The Problem
Gymnasts often experience lower back pain due to the high-impact nature of their sport. Improper landing mechanics can exacerbate this issue, especially if the ankles are not functioning correctly, leading to a chain reaction that affects the entire kinetic chain.
Kinetic Chain Dysfunction
Kinetic chain dysfunction refers to the interconnected series of joints and segments that interact to produce movement. When one segment of the chain is not functioning correctly, it can affect the entire chain, leading to compensatory movements and potential injuries. In the context of gymnasts, ankle dysfunction can lead to lower back injuries due to the demands of their sport and the high-impact nature of their movements.
Together with Patrick, we identified the deficiencies in the kinetic chain and established the key dysfunctions. We also identified all the muscles involved in the chain to train them in isolation initially, followed by the integration of compound exercises to fully mobilise the kinetic chain. After three weeks of intensive training, we successfully eliminated lower back discomfort during landing actions and other physical activities that previously caused back pain.
The assessment of ankle, gait and landing mechanics and lower back examination assisted to build several protocols.
Ankle Assessment
Key tests include the Range of Motion (ROM) Test, which measures dorsiflexion and plantarflexion, and the Anterior Drawer Test, which evaluates the integrity of the anterior talofibular ligament (ATFL). The Talar Tilt Test assesses the stability of the calcaneofibular ligament (CFL) and deltoid ligament. These tests help identify instability, restricted movement, and previous injuries, such as sprains or fractures. Accurate assessment allows for targeted interventions to improve ankle function, thus enhancing overall kinetic chain efficiency and reducing the risk of compensatory lower back pain.
Gait and Landing Analysis
Key methods include video analysis, which provides detailed observation of landing techniques from various angles, and force plate analysis, which measures ground reaction forces and distribution patterns. These analyses help detect asymmetries, improper alignments, and compensatory movements.
Lower Back Examination
When ankle stability or mobility is compromised, it alters the biomechanics of the knees and hips, leading to compensatory movements and increased stress on the lumbar spine. This dysfunction can result in overuse injuries, muscle imbalances, and chronic pain. Comprehensive evaluation through Range of Motion (ROM) Tests, Anterior Drawer Tests, and Talar Tilt Tests can identify these issues early. Further, examination includes nerve compression tests, such as those for sciatica, and assessments for muscle stiffness in the PSOAS and piriformis. It also considers underlying problems that athletes may experience.
Ankle-To-Lower Back Mechanics of Injury
Stage 1: Ankle Instability
The trigger takes place when a gymnast with previous ankle sprains lands from a jump. Due to instability, the ankle fails to properly evert, causing excessive foot pronation.
Stage 2: Knee Valgus and Hyperflexion
To compensate for the pronated foot, the knee collapses inward (valgus) and flexes more than usual. The quadriceps and knee ligaments endure increased stress. At this stage, there is a tendency of building compensation where the athlete distributes their weight on one leg. This tendency creates muscle imbalance and manifests itself in lower back discomfort due to the ineffective landing mechanics.
Stage 3: Hip Internal Rotation
The inward collapse of the knee forces the hip into internal rotation. The hip flexors and adductors overwork to stabilise, while the gluteals underperform.
Stage 4: Increased Lumbar Lordosis
With the altered lower limb mechanics, the lumbar spine extends more to maintain balance. This increases the lumbar lordosis, leading to overactivity of the erector spinae muscles.
Stage 5: Impact Transmission
The misaligned landing causes a direct transmission of impact forces up the kinetic chain. The lower back, lacking proper shock absorption, takes on excessive forces.
Stage 6: Muscle Fatigue and Overuse
Over time, the lumbar muscles fatigue, leading to micro-tears and overuse injuries. Chronic compensation results in tight hip flexors and hamstrings, further stressing the lumbar spine.
Completely Solving Persistent
Lower Back Discomfort
We build four protocols to address every event of the kinetic chain dysfunction. The protocols are added to the Notion with necessary training parameters and progression systems with subsequent tiers.
We also developed a pain management protocol based on the Stuart McGill's Big Four, McKenzie Spinal Health Method and Stretch Systems for Nerve Compression.
Stuart McGill’s “Big Four” exercises are designed to enhance core stability and strength, crucial for preventing and managing lower back pain. The philosophy behind these exercises is rooted in biomechanical research and clinical practice, focusing on building a robust and resilient core that supports the spine during various activities.
The McKenzie Method, developed by Robin McKenzie, is a comprehensive approach to diagnosing and treating lower back pain. It emphasises self-care and active patient involvement, promoting independence and long-term pain management. The method’s philosophy is based on the principles of mechanical diagnosis and therapy (MDT), focusing on understanding how different movements and positions affect pain.
The combination of both routines was fundamental to eradicate the lower back discomfort during the high intensity activities combined with the entire kinetic chain training. The pain management protocol was designed as follows:
McGill-McKenzie Protocol
Warm-Up: Light cardio and dynamic stretches (10 minutes).
McKenzie Exercises:
Prone Press-Ups: 3 sets of 10 reps
Standing Extensions: 3 sets of 10 reps
McGill’s Big Four:
McGill Curl-Up: 3 sets of 10 reps
Side Plank: 3 sets of 30 seconds per side
Bird Dog: 3 sets of 15 reps per side
Modified Curl-Up: 3 sets of 10 reps per side
Additional Exercises:
Glute Bridges: 3 sets of 15 reps
Hamstring Stretch: 3 sets of 30 seconds per side
Child’s Pose: 3 sets of 30 seconds
Conclusion
This comprehensive project addresses the multifaceted nature of lower back pain in gymnasts and performance artists, linking it to kinetic chain dysfunctions, particularly those originating from ankle instability and improper landing mechanics. Through a detailed analysis of biomechanical principles, we identified key areas of focus: ankle stability and mobility, knee and hip mechanics, and core and lower back strength.
Utilizing both McGill’s Big Four exercises and the McKenzie Method, we crafted an integrative approach to both immediate pain relief and long-term prevention. McGill’s Big Four enhances core stability and strength, which is crucial for protecting the spine from injury. These exercises are preventive and protective, emphasizing low-load, high-stability movements that build a resilient core capable of supporting rigorous physical activity.
The McKenzie Method complements this by providing a structured framework for diagnosing and treating lower back pain through specific, directional preference exercises. This method empowers athletes to take an active role in their recovery, promoting self-care and education for long-term pain management and prevention.
The diagnostic tests and benchmarks we established allow for precise identification of deficiencies and progress tracking, ensuring targeted interventions that effectively address kinetic chain dysfunctions. Our protocols cover every muscle involved, offering a thorough approach to correcting biomechanical issues and enhancing performance.
By combining McGill’s and McKenzie’s approaches, we offer a holistic solution that not only alleviates existing pain but also fortifies the body against future injuries. This integrated method is particularly beneficial for gymnasts and performance artists, ensuring they can sustain their demanding routines with optimal spinal health and reduced risk of injury.
