تمرینات اصلاح کننده لوردوز (Advanced Corrective Exercises Hyper Lordosis)

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درد زر ‎LORDOSIS‏ Yousef yarahmadi 

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Introduction © Normal lordosis ۳۲۱۷۵۵۲۱۵۲۵ icy Related muscles ۴۲۵۷۵۱۵86۵ 0۲ ۱0۲۵05 Complications of lordosis Lordosis relationship with age, gender and sports Common cuases 220515 300 روت ۱ ۷ 9 o Static postrual assessment 6 ‏غمع ممع ناوالا‎ 255655104 3 3 و و و هو و هو ل كا ‎Strength Assessment‏ ۵6۲656 60۲۲۵61۷ ‎Inhibition‏ © ‎Lengthening‏ © ‎leon)‏ كن ‎Integration‏ © 

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ها مس مس م۱۱ ام وی ما۱۳ ‎ca‏ ایا ‎a‏ متا متا ما ۰ e0o0?). Columna vertebral Lordosis de la normal columna vertebral Curvatura, Oe ae econ eco tee 1 lumbar = aol exagerada w O° (O98). 

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گقالی میانگین لوردوز کامل کر را در افراد 20 تا 70 ‎Here) ole‏ ۳ .است (1382) 

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>« سسسس«<-«۳ MUNA ner) eS) 12.24+55 14.56448 14.40+42 79 32 12.23435 9.71237 48 68 65 15.30 43. 6 22 14 11.40+36. ۰ 94 91 كل ايران 

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* ee ed ee oe eee eet eed ore MS re Ce Use (CC MCS ‏ا‎ ‎۱ AC slelele افزايش بيش از حد كودى كمر را كود يشتقى مى نامند افزايش كودى كمر به نحوى ‎ed‏ ا كودى كمر مينامند Image: Kapandyi: Physiology of the Joints 

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* Hyper lordosis 9 ۱ ‏و‎ ‎] ‏هت‎ Rt ea ne a ae ce ek Owe! oo lumbar lordosis# ASIS: pubis symphsis: anterior tilt Sacral Angle, Lateral View ene NIC eee Ne ‏مت سس‎ 0 as ‏يي‎ ‎۱ ed Ce ad 0.899, p = 0.000). (ant 6: etd. ‏ال‎ et ol, ‏ری‎ 

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MUSCLES °Some muscles around the hip and spine become tight and some become weak and stretched, causing an Tight imbalance. balance Weak, i ww Tight ‏اتير‎ Weak 

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۰۳۷۱۳ FLEXORSHIP FLEXORS (IN PARTICULAR 0 THE ILIOPSOAS * MUSCLE). * Trunk extensors (erector spinae and quadratus Seem lumborum) 

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pore, ond ‏رممممم )راوج‎ OOOO, we ried is DOGO). +. Dhe hatsskous dorsi otaches the pebis ord wall coteriony rotate the pelts, whick couse ‏مس‎ oF he heobor spice (Schram, 6009 ‏جه ,9000 رسد‎ ced 1 DOGO). = 

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Weak aodominals Weak gluteus maximus Tight iiopsoas عط دمعتدهوماهه مفصه[ عنسنقه۷1 ‎toate Rena Ca‏ 1۱ ‎muscles(janda, 1968; as cited Chaitow, 2007)‏ When overused and fatigued, postural muscles tend to become hypertonic, while phasic muscles tend to become weak and inhibited. The phasic muscles are antagonists to postural muscles. Because postural muscles tend toward hypertonicity, they create a functional weakness in the phasic muscles through the process of reciprocal inhibition(Chaitow, 2007) 

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5 Specific postural changes in LCS: anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension. 

