Yim Physio Near Me: The second physiotherapy with 9 of 18 basic strengthening exercise for correct lumbar hyper

Ref: https://www.naturallyfitlifestyle.com/a-guide-to-postpartum-hip-realignment-with-pelvic-tilting/

Posterior pelvic tilting has been utilized as a rehabilitation method for improving the lumbar spine alignment in LBP patients because it improves lumbar lordosis. It is the pelvic exercise in the sagittal plane that is generally used to correct the alignment of the lumbar spine of patients with chronic lower back pain with lumbar lordosis. So, posterior pelvic tilt strengthening is important to reduce the posture causing lumbar lordosis.

In my clinical experience, I have found painful structure more than one i.e., lumbar erector spinae muscle, thoracolumbar fascia, attachment at posterior iliac crest, upper gluteal, or SI joint.

Some of them can be improved by stretching, however, some of them must exercise to treat the disorders. One sample case with tenderness at posterior iliac crest, the patient could get better by strengthening exercise of transverse abdominis with less tenderness at posterior iliac crest and feel more comfortable.

Abdominal brace exercise
(Ref: https://www.semanticscholar.org/paper/Intra-abdominal-Pressure-and-Trunk-Muscular-during-Tayashiki-Takai/ca32668dad3abd7a346bc56617691edcfba134c5/figure/0)

Second basic 9 of 18 therapeutic strengthening exercise to posterior tilt (Remark: If there is tightness of the back extensors or hip flexors, it is necessary to treat these muscles to restore normal length before the abdominals can be expected to function optimally that can learn more on https://yimphysionearme.blogspot.com/2022/09/physiotherapy-with-6-stretching.html )

Each exercise needs 10 - 15 reps with 3 sets for 3 - 5 days a week.

Exercise #10: Quadruped abdominal bracing: lift abdominal belly up as flatten it with maintain spine straight. Keep breathing during exercise.

Exercise #11: Bird dog: lift abdominal belly up as flatten it with maintain spine straight. Straight one leg backward to hip level. Keep breathing during exercise. (Do not arch and numb the spine)

Exercise #12: Bird dog with hamstring curl: lift abdominal belly up as flatten it with maintain spine straight. Straight one leg backward to hip level and hold for moving knee joint. Keep breathing during exercise. (Do not arch and numb the spine)

Exercise #13: Basic prone plank: Spine must be straight that is not allowed to curve or arch during exercise. lift abdominal belly up as flatten it with maintain spine straight and keep breathing during exercise. . (Do not arch and numb the spine)

Exercise #14: Mountain climbers exercise: lift abdominal belly up as flatten it with maintain spine straight. Bend leg to chest and keep breathing during exercise. . (Do not arch and numb the spine)

Exercise #15: Prone plank with hamstring curl: Spine must be straight that is not allowed to curve or arch during exercise. lift abdominal belly up as flatten it with maintain spine straight and straight one leg backward to hip level and hold for moving knee joint. Keep breathing during exercise. . (Do not arch and numb the spine)

Exercise #16: The wall - sitting: Sit with back on the wall. Squeeze abdominal belly to flat spine to the wall and hold it. Keep holding muscle and breathing with lift both arm up to ear level.

Exercise #17: The wall standing: Stand with back on the wall. Squeeze abdominal belly to flat spine to the wall and hold it. Keep holding muscle and breathing with lift both arm up to ear level.

Exercise #18: Perpendicular Standing: Patients stood with the feet shoulder distance apart, tried to keep the trunk perpendicular to the ground as much as possible. While their eyes looked forward, slowly bent their knees and lowered the trunk. Then, they returned to the starting position.

Abdominal muscle weakness related faulty posture and low back hyperextension

There are two types of posture that exhibit this weakness: (1) anterior tilt (lordotic posture) and (2) anterior displacement of the thorax (sway - back posture). The lateral fibers of the external oblique extend diagonally from posterolateral rib cage to antero - lateral pelvis. By this line of pull, they are in a position to help maintain good alignment of the thorax in relation to the pelvis, or to restore the alignment when there is displacement.

The kyphosis - lordosis posture consists of lumbar spine hyperextension (lordosis), pelvic anterior tilt, and hip flexion. In part of weakness cause kyphosis - lordosis posture, there is weakness of neck flexors, upper back erector spinae, and external oblique. Hamstrings are slightly elongated but may or may not be weak.

