Low
Back Pain in the Diver
By
Bob Mangine, M.Ed., PT, ATC, and Marsha Mangine, M.Ed., PT,
ATC
Why are some injuries more prevalent
in one sport than another? Specific injuries tend to occur
in sports based on the physical demands and mechanics required
to perform a given sport. These injuries can be both traumatic,
one-time occurrence or of an overuse type, occurring over
a period of time. For that reason, it is important to understand
the techniques and motion for performing the sport. Factors
that can increase and decrease injuries are many, such as
skeletal maturity, body composition, coaching technique and
exercises to improve performance. Diving is no different.
There are certain injuries that are consistently seen within
the sport of diving.
The sport of diving has tendencies for specific injuries to
the shoulder, wrist and low back. Shoulder injuries can be
either traumatic, like a one-time dislocation, or chronic,
like overuse instability. Wrist sprain injuries are frequent
to today's diver. But, perhaps the most troublesome injuries
to divers can be those that involve the low back and pelvic
area. Specific injuries to this region include muscular strains,
facet joint dysfunction, hypo- or hyper-mobility of one or
more spinal segments and SI joint abnormalities.
The area of the low back and pelvis is a dilemma that effects
divers of all ages and performance levels. The senior author
has reported in 1982 that approximately 85 percent of all
divers would suffer some form of back discomfort in their
career. The reason for this staggering statistic is the nature
of the sport itself. Everyday divers ask their body to perform
the movements that require the mobility of a gymnast, while
traveling at high speeds of the end of a board and culminating
the experience by entering a pool of water which at times
can feel like hitting a pool of bricks.
In diving the early stage of the dive requires proper line
up and positioning. This is the stage that sets the whole
performance in motion. The diver must work on proper posture
on the board or tower, because the alignment at the start
dictates the initial performance. Emphasis by the coach on
proper alignment is drilled into the athlete. Proper muscular
balance between muscle length and muscle strength is a must
for the athlete to master the early stage of line up and positioning.
The second stage is the take off and in air movement. This
phase requires skill, physical strength, agility, special
awareness and control of speed. The diver must recognize their
position in the air, control movements in the air and synchronize
those movements to entry in proper position. Poor entry by
being over or short can result in high forces applied to the
spine and other joints. Without adequate strength and dynamic
control, divers the body may not be able to hold position
upon entry.
The key element to strength is the core trunk muscles. Training
of these core muscle groups (the abdominals, hip flexors,
back extensors, and the hip abductors) are critical for the
diver. Classically the training of abdominals is included
in most routines; however, the back extensors and hip muscles
are often overlooked.
In the previous article, Terry Robinson, addressed exercises
for strengthening the abdominal muscles. For a complete lumbar
spine stabilization training program, the opposing muscles
must also be addressed. The spine extensors or erector spinae,
support the lumbar spine and extend the back. The pelvic girdle
muscles including the gluteus maximus and the gluteus medius
stabilize the pelvis and provide a stable base of support
for the abdominal muscles and back extensors to work from.
We are recommending three exercises for extension training
and pelvic girdle stability.
The first is bridges with single leg support. This requires
no weights for the training program and 30 to 50 repetitions
are performed.
The second utilizes an exercise ball and the athlete extends
opposite arm and legs attempting to complete a straight position
and a flat spine position. The athlete performs 30 repetitions
and builds up to 50.
The third exercise works both balance and pelvic control.
The athlete's upper extremities are placed in the entry position
in single leg balance. Simultaneously, one leg is placed behind
the single stance leg and gently push on the back of the leg
providing a light form of resistance. The athlete is instructed
to maintain straight aligned position and holds this position
for 20 to 30 seconds per leg.
The key to lumbar stabilization is to achieve optimal strength
for the front (abdominal musculature) and back muscles (erector
spinae muscles), while maintaining balance upon entry into
the water. It is important to emphasize techniques and control
of motion for optimal performance of the dive. Strengthening
of the core trunk musculature is the key to controlling motion
and supporting the spine for the imposed forces that occur
with diving.
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