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Prevalence of hyperlordosis © (32%) of School children in the Czech Republic (KRATE”NOVA ’ ,Z°EJGLICOVA’, MALY’, FILIPOVA’, 2007). ۶ No sports activities were reported by 20% of children, and these children had significantly higher probability of poor posture than children performing sports. (KRATE* NOVA’ et al., 2007). فراوانى ناهتجارى لوردوز در سه رده سنى نوجوان, جوان و ميان سال 9625.8 ‎CW UI OPT‏ اا 0 ‎of pupils aged 11-13 years in Karaj (Lasjouri and‏ 22.99% © ‎Mirzaei, 2005)‏ © 83.7% of lifting load workers of Behshahr industrial factory (Gharahgouzlou, 2000). سیمرغ و همکاران شیوع هایپر لوردوز را در دانشجویان دختر 34-19 سال 25,49 ‎rc oben‏ 1 » 6 

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Prevalence of hyperlordosis _ © 9.75% of teenagers' boy and 6.89% of teenager girl between 11-15 year-old of Lorestan province (Bahrami and Farhadi, 2006). © 65% of individuals with Schuerman disease, 27.8% of postural kyphotic individuals (Vanzi, Chih , Meves , Caffaro, and Pellegrini , 2007). 

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Complications of hyperlordosis * Research has shown low-back pain to be predominant among people who have altered lumbar lordosis (curve in the lumbar spine) © NAGMimpairment in the hip flexor muscles and lumbar extensor muscles © Impaired muscle performance due to stretched and weak abdominal muscles © Watson reported that 67% of players with lordosis suf- fered muscular injuries, while in the group without postural changes, only 36% suffered the same injury (1995). » 06 

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Complications of hyperlordosis © Stress to the anterior longitudinal ligament (Kisner, 2007). © Narrowing of the posterior disk space and narrowing of the intervertebral foramen by Increased lumbar extension, leading to spinal nerve root compression (Kisner, 2007). © Approximation of the articular facets.(Kisner, 2007; Gross, 2009). © Increased weight on posterior vertebral arch structures © LBP and myofascial trigger points from hypertonicity in these muscles and exaggerate the lordosis.(Chaitow, 2009) © spinal pathology such as facet joint dysfunction, disc herniation, spondylolysis, or spondylolisthesis can result. .(Chaitow, 2009) » 06 

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Lordosis relationship with age, gender and sport The lumbar spine in the child has an exaggerated lumbar curve, or excessive lordosis. caused by the presence of large abdominal contents, weakness of the abdominal musculature (Magee, 2006). Beginning at approximately 9 years of age, there seems the low back. The deviations should becom: pronounced as the child grows older (19,22) ل ا تفت 000 تا مر تس ‎ee Oe (Ole ©00000(.‏ و تا 

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Lordosis relationship with age, gender and sport (Sores) Wes hor er Sh mE Ce Si ret) زن 40.26412.19 21 46.92 4 50.342 51.22415.29 4 45.966 caer مرد 34.45 2-4 39.20 2110 41462 6 40.52+10.35 37.37411.21 

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Lordosis relationship with age, gender and sport ا ‎ana aa ee‏ ری ا ‎eto MeL Ae vaGl Ole) ®‏ ۱ 1 ‏یساس‎ ‏سره‎ ‎0 ‎Geb et dl, (OO: 

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rdosis relationship with age, gender and sport ie ed ee ON ‏رطق ,مهو اس و))موسحت طن ما‎ 3 in * Lords oad hypetordosis were the wort prevdicat cpoeny the ‏مص‎ (90.0%) ard adult (P0.2%) Pounder respectively ‏ا موه(‎ a. OOS). any a y= nC ۳ ۳ on eed ‏رايا عجوب‎ rae ee 6 0١ | ۱ 

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rdosis relationship with age, gender and sport مهم م۱۳ ‎®C ad "climber's back" was‏ ‎characterized by an increased thoracic‏ ‎kyphosis, increased lumbar lordosis.‏ ‎The climbing ability level was strongly‏ ‎correlated to the postural adaptations.‏ ‎rls LON)‏ ] le rene Weed tee eee ‏جا نوت امي سسكام عه دز تمصي‎ ‏ی‎ ‎0 ‏عا) لدع‎ 0, ۳۵۱ 1, 3 

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EO a Re ek ete a ee nee ee eee ec ee a eee ‏ا‎ ‎See ‏مظاك جا عسوي أصد أله مرجت لحب جو 19) صيصب‎ ke eden Oe ence Mem om Oar 000). , Ohta P. , (999). 

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عد سس ]| IAD pie — 

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Sustained faulty posture and repetitive movement * Dueole thot ie repeated) plaved tao shortewed poviivc, suck uy the topsvas cowplex dori sitter, wall ‏بلصت‎ ‏ممح جا لجنا 001 لجل‎ short (U0 A). © Repetitive movement Ava a. ۳ also affects everyday ١ ‏سس‎ ‎people Waiters and waitresses, much the same as a mother incorrecto carries her child. 

