do. It forms the base of the pyramid and without it, we can’t progress.
Once we are able to create tension again, we must develop it over a period of time. This will provide us with static strength endurance.
Exercise selection, much like our rehab strategy, must be progressive. The following exercises will be introduced (and continue to be used later on) to build our static (without movement) strength endurance proficiency for our (anterior/posterior) torso stabilizers.
Level 1: Bridges
Level 2: Supermans
Level 3: Birddogs
Level 4: Planks
Exercise Index
Bridges
Supermans
Birddogs
Planks
Summary Back Rehab Protocol – Category A
Task 1. Drill a neutral posture
Task 2. In a neutral posture, brace and create tension
Task 3. Build static strength endurance of our torso stabilizers while utilizing a neutral posture and becoming proficient at bracing
Task 4. In the initial stages of a back rehab protocol, bridges, planks, supermans and birddogs can be used to accomplish Task #3
As we move into Category B, movement will be introduced and our strength levels will start to increase. The first step is to start slowly incorporating these Category A movements into your daily recovery. Here is the back rehab protocol as we know it so far.
Phase 1: Neutral | Bracing | Static Strength Endurance
Exercises: Pick 2-3 exercises; bridges, supermans, birddogs, planks, elastic band bracing
Volume: 3-5 sets of 30-60 seconds holds (at each posture)
Duration: 2 Weeks (or until you feel comfortable and strong)
References
1. Robertson, Mike. Coaching Neutral Spine, robertsontrainingsystems.com, 2011.
2. Verkhoshansky, Yuri and Siff, Mel. Supertraining – 6th ed., Ultimate Athlete Concepts, 2009.
By Smitty on May 9th, 2011
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bracing-drill-for-torso-stability.jpg: looks like someone recycled the logo for quake 1… 😀
Long time ago brother, one of our first shirts.
Please set this up with its own URL or an archive, so I can refer to it more frequently and share more easily.
I got hit from behind by a car in 2008, I’ve been back in the gym since Q1 of 2010 after reconstructive surgery of the L5/S1. It has taken a very long time to get my body where it is, and a long way to go still. This is great advice, I’ve used some since starting my rehab and some are new(er) to me. Thanks for the article!
BTW – can run a 10k, and lift 5 days a week.
Rick,
It will be right here: http://www.dieselsc.com/back-rehab-protocol
This is only part 1, lots more to come. It will be a whole back rehab protocol
This looks like a very good protocol. Can’t wait to give a good run. Thanks!
Jack, part 2 will be up later this week. Each part will add to the protocol and will progress you through each level.
Keep coming back and please share.
Jim
“Many fitness professionals coach “bracing” as if you were protecting yourself from a punch. This couldn’t be further from the truth. ”
Are you saying that this is a bad que to give? If so, why? What is it telling the person to do wrong?
Maki,
Read the entire statement. It is not only a bracing of the abs, but a collaborative tension created across the entire kinetic chain to engage or prevent movement.
So brace the entire body? I always thought that this que was ok to give the person the idea of what bracing was? I understand that it may not be the best que but it’s something you can do on the fly if you are training a big group?
What would be a better que to give?
Great post Smitty
Thanks Uncle Mike!
Hey, great post!
During Phase 1 & 2, should the exercises be done daily or say 3-4 times per week?
Thanks.
Exactly, 3-4 times per week will be great.
Thanks for the fast reply! I’m going to follow this, ill let you know how things go!
p.s I’m going to rehab my shoulder along with my back,your shoulder rehab program is 5 days per week, is ther anyway I could cut this to 4 days, so I can do back and shoulder rehab work on the same days?
Thanks,
Of course. The Shoulder Rehab protocol is just a template. Do it for any number of days you want and pick the exercises that work for you.
http://www.youtube.com/watch?v=A0ONHZmsFec
Thanks for the link! Which of exercises on the video or the article page are geared more for shoulder stability?
Thanks for your time and help!
This post is fantastic. It is a great description of what I do everyday trying to get out lower back pain patients back on track. It is becoming more and more apparent that there is little difference between a good strength coach and a good therapist (Chiro/PT/Etc.)
This and Brooks Kubik’s “Dinosaur Bodyweight Training” caused me to do bridges and supermans (Brooks identified a few varieties of these). They were difficult and valuable. I found myself able to feel the muscles and areas of tension better than with weights. I clearly need to reduce the anterior rotation of my shoulders and stretch my arms back more.