The Most Effective Spondylolisthesis Exercises- Multifidus with Hip Hinge
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- čas přidán 11. 07. 2024
- The Most Effective Self Help Spondylolisthesis Exercises for Pain Relief using a Standing Multifidus Co- Contraction with Hip Hinge. Taught by sports injury and spondylolisthesis rehab exercise expert Dr. Michael C Remy, DABCO, CCSP. Learn more spondylolisthesis exercises and how to build your own custom spondylolisthesis exercise program at: www.painfreeandfit.com
excellent presentation
Youre the best
Thanks Dr.Remy, your exercise dmonstration is useful for understanding mulltifidus action.
You are welcome Sujata. I hope it helps.
Amazing video
Thanks for the visit
Hi can you pls advise some exercises for retrolisthesis grade 1 ?
I have lots of sciatica pain down the leg with mine. Can you define dis Function?
Sciatica can be caused by a number of different conditions including disc herniation, stenosis, spondylolisthesis, spurs, traction inflammation, rhuematological, metabolic, toxic, autoimmune problems, infection, cancer, etc. It is very important to have your sciatica diagnosed by a doctor before you try any treatment- especially to answer what is causing your sciatica, that way the targeted treatment will have a greater effective chance of helping you. Any of these causes can result in the pain, shooting, burning, tingling, numbness down the back of your leg and sometimes into your foot/ toes that define sciatica. Corrective and healing exercises can be broken down into 3 types for sciatica. One- pain relief exercises such as turning your leg outwards (hip external rotation and abduction) and bending your knee which slackens the sciatic nerve and often relieves pain, or other positional relief maneuvers that decrease the mechanical irritation on the nerve, 2- Nerve stretching exercises (better for chronic, long standing sciatica) where you straighten your knee as you pull your straight leg towards your chest and hold for 2-4 seconds and repeat 6-10 reps, and 3- corrective posture and mechanical exercises based on an analysis of your condition which over time corrects the mechanical and posture issues that often cause the sciatica in the first place. You should get to a specialist in diagnosis and rehab exercises if your sciatica is mechanically based. I have found that similar to exercise, chiropractic manipulation is generally more effective than a generic rehab/ PT approach because it is more targeted and customized. That is not to say that you cant find a good PT who can customize a program for you, but either way, any treatment program should begin to offer relief within the first two weeks of treatment, otherwise it is probably not the right approach.. Hope this helps.
Your video is very informative. Can you tell me why i wake up in such pain every morning. I've tried a pillow under my hips in prone to keep my LS in flexion and under my knees in supine but I wake up with unbearable pain in my left hip every morning.
Hi Dawnna.
There are several reasons why morning can be so difficult including arthritic changes of the facet joints, SI joints, and hip joints. All of these are commonly associated with spondylolisthesis, and aggravated for different mechanical reasons in extension (bending backwards), which you seem to have trouble with as per the flexion positions of relief you have tried. All soft tissues become tight without movement, especially degenerative ones, or those that have chronic inflammation or neurological guarding from chronic pain. As a result, morning can be the worst time of the day because of the lack of motion for all of the sleeping hours. I would recommend trying early morning mobilization of your spine and hips while still in bed, performing 5-10 reps in multiple directions of small (1/4 inch) movements. This will facilitate circulation, soft tissue fiber mobility, and neurologically stimulate sensory nerves hat transmit motion to your central nervous system, which have an inhibitory effect on pain sensation. I have a video (released on the channel previously) entitled " DDD Back Mobilization Exercises" that is close to what I am talking about for the spine, but you have inspired me to shoot a new one specifically for spondylolisthesis that I will do this week for you. Other suggestions would be anti inflammatory and analgesic dietary changes, and a low back healing exercise program to stimulate proper mechanics and healing of your damaged areas (both available at the painfreeandfit.com website), which is always the real long term answer to chronic problems as it addresses the root causes of most pain. I would also consider soft tissue and joint manipulation to break up any soft tissue adhesions or scar tissue that is so common in chronic back and hip cases. Thanks for the question, and I'll try to get that video out by the end of the week.