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Sustained faulty posture and repetitive movement * Repetive woveweus cod COUP ‎decors ost ert‏ رما روا وا ‎waste yroups wore prececviceniy. Phir‏ ‎lets‏ توح ‎of‏ مايه ‎hea‏ لمم ع ‎ears.‏ اس ما ‎ 

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leads to id substitution ists (hamstrings) lizers (erector spinae). LE ‏سم‎ Figure 3.5 Altered reciprocal inhibition and synergistic dominance. 

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Heavy abdomen: Pregnancy or Obesity ~ As the pregnancy progresses,both forward rotation and hyperlordosis increase as the sacroiliac ligaments become lax. These factors contribute to increasing mechanical strain on the low back, sacroiliac, and pelvis (Ritchie, 2003). هو مها مارا اج سوب ‎Nhe‏ * ‎exercises redures‏ مصاع يوام م2 ‎sk be cxrober of‏ تسا لم فلوسا لس جيه ‎prevrswes,‏ ‏یی ‎coon went rekdted ws SS back pata‏ تا له رل لعو .مطح حا “اه تلایا ‎COO).‏ ساس ه00) e008). LW 

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Curve is greater veight women 

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Compensatory mechanism that result from deformity, such as kyphosis ~ Lumbar lordosis had significant correlation with thoracic kyphosis(Lee, 1999). ~ 65% of individuals with Schuerman disease, 27.8% of postural kyphotic individuals (Vanzi, Chih , Meves , Caffaro, and Pellegrini , 2007). ~ Kyphosis and lordosis increased and mobility decreased in the 90 children who were examined both at age 5-6 and 15-16 years. The relationship between kyphosis and lordosis decreased in girls but not in boys (Widhe, 2001). ۶ A definite correlation exists between the presence of idiopathic lumbar scoliosis and hyperlordosis of the lumbar spine. (Pelker and Gage, 1982). * A positive correlation was also observed between the ranges of the kyphosis and lordosis in most of the age-groups (Willner and Johnson,1983). 

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wearing high-heeled shoes! ee ae tle eg ers mopar hee tyre Oe ee eee ei Be hee vcd ced fee ek focivaica were deoreused. The back ‏لاه ای‎ ‏وه‎ did ant ater heir uvtvities. (DEOO1K, ۵60660۵۵0۵, eral KLOODGCO, (OF). Although other effects, such as decreased gait speed and step length, and increased knee flexion at heel strike have been found in more than one study, no increase in lumbar lordosis has been found. The results indicate that the greatest compensation is at the ankle and knee. Where a significant effect occurred in the lumbar spine (males, dynamic study), high heels decreased the lumbar lordosis(de Lateur, Giaconi, Questad, Ko, Lehmann, 1991). 

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eeled shoes 9 errata phe hoewates carer cat ‏مس اج و بت ال ما اما‎ “he kore Blxica ond ache prntorPexica faoreased io hktcherted crat(Gooni WL, Yoo WY’, Wa GO. 199°). 

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eeled shoes 1 (Rosie herd arkmara of bere brocht cht miei br ore sree ‏و رن امه ات مه و وه لو لوا ماما را ام‎ keel inckrtion. Clairdly, potas wit buy back pas say be ‏تخل‎ by hicks heel ‏سي محص مووي‎ of ‏طخ مس‎ oro kab ‏متعم )ما‎ ‏روا اس رم ما‎ (98). ۶ 6/۳۵ Prow a chair while weartey high-heeled shoes dewoads siqnificcrat C6 and RP wore ‏وب لاو لو توص ۳۲ .مین‎ bekoviors dur to usr tobdkrae (Kier et ol. COA). 

