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BETTER BACKS PROGRAM

Overview and Lumbar training with Marty ��(BIM Eltham and The Clinical Mentors)

VARK - VA - Phones for video, R - Phones to have slides, K - Demo

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BETTER BACK PILATES PROGRAM�A SIMPLIFIED “GLAD” STYLE PROGRAM

The Big 8 that we see at BIM – just a little taster to get us started – lets spend 20 mins just going through our most common exercises

Levels have to take into account more flexion preference or more extension preference and show that we can increase load throughout from R to RBY and so on

Scooter Level 1 – Holding on Level 2 – Finger tips Level 3 - Skater
Hip extension Level 1 – Narrow Stance Level 2 – Waiter Level 3 - Extended
Hip abduction Level 1 – Standing Level 2 – Karate Kick Level 3 – Foot plate
TA / 100’s Level 1 – Leg press Level 2 – Hundreds neutral Level 3 – Hundreds leg ext
Arm loops Level 1 – Chariot / Row Level 2 – Sitting Char/ Row Level 3 – Knees back
Cat Level 1 – Cat hip tucks Level 2 – Cat ROM Level 3 – Stomach pull
4pk hip ext Level 1 – Cat open chain ext Level 2 – Reverse 4pk Level 3 – Trap Bar
Mat / band exercise Specific to the client to activate/ get them switching on

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LUMBAR TUTE QUESTIONS

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RECOMMENDING PILATES�3 DOORS AND R4L

R <DxVxF

They already do….� Need a coach!!!

4-5^th session generally introduce the reformers at the start of the session

Particularly if you have done a good treatment plan in session 3

“This would be good for you”, “This is my best recommendation” then hold tongue

Don’t over complicate it. Supervised rehab is the best way to get results. Recommend your best (put it on the menu!)

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R4L JOURNEY

Evidence – getting people to lifelong health – to wellness

Exercise / CHANGE ENVIRONMENT/ positive beliefs
Not simple

Balance – as people we don’t want clients giving you �/ your profession a bad name or reputation

Tried to “sell me” on it

VS

Didn’t fix me

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1. PEOPLE HATE TO BE SOLD�YET THEY LOVE TO BUY THINGS WHEN THEY SEE THE VALUE OR THEY FEEL PART OF A COMMUNITY�THERMOMIXES: KEEPING UP WITH THE JONES’

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2. PEOPLE MAKE ‘GUT’ DECISIONS �THEY ONLY LISTEN TO SOMEONE THEY LOVE/TRUST

When you recommend something – do it with INTEGRITY

You need to believe it yourself

Might need to wait until you have helped them and showed that you care before you present a plan

Hence R4L at the 3^rd session

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3. PEOPLE LOVE TO FEEL THEY ARE A PART OF A GROUP / PART OF A COMMUNITY OF LIKE-MINDED PEOPLE

Use stories, people with similar issues who had success

Motivating to know they aren’t alone and there is hope

People like you/us often go well with (ONERO, Pilates)

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4. PEOPLE LOVE TO HAVE OPTIONS�BUT NOT TOO MANY OPTIONS

1 Option is an Ultimatum
2 Options are a Dilemma
3 Options give a perfect balance
4 + is too much that they get caught in indecision

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3 DOORS

Door 1 - Reduce your pain / home program �Nothing wrong with that if that’s their goal�People aren’t always ready to start lifelong health�Educate that issues can return and pro’s / con’s so they don’t practitioner hop

Door 2 – Your best / most common option�Pilates x 2 per week for 12 weeks

Middle of the bell curve

Door 3 – VIP service OR Big decision �Personal Training / Referral on

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HOW WE DO PILATES AT BIM ELTHAM�OVERVIEW

40 min session assessing and writing their program
More details in next slide

Initial Assessment

3 x 30 minute 1:1 sessions going through their program and 1 x class
Paid up front $300 ($75 per session)
Done within 14 days (set up the 2 / week habit)

