Tackling Faulty Lower Spine and Hip Posture in Gymnasts (Part I): Links To Injury and Possible Contributing Factors

 The very first post I ever put up on this blog was about hip flexor mobility restrictions, and it had some information related to improper posture in gymnasts. It concerned how a lack of hip flexor mobility can contribute to both decreased skill performance, and possibly some injuries. Although that is definitely one contributing factor for the typical lower back posture many athletes assume, there is a lot more to it that coaches and athletes can learn about. Due to it being so common with gymnasts, many members of the sport view it a natural part of doing gymnastics. However, it is not something that should just brushed over. I hope to educate readers about the possible reasons behind this lower spine/pelvis/hip posture, describe why it can be problematic for gymnasts, and discuss how to deal with some of the issues. During this weeks post I will break down some possible contributing factors gymnasts may have, and why it might lead to some not so fun situations related to skill performance/injuries.  Here’s a common picture we probably all see, gymnasts waiting for turns hanging out in this type of archy posture. I happened to catch one of our girls in the background of a photo. 

Example of Resting “arch back” Gymnastics Posture

This type of posture can be linked to a few big issues like:

• Increased lower back stress during backward bending skills, and contributions to possible hyper mobility of the lower spine. This can lead to various sprains/strains of the spine, and possible slippage of the vertebrae if it becomes a habit.
• Decreased performance for bridge based skills (tumbling, bar releases, yerchankos) as well as for leaps, dance, and jumps requiring hip extension
• Increased risk of forceful back extension with landings, dismounts, and bounding or “jamming” the back (opening early in front skills, or 1 1/2 punch on floor for example). Which I can tell you from experience, feels just awful.
• Faulty dismounting and landing mechanics, which can then be linked to multiple other spine and lower leg problems
• Builds a base of faulty movement patterns for gymnastics skills and development, which gives coaches and gymnasts a major headache down the road when athletes struggle to undue the habits.

There is a lot of research available that looks at the lower back of gymnasts, and a lot of it points to injury sites at a spot known as the “thoracolumbar junction” and the “lumbosacral” junction. The first is the level of the spine that goes from the end of the middle of the spine (thoracic spine), and the lower spine (lumbar spine), and the second is the junction that goes between the lower spine to the end of the spine in the hips (sacrum). These transitional spots in the spine tend to develop more mobility, have been demonstrated in studies to take the most force during tumbling and landing, with some studies showing up to 11x an athletes body weight at the lumbosacral junction during certain event landings. Due to these factors, it can often times become a common site of injury for many gymnasts.

http://www.allinahealth.org/mdex/en93693.jpg

Although there is no research specifically on the forces on the spine for gymnasts with the faulty posture compared to gymnasts without it, based on other information available I would be willing to bet that landing with improper mechanics and this posture can significantly increase the forces through the spine. Many coaches and gymnasts have seen when one of their athlete lands a front handspring, front punching skill, or dismount in the loose arch back position and “jars” their back. It’s not fun for anyone involved to watch or experience. 

As a quick nerdy side note, there is some really cool new literature in the PT world done by Thomas Myers that explains how muscles and connective tissues connect in patterns/chains and can link to common issues. In one of the chapters of his book Anatomy Trains, he describes a chain known as the Spiral Line. Without getting to in depth, he outlines how flat feet or over pronation can be linked through other muscular connections the pull on some structures of the front/side of the thigh, then possibly contributing to the pelvis to tilt forward (anterior pelvic tilt). When I was reading through this part of the book it certainly peaked my interest, because flat feet, restricted tissue mobility of the front/side of the thighs, and anterior pelvic tilting are some of the most common connections that can be made in gymnasts with some common overuse injuries and pain. Although I will outline more of the localized structural problems around the pelvis and spine, it’s really cool to apply some of Thomas Myers work to gymnastics in order to think about how the entire body may have a chain linked effect. You can even think about the “jarring” of the back from this postural problem. There is some scientific evidence that shows forces going through certain spots in the spine (thoracolumbar junction and lumbosacral junction) can have drastically larger loading and sheer forces. Some basic landing models (by no means conclusive) suggest 11-20x more forces through these focal loading points. In my mind it makes sense that if someone is tumbling and compresses their arch to be flat footed, it can then pull on the entire chain Thomas Meyers outlines increasing the pelvis tilting forward. When you add this position and strain to the high forces of tumbling, in conjunction with the gymnast maybe not having great hip and pelvis stability in a sightly arched back position, it could be setting the stage for both progressive microtrauma damage over time at the noted points that seem to be subject to higher force loads. Along with this it can be predisposing traumatic jarring of the back and injuries at these “weak links” in the spinal chain. Just food for thought that came to me while reading, and I wanted to share for those interested. On to some other concepts for this concept.

