Williams flexion exercises focus on placing the lumbar spine in a flexed position to reduce excessive lumbar lordotic stresses leads to tightness of hip flexor muscles and lengthen or weakening of hip extensor and abdominal muscles. Some of the postural changes like excessive lordotic curvatures, May lead to mechanical back pain( refer previous posts of mechanical back ache) . Exercises are designed to (1) strengthen the abdominal, gluteal, and quadriceps muscles, and (2) stretch the erector spinae, hamstring, and tensor fasciae latae muscles and iliofemoral ligament.
INTRODUCTION
Williams flexion exercises — also called Williams lumbar flexion exercises, Lumbar flexion exercises or simply Williams exercises — are a set or system of related physical exercises intended to enhance lumbar flexion, avoid lumbar extension, and strengthen the abdominal and gluteal musculature in an effort to manage low back pain non-surgically. The system was first devised in 1937 by Dr. Paul C. Williams(1900-1978). He strongly believed that lumbar flexion or abdominal strenthening exercises can give resolution for mechanical back pain condition.
GOALS OF WILLIAMS FLEXION EXERCISES
The goals of these exercises are to open the intravertebral foramina and stretch the back extensors, hip flexors, and facets; to strengthen the abdominal and gluteal muscles; and to mobilize the lumbosacral junctions. So one who have weakness in their abdominal muscles should do these exercises to get rid of back pain along with core strengthening exercises.
CORE EXERCISES
Williams believed that the back pain was the result of human evolution in movement from a quadruped to an upright position, proposing that the standing position was the cause of back pain because it placed the low back in a lordotic curve. Williams advocated seven exercises to minimize the lumbar curve-
pelvic tilt exercises, partial sit-ups, single knee-to-chest and bilateral knee-to-chest, hamstring stretching, standing lunges, seated trunk flexion, and full squats.
1- Pelvic tilt exercises:
Lie on your back with knees bent, feet flat on floor. Flatten the small of your back against the floor, without pushing down with the legs. Hold for 5 to 10 seconds.
2- Partial sit-ups:
The athlete lies in "hooklying" position (supine with knes bent and feet flat). With hands behind his or her head, the athlete elevates the upper torso until the scapulae clear the resting surface and stress is placed on the rectus abdominus. After returning to the start position, the sit-up is repeated for a prescribed number of repitions.
3- Knee-to-chest:
Single Knee to chest. Lie on your back with knees bent and feet flat on the floor. Slowly pull your right knee toward your shoulder and hold 5 to 10 seconds. Lower the knee and repeat with the other knee.
4- Hamstring stretch:
Lying supine, the athlete places both hands around the back of one knee. The athlete straightens his or her knee and pulls the thigh toward his or her head so the hip goes into flexion. we now know that tight hamstrings actually tilt the pelvis posteriorly and promote trunk flexion.
5- Standing lunges:
This exercise actually results in some extension of the lumbar spine when performed properly. Nonetheless, it is a good stretching exercise for the entire lower extremity, especially the iliopsoas, which may be a perpetrator of low back pain if it is abnormally tight or in spasm.
The athlete begins the forward lunge in a standing position with the feet shoulder width apart. He or she then takes a big step forward with the right leg and plants the foot out front, keeping the body relatively straight. The knee should stay over your ankle and not extend out over the toes to minimize stress on the knee joint.
6- Seated trunk flexion:
This exercise is performed by sitting in a chair and flexing forward in a slumped position. Maximum trunk flexion is obtained and direct stretching of the lumbosacral soft tissue structures occurs.
7- Full squat:
William's squat position is with the feet placed shoulder width apart, the hip and knees are flexed to the maximum available range of motion, and the lumbar spine is rounded into flexion. Upon reaching maximum depth, the athlete "bounces the buttocks up and down" 15 to 20 times, with 2 to 3 inches of excursion on each bounce, then repeats 3 to 4 times.
RATIONALE
Williams believed that the basic cause of all pain is the stress induced on the inter-vertebral disc by poor posture. He theorized that the lordotic lumbar spine placed inordinate strain on the posterior elements of the inter-vertebral disc and caused its premature dysfunction. He was concerned about the lack of flexion in daily activities in the accumulation of extension forces that hurt the disc. This same concept has been proved by latest studies. Because before we believed , once get the back pain, physician or physiotherapists were advising to take complete bed rest. But these things changed or disproved by latest studies , they recommend early mobilization are giving better result in back pain.
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