Dr. Michael C Remy you're a star . Thank you
im a truck driver and i only feel it when im sitting for 4 plus hours strait how often do you think i should take a break i only feel this when im sitting down
Hi Ron.
What you are describing is pain related to disc compression more than the typical spondylolisthesis symptoms as disc compression is 12-13 times greater with sitting and gets worse the longer you sit than standing. Spondylo pain is more likely when standing and relieved with sitting, unless the involved soft tissues are being stretched while seated. Many people will have both spondylo and disc involvement together. Either way, you need to figure out how long you can sit before symptoms of discomfort arise (tolerance level), and take a break before that point. By learning about your posture tendencies while standing and sitting, you can avoid asymmetrical stress on your spine which is commonly involved with symptoms such as yours. A spinal stability conditioning exercise program will also often help your back. Both of these begin with an analysis of your body mechanics and posture (available at the painfreeandfit.com website). Another effective strategy is to use mobilization exercise for your lower back intermittently while you are sitting/driving those long hours, and I will be posting a video on exactly that on the channel next week. Seated mobilization helps my own DDD while driving long distances and I recommend it routinely to my patients with disc trouble who must sit for their jobs. Hopefully, this will all help you too.
Do this exercise help reverse the Spondylolisthesis backwards as it tense the Multifidi muscles as they are attached to the sacrum at the end?
Hi Fadi.
Besides pulling the joint capsule out of the vertebral facet joint, multifidus contraction also exerts an extension (bending backwards) effect on the vertebrae, which if acting by itself would actually help drive the vertebrae more forward and worsen most cases of spondylolisthesis. This hip hinge exercise is designed to use the multifidus to pull the facet joint capsule backwards to avoid pinching it & synovitis, as the low back erector spinae muscles (lower lumbar fibers of longissimus and iliocostalis) exert a backwards pull on the vertebrae, which in conjunction with the abdominal muscle function explained in the video helps to hold a neutral "safe" spine position for movement. It is using these muscles in concert that stimulates a pain avoidance motor function and also stimulates healing of spondylolisthesis stress. There is no way to reverse a spondylolisthesis (outside of stabilization surgery), but most patients in my experience do not need to reverse the forward slippage to resolve pain, but only condition their spines to hold stability through corrective exercises, of which this exercise is one of the entire healing exercise approach. Targeted exercise, skilled manipulation, posture changes, and learning correct movement for spondylo as explained in our FAST TRACK program on the painfreeandfit.com website are usually the successful recipe for most cases of spondylo. Hope this helps, and thanks for the question.
Dr. Michael C Remy
Thank you so much for this detailed answer and thorough explanation. I really appreciate this .
Doc what is the reason why I have lower back pain when walking? I have a slight slippage in my L5-S1 (not touching nerve thank God) but my back feels incredibly weak. I have a sedentary job. Could it be that maybe taking time off work help in recovery as I feel like the core of my issue is my job and the constant compressing of the disc and back muscles aren’t helping me recover? I’m doing everything I can to strengthen my back but the constant sitting aggregates the issue and is keeping my back weak.
It all depends on the mechanics of your back as it relates to your pain Rogelio. Typically back pain that is worse sitting is disc related which may bother when walking if the arch of your lower back is decreased or if the hip flexors (iliopsoas in particular) is pulling on your discs when stepping forward. If this is the case, the typical modification would be to emphasize pushing the leg back with each step and limiting the forward step distance. If the opposite is true (where the back of the disc is being compressed with too much of an arch), the typical modification would be to flatten the lower back arch as you walk with abdominal tension, posterior pelvic tilting, and limit the distance that the legs travel behind you. Again, these are just typical scenarios and your best bet would be to have a consult with a qualified doctor and rehab expert to determine what is best for your unique case. An alternative would be my Walk Away Back Pain ebook available at painfreeandfit.com for a complete self-analysis and tailored walking modifications.
Thanks for the question, and I hope this helps.