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eeled shoes ‎Rerenior spe oouiy wes observed iPro Plexiza ord‏ و م6 ‎high kell shoes. The probaced‏ وت ی مروت )روط ری ‎wearer oP shoes wal stlet yr buy cad high heeks by teedvickraks wiht backs pot‏ با سوه مس و ماه مالعا رو ‎eon sae Bor their spin oes‏ :(0006 رازه( ‎Olhsy , Ditohacays,‏ ‎ ‎ 

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A corrective exercise is only as -good as the assessmen ess (NASM) 

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Health risk appraisal ۱4۱۹ Vr Ra eae Ce eee eee captor od fer gptoiory ort veer stcedkoy of the tedviduel’s physical meadtioc aed ot dor provider | ee ‏ب بوب‎ 

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2. 6۳۱۵۲۵۱ ۱۱۲۵-5۲۷۱5 

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Questions Yes No بره What is your current occupation? 2 Does your occupation require extended periods of sitting? re extended periods of repetative 3 Does your occupation movements? (If yes, pleas 4 Does your occupation require you to wear shoes with a heel (dress shoes}? 5 Does your occupation cause you anxiety (mental stress)? ۱ eo Te ‏ا اي‎ A Ne 0 ‏ات‎ 

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MENTAL STRESS Oe eee eee eel oe ee eat a) ee tae eee ee 

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ا REPETITIVE MOVEMENTS , a ee en ee de cna cian cake (oye een 

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RECREATION Refers to an individual's physical activities outside of the work environment. . For example, many people like to golf, sh nnis, or engage ina NZ Ta inlet Colao RCN Teoma IL Better designing of a program to fit the: ‏إمأعط دع5دع]]5 01 كعم لاغ عاغ مه غطوأكما دعل ألام,م‎ that can lead to muscle imbalances 

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‎HOBBIES‏ ت ‎Hobbies, refer to activities that an individual may partake in regularly, but are not necessarily athletic in nature gardening, working on cars, reading, watching television, and playing video games ‎In many of these cases, the individual must maintain a particular posture for an extended period of time ‎ 

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MEDICAL HISTORY ۱ (eek an ome a a ‏راجت 9( ,ای‎ cena one pce ‏بوه مج‎ 

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Past Injuries ON eee ne nea eee oe] 

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Past Surgeries ‎eer Re UT Cle els hy‏ ات بل فلت بات ‎and may have similar effects to those of an‏ ‏۳ بو ایا ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎Gr‏ اللا ل ال اا نت9 ات یر ‎Appendectomy (cutting thr ۳۹‏ ‎1 ‎ ‎ 

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Static postural assessment: ۱۱ جمعخصام عاط" ب عجانذ3ا) ” ‎SEA A‏ ا ۱9 اه وت وتا ۳ * . 7. Levent (eC mee. 

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* Static postural ‏5و2‎ 66506۳۱ LOTERGL O1EO ee nea ce atone Relat et ee cures cee oe Od enter nea eens Ce ea eee ‏و‎ Gee eee 0 

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Movement assessment See Racer (Oh Ga ext oub eC EUR sel Ke leex NC Om CeCe NC Od Ne) 4100 a eae eee ne ae ee ee ee وت معتهممما كلقط معطلالا ‎muscles that are underactive around a join’‏ terms “overactive” and “underactive” are usec Pav a Roe mute acne on mate necessarily to its own normal functional capacity. At altered length-tension relationships or altered reciprocal ir three) (10). This results in an altered recruitment strate T= Clee uu co lesen ‏کف ری‎ the use of the kinetic chain checkpoints to 5 detect compensation in joint motion, inference: as impairments can be made (1-3,9,10). 

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Movement assessment: O. Proasiticcad ‏و‎ ‎0 (Cris) fon seo Eyer 

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Transitional Movements Assessment Dee 200 eed woovewed wih a cham i ooe's base oP support (DBGO). ۱۹ ra Se teen eee ae ad ‏موی تسپ‎ 9 ce ee a ‏سم‎ eee eee eee tee ee ‏ا ل‎ cana 

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0002 CBSGEGGOEDT Overhead Squat Position * PROCEDORE 0 ‏تس کی‎ ‏الي سیم‎ ©. Cows Puy ‏و وت‎ ‏ل ا‎ 3-57 oe 

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—————— LL = &5X > * Transitional Movements ‏شظيضش(5”‎ ‎Assessment 0 5 ما۱۳ و کت لصتم تست لصا وگ Probable Probable Underactive Overactive Muscles Mucele< Hip Flexor Gluteus Maximus dct eh Complex Hamstrings Erector Spinae _ Intrinsic Core Stabilizers Latissimus Dorsi 