As you read on, keep in mind that this isn’t an issue that every gymnast has. Many athletes have different muscular imbalances or problems with their biomechanics that don’t fit the scenario below. Athlete’s may be on the other end of the spectrum and the recommendations in this post may not be appropriate. I encourage readers to process the information and only apply it where it might be fitting. By understanding the nature of the problem and taking some time to address it, I personally believe that many athlete’s may be spared some possible injuries while also being able to increase their gymnastics performance. 

Overall Problem and Contributing Factors 

One term that is sometimes used to describe the overall picture of this posture type is “Lower Crossed Syndrome” made famous by Vladimir Janda, who is pretty well known in the rehabilitation world. He outlined a pattern associated with the lower back and hip area that I will explain and show some reference pictures for. People have taken his work and expanded on it a lot. Many have added some more layers to the issue related to movement patterns, core stability issues, improper stabilization, and an athlete being able to know where their body is in space. Here is a global diagram and what some factors are, which I’ll go into below.

Anterior and Posterior Pelvic Tilt Reference – http://bretcontreras.com/wp-content/uploads/Pelvic-Tilt.jpg

Possible Contributing Factors To Resting Anterior Tilt Posture

It isn’t always just about the underlying tightness or weakness though. This type of acquired posture has a lot to do about how an athlete moves, and the compensatory movement they may acquire over the years of training. Although this is the overall biomechanical picture, there is a laundry list of problems that can possibly come up from having this posturing throughout gymnastics skills and training. There are also a lot of factors above and below the lower spine/pelvis that have to be considered as well. Here are some of the most common issues seen in gymnasts with this chronic posturing.

1) Tight Lower Back Musculature & Increased Lower Back Arch

This is the first factor that gymnastics most often have. Gymnastics inherently is  very extension based (bending backwards) with so much tumbling, handsprings, and skills involving the arch position. Along with developing segments of their lower spine that are hyper mobile, gymnasts also usually possess over developed and strong lower back musculature.They will often use this position as “default mode” and utilize this as a compensatory mechanism for other movement restrictions they have during skills. This compensatory mechanism is seen frequently during flexibility, drills, and skill work.

Due to the sport being very extension based and requiring the athletes to use their lower back muscles, they may become very over developed. If the athlete is constantly activating the lower back musculature for skills while also not paying attention to mobilize these muscles, they may become shortened and tight. When you combine the excessive extension from the sport, possible acquired hypermobility of the lower spine, compensatory motion, and overly tight lower back muscles, you may be able understand why the “arched” back posture may be seen in athletes. The anatomical term for this is an “increased lumbar lordosis”.

Lower Back Extensor Anatomy – Multifidus and Errector Spinae Shown http://fixtheneck.com/wordpress/wp-content/uploads/2012/07/backextensors.jpg

2) Tight Hip Flexors and Restricted Hip Flexor Mobility 

This was what my first post focused on, which can be read about in full here. In short, many athlete’s have a restriction in their hip flexor mobility for a variety of reasons. A few of these reasons include the sport of gymnastics requiring constant hip flexor use leading to tightness, spending a lot of time being spent in sitting and “hip flexed” positions out of the gym, athlete’s compensating with other joints for the hip flexor restriction during flexibility, and the hip flexors being under mobilized in many gymnasts. As you can see from the pictures above, the tightness in the hip flexors and the tightness in the lower back muscles act together to tilt the pelvis forward. If the athlete is not taking the time to pay attention to both these restrictions, it may overtime develop into the overall posture problem.

