Roman Chair Hyperextension Bench as Part of a Spine Rehabilitation Program for Back Pain

To help answer the question of

whether hyper extension exercises on a roman chair are appropriate as part of

your spine rehabilitation program, first let me provide some background information on

the subject. Then, I will describe the muscle control problems that arise

with back pain. Next, we need to establish goals for rehabilitation and

determine the specific training requirements to obtain those goals. And finally, I will describe the inherent problems of traditional roman chairs, followed by a solution.

Muscle Control during

Optimal Health

Research has shown that there are two types of muscles: Superficial

strength muscles
, and deep stabilizing muscles. Each has its own

unique characteristics.

Think of the superficial

strength muscles
as “sprinter-type” muscles. These muscles contain the same

type of muscle fibers that are highly developed in the legs of Olympic

sprinters. They are great for producing speed during a 100 meter dash but poor

for endurance during a marathon. In contrast, the deep stabilizing muscles

are more like “marathon-type” muscles (superior for endurance but poor for

speed).

In healthy individuals, the

primary role of the superficial strength muscles of the lower back and

abdomen is to move the torso. (Torso is defined as: The human body excluding

the head, neck, and limbs. This part of the body is also known as the trunk.

So, these muscles move the rib cage, lumbar spine, and pelvis.) They are also

responsible for controlling trunk posture during high-level activities. These

activities may include: lifting, pushing, pulling, jumping, running, and other

ballistic (fast) movements of the limbs.

In contrast, the deep

stabilizing muscles
of the back and abdomen are used to provide continuous

postural adjustments of the torso throughout the day during low-level

activities. Some examples of low-level activities are: sitting, standing,

moving from a seated to standing position, walking, and slow (non-ballistic)

movements of the limbs.

Muscle Control Problems that Arise with Back Pain

After experiencing back pain, the brain’s strategy for maintaining trunk posture

changes to a simplified, inferior strategy. First, the deep stabilizing

muscles
stop working properly. Second, the superficial strength muscles

of the trunk become over-active and their muscle fibers shorten up to restrict

trunk range of motion.

This over-active/shortening-up

response is recognized by experts as the brain’s attempt to “lock up” and

protect the painful segments of the torso during the acute phase of injury.

This compensation pattern typically continues after it is no longer necessary

during the chronic phase of back pain (when the injured soft tissue structures

have healed).

The strategy of using

“sprinter-type” muscles to try to maintain trunk posture throughout the day is

like forcing an Olympic sprinter to compete in a marathon, instead of the 100

meter dash. Obviously, the sprinter’s muscles are built for speed, not

endurance. So to say the least, this strategy would not be very efficient.

But, other problems arise secondary to muscle fatigue and subsequent muscle

spasm which result in disc & joint compression.

Goals for Rehabilitation &

Specific Training Requirements

Just as the goals and specific training requirements for sprinters are different

than for marathon runners, there are also vast differences in the goals and

specific training requirements for a rehabilitation program versus a core

fitness routine.

In rehabilitation, one of our

goals would be to release the superficial strength muscles. (Remember

that they have “locked up” the injured region of the spine.) This is

accomplished through slow, low-load, pain-free movement patterns focused on

lengthening the superficial strength muscles while relaxed. This is

something I describe to my patients as a relaxed muscle release exercise

(not to be mistaken as a muscle-stretch exercise).

Although it is true that we must stretch the fascia and related non-contractile

tissues, it is important to recognize that muscles must be released while

relaxed. This is required in order to reset the muscle spindles that

control the set-point of resting tone and muscle length.

The idea of a relaxed

muscle release
exercise is definitely a change in mind-set. What it means

is that typical hyper extension exercises performed on a roman chair bench are

not appropriate for the initial stages of rehabilitation for chronic back pain.

If the superficial strength muscles of the back and abdominal wall

are over-active (contracting too much) and the muscle fibers are shortened up to

restrict trunk range of motion, then “strengthening” exercises would not be the

proper type of exercise for rehabilitation.

Our next goal would be to retrain the deep stabilizing muscles in their

role as the primary trunk stabilizers during low-level activities. This is

difficult to achieve in a person with chronic back pain since the superficial

strength muscles
are attempting to perform that role by over-contracting and

shortening up to restrict motion in the previously injured region of the torso.

Therefore, an aggressive exercise utilizing a roman chair that emphasizes the

superficial strength muscles
of the torso and hips may neglect to activate

the deep stabilizing muscles appropriately. A more specific training

approach is required.

One important deep

stabilizing muscle
of the back is called lumbar multifidus.

This muscle attaches at each segment of the lumbar spine down to the sacrum and

pelvis. The specific training that I recommend on a back exercise machine

is a slow, low-load extension movement occurring at each vertebra, instead of

holding the curve of the lower back in a locked position while moving through

the hips. This exercise should be easy enough to perform 30 repetitions

without fatigue.

The Problem and the

Solution

The specific training requirements for lumbar multifidus rehabilitation are not

likely to be achieved as part of a home exercise program on a traditional roman

chair hyper extension bench. The design of the traditional 90-degree exercise

angle is too difficult and not properly designed to promote the specific

training requirements of spine rehabilitation. This type of roman chair will

emphasize the hamstrings, buttocks and superficial strength muscles of

the lower back. It is also likely that training on the 45-degree exercise

angle will be too difficult and not specific enough.

Fortunately, a solution has

been developed that may be designated as a hybrid of the roman chair hyper

extension bench. It’s called the Back Trainer Medic by Kettler

(made in Germany). The Back Trainer Medic was designed to assure the

correct movement pattern, so the individual segments of lumbar multifidus are

trained appropriately. The torso pad is curved and the height of the pad

is adjustable so it guides the user through the correct motion of the torso for

spinal rehabilitation.

The specific exercises that I

show my patients to perform on the Back Trainer Medic fulfill both goals that I

addressed earlier in this article: First, releasing the superficial strength

muscles
of the back (via relaxed muscle release exercises), and second,

retraining the deep stabilizing muscle of the back, called lumbar

multifidus (via a slow, low-load extension movement occurring at each

vertebra). The specific exercises are also demonstrated on a DVD video so my

patients can watch it at home as an additional guide.

The Back Trainer Medic has six levels of difficulty. The easiest level is

easier to perform than the 45-degree exercise angle of a roman chair, so it is

more appropriate for the initial stages of spinal rehabilitation. This

allows the user to progress to higher levels of difficulty while the lumbar

multifidus muscles adapt by improving motor control and increasing in size.

Another advantage is that this machine virtually eliminates the hamstrings from

the exercise so that your efforts are more specifically focused on training the

lumbar multifidus muscles.



Source by Dr. Howard A. Knudsen