Foundations

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HOW WE DO PILATES AT BIM ELTHAM�ASSESSMENT: SEE HANDOUT

Pilates assessment document for lower backs

Main tests
Mobility above and below
Strength tests
Function tests

Having your 3 priorities from assessment

Subcategorise when writing the program

Knowing the main aggravators

Disc = flexion
Facet= extension
SIJ = abduction/unstable movements (work in saggital initially)
Strengthen into preference, control into the aggravator

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LOWER BACK PAIN ASSESSMENT�(KNOWING THE PATIENT ALREADY)

Lumbar

Flexion / Repeat flexion
Extension / Repeat Extension / Quadrant
Any signs of preferences can be tested in the 3x1:1’s for DMA based on their objective asterisk

Hips / SIJ

IR / ER / Gillets
Active SLR tests and trial sling activation patterns (Lats/Glutes/Obliques)
5x5 sec activations of muscles and re test ASLR / objective asterisk

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FUNCTIONAL / STRENGTH TESTS �HUGE LIST IN THE WORD DOCUMENT

Can pick any – just needs to be reproducible

Less about you / more about the client and their understanding of improvement
“you couldn’t do that 12 weeks ago” in your reassessment

Side plank hold
Single leg sit to stand (reps in 30 sec or just ability)
Single leg bridge
Hundreds leg extension without arching

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PICKING YOUR CATEGORIES

Pick your 3 main areas of what you’d like to work on

Strengthen INTO their preferred range
Discs into extension – hip extension, 4 point kneeling and prone stuff
Facets into flexion – situps, scooter – bent forwards stuff
SIJ / Psoas / Anterior hip – keep it in nutation without going to EROM

Then face your kryptonite / learn to control into extension for facets and control into flexion for discs

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EXAMPLES OF CATEGORIES

Disc

Glute strength into lumbar extension
Abdominal strength into extension
+/- with focus on posterior oblique sling as had improvement with Lats bias

Facet

Abdominal control into extension
Abdominal strength into flexion
Hip extension ROM maintaining lumbar neutral spine (choose waiter instead of upright)

Next slide we’ll highlight some of our favs from the Better Backs Program

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EXTENSION PREFERENCE (DISC) EXERCISES

Strength into extension

Hip (flexors/extensors/abductors/ER’s)
Back
Core

Control into flexion (maybe not for the first 6 weeks)

Mobility / other factors

Scooter Level 1 – Holding on Level 2 – Finger tips Level 3 - Skater
Hip ext Level 1 – Narrow Stance Level 2 – Waiter Level 3 - Extended
Hip abd Level 1 – Standing Level 2 – Karate Kick Level 3 – Foot plate
TA / 100’s Level 1 – Leg press Level 2 – Hundreds neutral Level 3 – Hundreds leg ext
Arm loops Level 1 – Chariot / Row Level 2 – Sitting Char/ Row Level 3 – Knees back
Cat Level 1 – Cat hip tucks Level 2 – Cat ROM Level 3 – Stomach pull
4pk hip ext Level 1 – Cat open chain ext Level 2 – Reverse 4pk Level 3 – Trap Bar
Mat / band exercise Cobra, Swallows, Superman, Plank, Bridge, Single leg kick/hip extension prone, CARs and deep cuff in 2pk

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FLEXION PREFERENCE (FACET) EXERCISES

Strength into flexion

Hip (flexors/extensors/abductors/ER’s)
Back
Core

Control into extension

Mobility / other factors

Scooter Level 1 – Holding on Level 2 – Finger tips Level 3 - Skater
Hip ext Level 1 – Narrow Stance Level 2 – Waiter Level 3 - Extended
Hip abd Level 1 – Standing Level 2 – Karate Kick Level 3 – Foot plate
TA / 100’s Level 1 – Leg press Level 2 – Hundreds neutral Level 3 – Hundreds leg ext
Arm loops Level 1 – Chariot / Row Level 2 – Sitting Char/ Row Level 3 – Knees back
Cat Level 1 – Cat hip tucks Level 2 – Cat ROM Level 3 – Stomach pull
4pk hip ext Level 1 – Cat open chain ext Level 2 – Reverse 4pk Level 3 – Trap Bar
Mat / band exercise Rollups, child pose, rolldowns, knees to chest, clam, CARs in 4pk