Iliopsoas Anatomy Reference Picture – http://www.criticalbench.com/muscles/hip-flexors-muscles.jpg

Rectus Femoris Anatomy Reference Pictures – http://www.higher-faster-sports.com/images/rectus-femoris.jpg

3. Lengthened and Often Times Weak Hamstrings, Weak/Underused Glutes

Hamstring Muscles Anatomy http://images.medicinenet.com/images/illustrations/hamstring_muscles.jpg

Excessive hamstring flexibility is something that gymnasts are known for. The amount of flexibility needed for dance/jumps, beam , some bar releases, and many other skills requires athletes to have excessive hamstring range. Although there is a range of mobility needed, often times athletes possess extremely lengthened hamstrings that may be overstretched and not doing their job properly to support a gymnasts good lower body posture. The hamstrings can quickly become over stretched and weakened. When an athlete practices some hamstring exercises and gets taught proper technique mechanics, they may be able to get the best of both worlds for flexibility/skill performance. If an athlete simply focuses on hamstring flexibility for skills and jump strengthening to increase their leg power, it may further contribute to the posture problem. Often times it quickly translates to hamstrings that are very flexible but not functional, meaning decreased power output capabilities and also a factor in the arch back posture seen in gymnasts.

Along with the flexible hamstring, many gymnasts don’t properly utilize their buttock/gluteus muscles at all times. Gymnasts usually have very strong glute muscles, and the best gymnasts typically can show good control to contribute to proper core stability and body shaping for successful skill performance (Like squeezing the top of a cast handstand). However, there are many athletes show decreased activation of the gluteus during their skills, which leads to them being under developed and poorly activation. I’m sure everyone reading this knows a gymnast or is guilty themselves for hearing/saying over and over “squeeze your butt, squeeze your butt” during skills. Unless the gymnast uses it as an automatic movement pattern, it often times gets forgotten about.This lack of core and glute control is often why the gymnast shows frequent wobbles on beam, have poor core stability during skills, and has lines and shapes that aren’t the best. If the hamstrings are very flexible and the glute muscles are being under activation/are weak, this can combine together to further cause posture related issues.

4. Weak/Under Utilizing Lower Abdominals  

Gymnasts possess some of the strongest core musculature and lower abdominals out of any sport when it comes to certain types of core strength. Sorry to burst your bubble, but your 6 pack doesn’t guarantee you have good overall core strength, control, and stability. Gymnasts usually excel at core exercises that resist extension  (leg lifts/stalder ups, v ups,etc) and also are very strong in certain positions (hollows, round shapes, slightly flexed spine). However, there are many other types of core stability that paint the overall picture of having proper core strength that can stand up to gymnastics. Often times when I take gymnasts into positions they are not used to in order to test all aspects of their core, the wheels fall off the train and they are amazed with how tough some exercises are. In a future post, I’ll talk about some of the exercises I have gathered from the PT and gymnastics world that I have had good success with.

Also, many gymnasts don’t always properly execute their core strength correctly. Take a look at your gymnasts next time they do core work and see if their lower back pops off the ground as they try to compensate for a lack of good core strength/endurance. This is really the biggest reason that gymnasts usually continuously fall into the arch back posture while doings strength and skills. If someone isn’t on top of them making sure there is no tunnel in their back, they will compensate with stronger ab muscles or their hip flexors.

Also look at their skills in slow motion on video analysis and see how engaged their core is, and if they display the arch back posture during some skills. There should be no “tunnel” under their lower back with strength exercises, and no “butt out” arch  during skills. The athlete needs to get proper core engagement broken down to teach how to tilt the pelvis properly and engage the lower abdominals. If they go through 10 minutes of core strength or lots of turns with this problem, it may just be encouraging further improper core firing patterns and not really be building proper stability/strength. Taking the time to teach them may help them with their posture problems, but also increase their skill performance because they are learning proper shaping and core engagement.

http://www.aokainc.com/wp-content/uploads/2013/08/stomach-muscles-anatomy.jpg

Gymnastics demands that athletes be strong in all of these categories/muscle groups to protect themselves from injury and also successfully perform high level skills. Problems arise with gymnasts when the athletes have trouble activating and using those muscles under intense situations like complex skills and during routines. It is very common for athletes to show perfect shapes and control of the lower abdominals during drills or lower level activities, but then they completely fall apart during skills, and especially when fatigued. As the body compensates for the poor movement patterns, it usually just does whatever it has to “get the job done” and complete the skill. Gymnasts and coaches have to be sure to be sticklers for proper shaped conditioning drills, skill progressions, and routines even when fatigued. This will make sure they aren’t putting too much pressure on certain areas of the lower body as well as contributing to further postural issues.

