LOWER CROSSED SYNDROME

Transcription

1 LOWER CROSSED SYNDROME Lwer-Crssed Syndrme (LCS) is als referred t as distal r pelvic crssed syndrme. In LCS, tightness f the thraclumbar extensrs n the drsal side crsses with tightness f the ilipsas and rectus femris. Weakness f the deep abdminal muscles ventrally crsses with weakness f the gluteus maximus and medius. This pattern f imbalance creates jint dysfunctin, particularly at the L4-L5 and L5-S1 segments, SI jint, and hip jint. Specific pstural changes seen in LCS include anterir pelvic tilt, increased lumbar lrdsis, lateral lumbar shift, lateral leg rtatin, and knee hyperextensin. If the lrdsis is deep and shrt, then imbalance is predminantly in the pelvic muscles; if the lrdsis is shallw and extends int the thracic area, then imbalance predminates in the trunk muscles (Janda 1987).

2 Lwer Crssed Syndrme has 2 different presentatins in patients; ne manifested in the lwer back (Type B) and the ther in the hip (Type A). Janda's LCS Type A Janda's LCS Type B Lwer Crssed Syndrme Treatment When treating patients with LCS the shrtened muscles must be restred befre embarking n training f the weakened muscles. This is based n Sherringtn's Law f reciprcal inhibitin which states that when ne muscle is shrtened r tightened its ppsite muscle relaxes. Relaxatin pelvis the hip jint the lumbar spine Stretching the flexrs f the hip spinal extensrs f the lumbar spine the rectangular lumbar muscle Strengthening the deep stabilizatin system the abdminal muscles (direct abdminal muscles - the lwer part f the strengthening f direct abdminal muscle endurance) the pelvic the gluteal muscles (gluteus maximus)

3 Relaxatin pelvis the hip jint influence) slw circles in the hip jint(use the gravitatin the lumbar spine

4 Stretching the flexrs f the hip One-leg kneeling knee extensr stretch. Drive frward int the stretch, nt dwn! spinal extensrs f the lumbar spine

5 the rectangular lumbar muscle Hamstrings- The patient lies supine with their leg extended, knee lcked, and their lw back flat n the tale s the pelvis is level. The examiner places the patients leg with the knee that s lcked nt their shulder, supprting the knee while flexing the hip t stretch the hamstring. The examiner instructs the patient t cntract their quadriceps while they hld fr a cunt f ten. This can be dne fr 3 t 5 cycles. With each cycle the examiner shuld be able t increase the stretch n the hamstring. Always d bilaterally. Erectr Spinae - The patient lies supine in the fetal psitin, their knees t their chest with their arms wrapped arund their knees. The examiner places their inferir hand under the sacrum pulling dwn in a scping mtin with the superhand pushing up n the patient s knees. Actin 1 Stretches Gluteal while Actin 2 Stretches Erectr Spinae)

6 Gluteus Maximus - The patient is supine with ne leg flexed at the hip and the knee. The examiner s inferir hand is under the leg and their superir hand is n tp f the leg. This gives the examiner mre cntrl f the stretch. The examiner stretches the patient fr 10 secnds fllwed by the 10 secnds f the patient pushing against the examiner.

7 Strengthening We need t get the inactive r inhibited muscles wrking fr us again. We need t activate the gluteus, as well as the abdminals. Exercise fr increasing glute activatin is the single leg knee t chest hip raise. Hlding the knee t the chest while perfrming a single leg hip raise takes the pelvis ut f anterir tilt, and des nt allw fr tilt, r lumbar extensin that can ften times cmpensate fr glute activatin in a hip raise. SL Knee t Chest Hip Raise - Start Ideally we d like t start with 5-10 reps each leg with a cunt pause at the tp, then prgress t pauses all the way up t ten secnds n each leg. Every rep yu shuld fcus n squeezing with the back glute as hard as pssible. SL Knee t Chest Hip Raise - Finish Als we need t strengthen the abdminals n the frnt side. We accmplish this by using ISO hlds in the plank psitin fr time. We have several variatins f these ISO hlds including mving the arms and/r the legs t increase the intensity, and als adding weight t the hips when the athletes have advanced. Generally, the abs need t be strengthened with a neutral pelvic psitin.

8 We can als start t integrate ur activatin wrk int ur training. When ding squats, RDL s, and such always squeezing the glutes thrugh full hip extensin at the tp. As well, any single leg wrk such as split squats, lunges, and Bulgarian split squats are great fr the glutes. the deep stabilizatin system the abdminal muscles (direct abdminal muscles - the lwer part; strengthening f direct abdminal muscle by endurance)

9 the pelvic the gluteal muscles

10 Gluteus Maximus - Have the patient stand facing the wall with the tubing arund their ankle. Instruct them t have their knee lcked in extensin r bent at 90 degrees t islate the gluteus maximus while extending the hip away frm the wall. This mtin can als be dne in the prne psitin depending n thepatient s stability. Have the patient cntract fr 2 secnds, hld fr 2 secnds,and release fr 2 secnds. Hamstrings - There are three chices t chse frm using the thera-band depending upn the patient s stability. Either seated with their leg extended, standing with ne leg straight, r lying prne with their legs extended. Attach the tubing arund the ankle having the patient cntract their hamstring. The patient shuld cntract fr 2 secnds, hld fr 2 secnds, and release fr 2 secnds. (als exercise ball) Transverse Abdminals - First, have the patient lie n their back with their knees bent. Instruct them t pull their umbilicus in twards their spine and then up withut mving their pelvis. Once they can d this repeat the prcess with the patient sitting up. Finally, have the patient lie prne with a tennis ball under their umbilicus. Have them draw their umbilicus up and in twards the spine attempting t lift their stmach ff the tennis ball. Always remind them t d the mtin withut mving their pelvis. We want t islate the TVA. Hip Flexrs - Have the patient n the hands and knees with tubing arund n eankle. Instruct the patient t pull their knee twards their chest. The patient shuld cntract fr 2 secnds, hld fr 2 secnds, and release fr 2 secnds.

11 Erectr Spinae - Have the patient lying prne with their hands behind their head extending their back. The patient shuld cntract fr 2 secnds, hld fr 2 secnds, and release fr 2 secnds.