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SIJ REMINDERS

Start with more stable positions (in neutral stance)
Start double legged exercise
Start with flexion/extension

No abduction off the foot plate in the early phase
But its ok to do Karate kick once pain has settled- seems to be good for our pregnant clients due to sustained nutation

Consider which muscles to act in on the slings (from your pelvic control tests)

Scooter Level 1 – Holding on Level 2 – Finger tips Level 3 - Skater
Hip ext Level 1 – Narrow Stance Level 2 – Waiter Level 3 - Extended
Hip abd Level 1 – Standing Level 2 – Karate Kick Level 3 – Foot plate
TA / 100’s Level 1 – Leg press Level 2 – Hundreds neutral Level 3 – Hundreds leg ext
Arm loops Level 1 – Chariot / Row Level 2 – Sitting Char/ Row Level 3 – Knees back
Cat Level 1 – Cat hip tucks Level 2 – Cat ROM Level 3 – Stomach pull
4pk hip ext Level 1 – Cat open chain ext Level 2 – Reverse 4pk Level 3 – Trap Bar
Mat / band exercise Sit to stand, Bridge, other sling exercises like kneeling slide plank or pallof for lateral or hip flexor activation / adductor – all depends what you found on your ASLR test
All of the movements above should be good eventually but the ones highlighted are prime starters

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STRENGTHENING THE SLINGS �DEPENDING ON WHICH ACTIVATION HELPED THE MOST�

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MUSCULAR SLINGS: POSTERIOR OBLIQUE

Upper limb exercises in kneeling

Chariots, bicep curls

Bird dogs
Bridges with let pulls
Sit to stand with front raise
Standing hip extension on reformer

Posterior Oblique Sling

The posterior oblique sling is made up from the superficial fibers of the latissimus dorsi muscle, running along the back, and the contralateral glute max which blend together through the posterior layers of thoraco-lumbar fascia. The ITB and biceps femoris (hamstring belly) may also be involved, through its connections with the sacrotuberous ligament.

It has been found that patients with SIJ dysfunction, altered contraction patterns can exist, often with delayed glute max firing. As described by Hossain & Nokes in 2005, the Glute max fibers run perpendicular to the SIJ and thus should have great capacity to compress the joint surfaces. However, if delayed may enable greater shearing of load through the SIJ and pelvic girdle. To compensate, therefore, the biceps femoris may instead contract to a greater extent to afford stability via the sacrotuberous ligament, increasing reliance upon hamstring activity and offsetting the normal glute-hamstring balance.

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MUSCULAR SLING: ANTERIOR OBLIQUE

Core with adductor squeeze

Supine movements in the sagittal plane
Hundreds/dead bugs

Single/double leg stretch,

Adductor based exercises

Bent knee fall outs

Wood choppers

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MUSCLE SLINGS: DEEP LONGITUDINAL

Superman/Swallows
Deadlift
Back extension
Bridges
Hamstring bridges

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LATERAL MUSCLE SLING

Step up
Lateral lunges/sliders
Crab walk
Side bridge
Paloff (is kind of a mix)

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WE WANT TO GRADE EXPOSURE

Sandwich in some of the exposure exercises (remember the tequila slide from our presentation)
Facets eventually strengthen into extension and stretch into extension
Discs eventually strengthen into flexion

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SPINE PREFERENCES

Facet Pattern
Discogenic Pattern
Instability Pattern

Or

Flexion preference
Extension preference
Neutral preference

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THAT’S JUST HOW WE DO THINGS

Foundation – 3 x 1:1 sessions and 1 x class

Total package $300 or $75 per session – cheaper to make it more accessible

Twice per week for 12 weeks

Get results
No struggle for clinicians doing education
Packages fit accordingly

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HOW TO WRITE ANY REHAB PROGRAM WITH CASE STUDIES ��BUILD A FENCE