Dark black area represents weakness of muscles in kyphosis - lordosis posture
(Ref: https://www.pinterest.com/)

The sway - back posture is a combination of lumbar spine flexion (flatten), pelvic posterior tilt, and hip hyperextension that The pelvis is in posterior tilt and sways forward in relation to the stationary feet causing the hip joint to extend. The effect is equivalent to extending the leg backward with the pelvis stationary. There is weakness of iliopsoas, upper back extensors, neck flexors, and external oblique.

Dark gray area represents muscle weakness in sway - back posture
(Ref: https://www.pinterest.com/)

Moreover, the military - type posture has lumbar spine hyperextended (lordosis) and pelvis anterior tilt, as well. As the result of anterior abdominal weakness and hamstring muscles are somewhat elongated but may or may not be weak, allow pelvis rotated anteriorly.

The military type posture is demonstrated muscle weakness by light red areas.
(Ref: https://www.pinterest.com/)

The type of postural deviation that occurs depends to a great extent on associated muscle weakness. In the anterior tilt, lordotic posture, there is often hip flexor tightness along with the abdominal weakness; in the sway - back posture there is hip flexor weakness, specifically, iliopsoas.

In supine, patients with marked weakness of abdominal muscles and strong hip flexors can hold the extended extremities in flexion of the pelvis and lower them slowly but the low back arches, increasingly, as the legs approach the horizontal. The force exerted by the weight of the extremities, and by the hip flexors holding the extremities in flexion on the pelvis, pull the pelvis in anterior tilt overcoming the force of the weak abdominal muscles that are attempting to pull in the direction of posterior tilt. In stand, patients will demonstrate lumbar hyperextension (or forward abdominal belly) and hip flex.

External oblique in torso flexes
(Ref: https://www.physio-pedia.com/)

The external oblique muscles that hold the pelvis in posterior tilt during leg lowering are chiefly the rectus abdominis and external oblique. In many instances, abdominal strength is normal on the trunk - raising test, but the muscles grade very weak on the leg - lowering test. Since the rectus must be strong in order to do the trunk curl, the inability to keep the low back flat during the leg lowering cannot be attributed to that muscle. It is logical to attribute the lack of strength to the external oblique not to the rectus. Furthermore, the postural deviations that exist in persons who show weakness on the leg - lowering test are associated with elongation of the external oblique.

During posterior pelvic tilting, the activity of the Transverse abdominis was greater than that of other muscles. Previous studies examining abdominal muscles during posterior pelvic tilting using EMG were performed in several positions, including the supine position, the sitting position and the standing position. Therefore, not only the Transverse abdominis but also the internal oblique might be attributed to posterior pelvic tilting with external oblique.

Squeeze abdomen is done by transverse abdominis contraction
(Ref: https://shopc.off63.cf/)

Therapeutic exercise to posterior pelvic tilt

It becomes very clear in such situations that the trunk - raising exercise does not improve the ability to hold the low back flat during leg lowering. Indeed, it appears that repeated and persistent trunk flexion exercises may contribute to continued weakness of the lateral fibers of the external oblique.

Proper exercise of abdominal muscles could be a part of a preventive medicine plan. Good strength in these muscles is essential to the maintenance of good posture, but caution should avoid overdoing both the trunk curl and the pelvic tilt exercises.

Mention to the recent article (on https://yimphysionearme.blogspot.com/2022/09/physiotherapy-with-9-of-18-basic.html ), posterior pelvic tilt in supine position, with hands up beside the head, tilt the pelvis to flatten the low back on the table by pulling up and in with the muscles in the lower abdomen.

Do not tilt the pelvis by contracting the gluteal muscles

Without depressing the rib cage, hold the low back flat and breathe in and out easily, relaxing the upper abdominal muscles. There should be good chest expansion during inspiration but the low back should not arch upward from the table to raise the chest and make it appear like chest expansion.

Posterior pelvic tilt and leg sliding in supine position, bent the knees and placed the feet flat on the table. With hands up beside the head, tilt the pelvis to flatten the low back on the table by pulling up and in with the muscles in the lower abdomen.

Do not perform the pelvic tilt by pushing with the feet and rocking back on the buttock.

Hold the back flat and slide the heels along the table. Straighten the legs as far as possible with the back held flat. Keeping the back flat, return the knees to a bent position, sliding one back at a time.