Dr. Remy
@@DrMichaelCRemypainfreeandfit Thank you Doc! Last question. I’ve been doing my own research and could it also be possible that slippage isn’t necessarily causing the pain rather a symptom of overall abdominal muscle weakness? I think the muscle that’s injured is the multifidus muscle. Could my pain be associated with this muscle as well? My pain isn’t centralized where the L5 is. It almost feels like a rubberband attached to the left side of my spine is weak. Sometimes it spasms.
Just checking - these are slow-twitch muscles so you shouldn't get to tired doing them, correct?
Hi Dan.
The multifidus and other local core muscles are slow twitch (endurance) so they should be trained for high reps with light resistance or longer isometric hold times with low resistance. However, the hip hinge uses both local and global/prime mover muscles, so a mix of both endurance and higher resistance and lower reps are a better overall way of conditioning spinal stability to handle the real life demands that the spine typically encounters
Hello Dr . Michael C Remy , my name is Youness , i'm 25 years old 56 kg 170 tall , i'm having spondylolithesis in L5 S1 grade 2, i used to play soccer with local team , is there any way i can be fit without hurting myself , any special workout programme that i can do in order to get muscle , it really makes me feel sad :( Please help me DR Michael
Hi Youness.
Yes, there are plenty of exercises you can do to get fit and gain muscle without hurting your spondylolisthesis. In fact, if combined with a well structured healing spondylo exercise routine, you can also assist your body's healing mechanism as you help condition your spine to avoid spondylo pain. Begin with a good body analysis of your spinal joint stability, full body posture and biomechanics. This can be performed by a good rehab specialist in your area that specializes in this, or if you do not have anyone local to you, the analysis on the painfreeandfit.com website can be a great second option. Once you understand what your posture and mechanical issues are that affect your spondylo pain, and learn what your unique neutral spine position and associated muscle tensions are, you can then build a spinal stability exercise program to help you maintain spinal stability in different movements and physical exertions. The FAST TRACK Spondylo Healing Exercise Program available at the same website will help guide you through all of these steps and create such a tailored program. This can then be followed by beginning a strength and fitness routine to support your overall health and well being. This strength/muscle building routine should target failure rep ranges of 5-8 reps for upper body exercises, and 5-15 reps for lower body exercises to maximize muscle hypertrophy for muscle mass gains and should avoid lower back spinal extension by avoiding certain exercises such as over head bar presses, 2 handed standing curls, front lat pulldowns, etc. These are also covered in the FAST TRACK program recommended. Incorporating progressive soccer drills while maintaining spinal stability would be the last step to return to soccer without injury. These drills would progress from slow motion to faster cadences while maintaining a neutral spine, and also progress from stable surface training to unstable surface training . This rehab may be more detailed than I can explain in text, but I plan to make video exercise consulting available on a one-on- one personal training basis within the next month or so (if that interests you) through the painfreeandfit.com website. I hope this all gives you realistic hope about your condition, and a solid direction to start your healing and recovery. In 28 years of practice, I have found that It is rare that spondylo cases of all grades cannot enjoy significant pain relief and return to an active fitness lifestyle if assisted with a proper program. Hopefully , you will enjoy the same outcome. Thanks for the question.
Can I weightlift with l5s1 spondylolisthesis
As long as you condition your custom neutral spine and RPI to hold your back and spondylo segment in a safe position, weight training can be safe. This comes from a thorough analysis of your mechanical issues relating to spine stability. I would recommend the FAST TRACK Program for Spondylolisthesis at painfreeandfit.com to walk you through the process.
Hello dktr Michael
I have grade 3
And its so terrible
Can jou explain witch exercises are the best to do.
I am in a revalidation traject
But i have the feeling that its not to the point.
They learn me hoe to bend forward but not in the way you do.
I cannot walk for long periods
Cannot dance like a did before.
My whole life has become very difficult
I am in extreem neck pain
I lean to the right al the time etc etc
I also have stenosis,scoliosis,extreem lordosis kyphosis
Is my life over?
Thank you for your answer
I am from the netherlands
Hi Tamara.
