CrossFit: Mobility for Returning Low Back Patients

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CrossFit: Mobility for Returning Low Back Patients

Today’s guest post comes to us from Clinton Lee, DPT, of New York, NY. This post is geared toward those of you that may have had prior bouts of sciatica and are making a return to lifting. If you have suffered from disc pain or sciatica, then hip mobility should undoubtedly become a staple of your maintenance routine. As stated by Dr. Lee, DPT,consult with your physical therapist, physician, or other appropriate healthcare professional for clearance to perform exercises of this nature.

Last week, Dr. Joseph Lavacca’s blog post taught us effective exercises and mobility drills of the shoulder, scapula and thoracic spine for athletes returning to overhead exercises. I thought I would switch gears and talk a little bit about some lower body mobility drills for athletes with sciatica, hamstring pain, or other lower body issues as they return to resisted lower body strength training, especially barbell exercises such as the back squat and deadlift.

Those recovering from bouts of sciatica may experience discomfort in the low back, the posterior thigh or buttocks which may compromise their performance of the squat or deadlift. Addressing hip, lumbar spine mobility and neurodynamics of the sciatic nerve may help encourage appropriate joint mechanics and desired movement patterns for pain-free strength training.

These are some of the common drills that I have some of my clients perform prior to their warm-up sets. As always, make sure to consult with your physical therapist, physician or other appropriate health care professional for clearance to perform exercises of this nature.

TACTICAL FROG


Is this not the coolest name ever for an exercise? The tactical frog can be a great mobility drill to promote motion in the hip joint capsule in gravity-eliminated position–you’re basically mimicking the squat in a horizontal position. In quadruped with both hips slightly abducted, gently guide your body towards the direction of your feet. Maintain a neutral lumbar spine and work within the limits of your mobility, gradually sinking your hips deeper and deeper. I usually have my patients shift as far back as they can before their back starts to round. Motion need not be limited to an anterior-posterior direction, and you can play around with different angles depending on where you perceive the tightness to be.

SQUAT WITH THORACIC ROTATION

At the base of a deep bodyweight squat, use one hand and grab the outside of your opposite foot. Rotate your torso slightly and extend your other hand upward towards the ceiling. You should be able to feel a stretch in your mid-back as your shoulder blade protracts and thoracic spine rotates. Repeat for the other side.

SCIATIC NERVE FLOSS/DYNAMIC HAMSTRING STRETCH


A lot of times people mistake sciatic nerve tension for muscular hamstring tightness. Sometimes people will present with both, and the following drill helps address both issues. Lie on your back with the unaffected leg laying straight out. Cradle your affected leg in a vertical position with both hands behind the knee. Straighten your knee while simultaneously pointing your toes toward the ceiling (plantar flexion), and then bend your knee while pulling your foot the other way (dorsiflexion). Perform one set of 20 repetitions, and repeat for the other leg.

DYNAMIC TOE TOUCHES


Here’s a functional way to improve toe touch ability that encourages mobility at the lumbar spine, hips, knees and toes. Reach down towards your toes (or as far as you can go) with your knees extending as your trunk flexes downward. When you arise, allow slight flexion in both knees to occur. This can be effective for patients with sciatic or low back pain whose symptoms present a little more proximally or have more nerve root involvement, but precaution must be taken because of the tension on the dura. If this drill cannot be performed comfortably, consider nerve glides in the sit/slump or supine positions as an alternative regression. Also a great way to address neurological tone in the posterior chain, especially in the setup for the deadlift.

Another precaution to take into account when returning to the lower body powerlifts after a hiatus is to gradually progress the load and volume. That progression at first may be more linear and slower than what you’re used to, but it’s important to re-establish these neurological and strength adaptations which serve as a foundation for more advanced training later on.

Feel free to leave comments, feedback or any additions in the comments below!

QUICK BIO OF AUTHOR, CLINTON LEE, DPT

“Clinton is a New York City physical therapist that has been working in orthopedics and sports rehabilitation since 2010. He is a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association, a Level 1 Sports Performance Coach through USA Weightlifting and a StrongFirst Level I Kettlebell Instructor. He enjoys providing individualized, evidence-based physical therapy care to diverse populations across the lifespan and incorporates his knowledge of strengthening and conditioning principles and sports performance in his rehabilitation of competitive and recreational athletes alike.

Clinton has also served as an adjunct instructor professor and teaching assistant for Long Island University’s Doctor of Physical Therapy program. He is a member of the American Physical Therapy Association and enjoys attending continuing education seminars throughout the year to stay aligned with best practice guidelines.

In his spare time, Clinton enjoys traveling, basketball, running, volleyball, swimming, hiking, biking and strength training. He has competed in recreational half marathons and an olympic-distance triathlon. He is also very much a dog person and loves spending time with his adopted rescue puppy Gracie.”

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