Overall Picture: Increased Back Arch, Hips Flexed, Global Anterior Pelvic Tilt

All of these four factors, along with some other issues, contribute to make and overall “anterior pelvic tilt” which means that the pelvis bone is rotated forward in relation to the spine like the picture at the beginning of this post. Due to these factors all coming together to promote a resting posture that is not ideal, and the gymnast developing faulty movement patterns around it, it shows up and affects all of a gymnasts flexibility, drill, and skill work.

Improper Half Kneeling Hip Flexor Stretch – Note Anterior Pelvic Tilt and Compensatory Use of Lower Back Arch

Example of Bridge in Gymnast Who Has Restricted Hip Flexor Mobility – Note Anterior Tilt of Pelvis, Increased Compensatory Lumbar Extension

Handstand with anterior tilt causing faulty handstand mechanics

As I touched on above, here are some problems associated with these issues.

• Increased Back Arch:
  • Overuse injuries, muscular strains, ligamentous sprains of the lumbar spine with gymnastics training
  • Other more serious lower spine pathology like spondylolisthesis (slipping of vertebrae forward) and  spondylosis (fracture associated with slippage), and others
  • Increased risk of forceful back extension with landings, dismounts, and bounding or “jamming” the back
• Tight Hip Flexors/Hips Flexed:
  • Decreased skill performance in dance, jumps, leaps, as well as back/front handsprings, yurchenkos, etc.
  • Increased strain on quadricep muscles and possibility of increased hip flexor injuries/strains
  • Increased lower back pressure with skills as the athlete compensates to overcome the lack of mobility
• Poor Lower Abdominal Control/Weakness:
  • Possible skill deductions due to being “loose” and not having tight body positions
  • lack of overall core stability in high risk skill scenarios and fatigue that can lead to various lower extremity injuries with landings/jumping
  • contribution to compensatory functional movement patterns
• Poor Hamstring or Gluteus Control/Strength:
  • Possible decreased skill performance with decreased hamstring and glute force output for dance/leaps, tumbling and landing control.
  • Also possible increased risk of injury due to poor landing mechanics, increased “deep squat” landings with lack of gluteus control
  • Poor acceptance of high forces from tumbling/landing/dismounting.

 

So for now, this is just the tip of the iceberg in getting educated about what might cause a gymnast to have this problem, and why it matters for their safety and gymnastics performance. Just being able to recognize the problem and think about how it may affect a gymnast is a great start for coaches and gymnasts. In the next posts in this series I’ll break down some quick tests people can use to see what’s contributing to the problem, as well as some pre-hab techniques for each possible factor. Hope this is useful for readers. Best of luck,

Dave

References

• Caine D., et al. The Handbook of Sports Medicine In Gymnastics. First Edition. John Wiley and Sons, 2013
• Bradshaw E.J., Hume P.A. Biomechanical approaches to identify and quantify injury mechanisms and risk factors in women’s artistic gymnastics. Sports Biomechanics. 2012; 11(3) 324 – 341 
• Cook G., et al. Movement –  Functional Movement Systems: Screening, Assessment, Corrective Strategies.  First Edition. On Target Publications, 2010.
• Myers TW. Anatomy Trains: Mysofascial Meridians for Manual and Movement Therapists. Second Edition. 2009
• Oscar E. Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Lotus Publishing: California; 2012
• Page P., Frank C.C., Lardner R.. Assessment and Treatment of Muscle Imbalances: The Janda Approach. Sheridan Books; 2010
• http://www.stopchasingpain.com(Dr. Perry Nickelston)
• Neumann DA. Kinesiology of the Musculoskelatal System: Foundations for Physical Rehabilitation. First Edition. St. Louis: Mobsy Inc. 2002:103 – 111.
• Magee D. Orthopedic Physical Assessment. Fifth Edition. St. Louis: Saunders Elsevier; 2008.
• Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. Third Edition. Baltimore: Lippincott Williams & Williams; 2011:197 – 204.