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MODIFICATIONS TO THE OVERHEAD SQUAT ASSESSMENT Heels Elevated 1 1 te sireick (or extecsbity) recnied eed eg eae ed een eee ee ee eee 0 0 ۰ 

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bee ae ee ee ere ‏ل ا‎ SQUAT ASSESSMENT ‎a ee oe‏ سا ‎PRN aN rp ee le ‏ل ل يمي‎ ‏ا يي ل‎ ‏ل ين‎ eR ‏يي‎ ‏ا ا ا‎ a ‏مت‎ Roa ‎ ‎0 

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* Transitional Movements Assessment "0 Na A a eS Ree Cen eA ai Ee ae RO De eC aac ast ROAM ke ee Pa ee oe ee 2 0 ‏ل ل‎ ea) oe See ae Push-Ups Assessment, Compensations Probable veractve Probable Muscles Underacte Muscles ErecorSomae tsi Coe Stes Hp Fos Gites Maxis eee 

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* Transitional Movements Assessment PULLING ASSESSMENT: STANDING ROWS ‏رفری ریا‎ CRC 000 ‏مرچ‎ i acavana Oe er ae ee ey Probable Probable OveractiveMuscles Underactive Muscles Hip Flexors, Brector Intrinsic Core Spinae Stabilizers Low Back Arches EE 

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* Transitional Movements Assessment 6 ما« »> . stand wk Peet shouder-utdis wat ond pee potty Porward. ©. Choose a deobbel weight which ‏الق‎ vac perPora (0 repetiows vowPorkby. 

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* Transitional Movements Assessment * STANDING OVERHEAD DUMBBELL PRESS Standing Overhead Dumbbell Press Assessment Movement 9» Probable Overactive Muscles Probable Underactive Muscles Hip Flexors Intrinsic Core Broctor Spinae Stabilizers Latissimus Dorsi Gluteus Maximus tne arms bisect tne ears ea Ee wea oe 

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shoulder flexion test * PROCEOORE ee Ld 8201706۶ م۱ 

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DYNAMIC MOVEMENT ASSESSMENTS: Gait assessment ‎Tee 0‏ از لت مت وه مه موه و چم ون ‎ 

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0 تفص لك 0 Treadmill Walking Assessment Compensations Probable Overactive Muscles Probable Underactive Muscles Hip Flxoe Complex luteus Maximus Intrinsic Cone Stabilizers Hastings ا ‎ae‏ وه وه سس مت توص هت تست ۱3 836) 87665 

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Assessment Implementation Options Pe ee el ee ao ol ai Depending on one’s physical capabilities, choose تا ای وتات یت perform safely ‎that take‏ د ‎lala‏ 45-001۳۴۷۱۵ 10 -30 وط۲ع۵۴۴ ‎a NET Tc‏ سا انلیا ا ‎ea ate‏ ‎findings can be a way to help generat‏ ا ا للا ‎ ‎ ‎ ‎ 

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لفل ف امف 0006 ١ Compensation Potential ROM Observation Low back arches Decreased hip extension Decreased shoulder flexion Decreased hip internal rotation 651) 2008111, 665656655002001“ Compensation One or More of the Following Muscles Test “Weak” Low back arches Gluteus maximus, hamstring complex, or abdominal complex 

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ا ‎aa‏ ال يي ل يي ی مت جما ف جامصا وباسجامات با اس و بت زب هروا ‎ed‏ * er en ne ‏ماسب‎ ‎RCs ‏ا‎ ‎eee Retro ene eats ead : ‏ا سي سي مایت ری‎ 0000 ‏ل‎ ete Seed 

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تلبت یرب تیب ادا ‎Hip Extension Assessment, Measurement‏ 

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جما , (لاسسه ‎ee ae ee a Oe‏ * الجمصاا صممصص جد جد لحت بوطلاصيم ‎See ata‏ وف ا ا ل ال الي ل 7 ا الا Od ed eee eed ne Se en 

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Shoulder Flexion Assessment, Measurement ° Ahokday he leds are tt exterod rokion, place he tucob oo te ferd border of the sap ut wd pestel flex he shoudler ul excesee srapder wovewed & Pet or the first reset barter & wied. 