No, your life is not over, but you definitely have some challenges. There is always hope in any condition, and while I am not your doctor, I can tell you that many cases of grade 3 spondylo with or without scoliosis/ stenosis can be improved through corrective exercises and posture. It all begins with a thorough analysis of your posture and body mechanics, which if you do not have a specialist in your area, I would advise the free analysis available on the painfreeandfit.com website. Your other option is to set up an appointment with me for a video conferencing body analysis via zoom. In any case, from the analysis, a spinal stability program is then created which trains you to hold a neutral spine position with correct muscular stabilization tension based on your unique analysis findings. This is followed by a graded corrective exercise program which over time uses increasingly more challenging exercises designed to return you to the physical activities you desire while holding a safe or neutral spine position . These programs are available in the FAST TRACK spondylo program also available on the website, or on a one-on-one personal training basis with myself through video conferencing. While some grade 3 cases with stenosis do require surgery, many do not, and those that do will still need a corrective exercise program following surgery to optimize their recovery and help prevent future problems. I hope this helps, and please remember that most conditions can be helped if the correct approach is taken. Keep in touch and let me know how you make out, or if I can be of any further assistance.
Thank you so much for your answer !!
His explanation is so confusing. But I believe he understands The issue.
If his name is remy, you’re about to get some good lower back advice.
I have spondolysthesis with grade 1 and I am 18 years old , can it be cured naturally
Hi Vedansh.The forward movement of the vertebra cannot be cured naturally, but the symptoms definitely can be cured naturally. By learning what your unique neutral spine position is, based on a thorough assessment of your muscle imbalances, spinal stabilizing system , posture and movement tendencies, and strengthening your ability to hold the neutral spine in a variety of postures and movements, you can condition your spondylo to avoid the aggravating mechanical effects that are interfering with your body's healing mechanism. Chiropractic manipulation and flexion distraction stretching can also be of great value to many with spondylolisthesis, if combined with the rehab exercises. If you don't have an advanced rehab expert near you to help you, I would recommend my FAST TRACK Spondylolisthesis program at painfreeandfit.com to learn your mechanics and unique neutral spine, and the exercises needed to promote a pain free state, increasing your chances to stay active without pain. I hope this helps, and let me know how you make out.
Dr. Remy
Dr. Michael C Remy I have a one more question Dr Michael I am a fitness freak so can I do weight training to grow my upper body. With this and plz advice me so that it will not turn into higher grade.
@@vedanshsharmafitness5126
Hi Vedansh.
Generally speaking you need to own your ability to maintain a neutral spine that is specific for you, and train it to resist your typical movement pattern tendencies. As a rule of thumb, you can do anything fitness related as long as you hold a neutral spine, but this ability to be held must be built up over time to meet your workout demands. Extension of the spine should be limited in all exercises as a safety rule of thumb. More of this is in the FAST TRACK Spondylo program at painfreeandfit.com, or if you want a specific routine to avoid aggravating, let me know and I'll set up a consult appointment for you.
Dr. Remy
I can't feel multifius...
The easiest way for most to feel the multifidus is by feeling with your thumb at the lower and lateral aspects of the spinous process in a relaxed standing position and then feeling its contraction after exhaling the reserve air in the lungs after a normal exhale, or when hip hinging forward
This really helped me activate my multifidus. But the excercise caused me a lot of pain and I felt like I was about to throw my back out. I have grade 2 spondylolisthesis as well as posterior herniated discs at and around the same level. It very difficult to benefit one injury without further damaging the other. Do you have any advice for people who are dealing with the same issues?
Hi Bryan.
It is good that you learned how to activate your multifidus, but please remember that all exercises must be done with your unique RPI position and tension to prevent pain, AND the motion of the hip hinge must be done over a range of motion and for a number of repetitions that are comfortable. If you still feel pain, you are not performing the exercise correctly and need a rehab specialist to walk you through the exercise so it is done correctly for your unique problem. Another option is learning your RPI and neutral spine position with proper exercise form as is explained in detail in the FAST TRACK spondylo program at the painfreeandfit.com website. Generic approaches to exercise often fail with pain conditions because they need to be specific for the individual (RPI and neutral spine position). This point I emphasize in all of my exercise videos and is the number one mistake people make that cause pain and a worsening of their condition. I hope this info helps, and let me know how you make out.
-Dr. Remy