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Strength assessment Table 8.2 Numerical Score Level of Strength Norm (uses oth Weak (little to no actis مت مسقم صل .(©,6,6) اسجيجمي لممسمي "ا ب قاد بطم مسومم لانن مهم لجمجو رمات ن ”ابر ‎SIRO‏ ‎ee ce oe ss‏ ا ل ا ل 00 ‎eames cnet‏ ا ا ا 0 Pete tate ‏معط‎ )6( درم + 6 

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1203 ٩601 Step 2 lace muscle in shortened position, or to point of joint» Place muscle in midrange position and retest compensation strength Ask client to hold that position while applying pressure, * If muscle strength is normal in midrange, Gradually increase pressure. there may be opposing m Client's strength is graded joint hypomobility—inhibit and lengthen, If client can hold the position without compensation If the muscle is weak or compensates in mid- then the muscle is noted as strong. range position, the muscle is likely weak— If the muscle is weak or compensates, move to step 2. reactivate and reintegrale. 

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0 ا ل ل ل ا غ2 | 1 eS OR ‏ل ا‎ Medial Hamstrings Assessment, Execution 

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8 ‏اک‎ ‎[۱ Cre (atric 0 CnC en eel Choon Pree Tet Ne ed ne oe ea eee Rn eee NC nce oe aed a crete) Teeny tet ner Rectus Abdominis Assessment, Execution 

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۱ ‏کر کر‎ Ore Cates crane ae Pee a Ce ee aed er ee ‏ا‎ ‎Leer ‏ا ا‎ ed eed cee Oc Uae rw Oblique Abdominals Assessment, Execution 

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۱ مه 0 [eee coe eee cos eee eee cee cee 0 ans Sees en ne ene Fe ener one Co ee fee cans et ee Sas 0 cee ‏ااا‎ زز0‎ ادص بايا وات 00 ,© Latissimus Dorsi Assessment, Execution 

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0 CON ead Oe a ec FON od cone BORO eae eto eed Cc ee a Mer even near oot coer teres ON Ca are RO ered cece od ee oe Gluteus Medius Assessment, Execution ] this tr sich exterad roktioa ‏سل لو‎ + Bpply yrakd oad 0 to te kierd epee oP he buver ky het cbove the ack tet ta bor epee oP ‏سا‎ ده لت 

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_-— CORRECTIVE-EXERC! 3 CONTINUUM ‏عم‎ انان ی یب دنت تا ‎Integrate‏ اس Lengthening Activation techniques techniques Static Positional stretching isometrics Neuromuscular \solated stretching strengthening 

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:Self-myofascial release .a flexibility technique used to inhibit overactive muscle fibers SMR can be used for two primary reasons: 1. To alleviate the side effects of active or latent trigger points by holding pressure on the tender areas of tissue (trigger points) for a sustained period, trigger point activity can be diminished. This will then allow the application of a stretching (or lengthening) technique such as static stretching to increase muscle extensibility of the shortened muscles and provides for optimal length-tension relationships. ٠ ‏وه‎ 

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© 2. To influence the autonomic nervous system ©The importance of the effect neuromyofascial release or pressure and tension has on the autonomic nervous system is that it influences (6): 1. The fluid properties of tissue that affects the viscosity (resistance to flow or motion). 2. The hypothalamus, which increases vagal tone and decreases global muscle tonus. 3. Smooth muscle cells in fascia that may be related to regulation of fascial pretension. + 80 

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ctivation * Activation refers to the stimulation (or reeducation) of underactive myofascial tissue. ® Isolated strengthening: ® To isolate particular muscles to increase the force production capabilities through concentric and eccentric muscle actions. Isolated strengthening is a technique used to increase intramuscular coordination of specific muscles. 

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6 ‏مصمناتعو۴‎ isometrics: © incorporates isometric contractions performed at the end ROM of a joint. It is a static technique meaning that there is no active motion. This technique would be more appropriate for a person with adequate core strength and neuromuscular control as it will involve higher intensity contractions or force. Like isolated strengthening techniques, the purpose of this technique is to increase the intramuscular coordination of specifi c muscles necessary to heighten the activation levels before integrating them back into their functional synergies. 

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۱7 rl Integration © Integration techniques are used to reeducate the human movement system back into a functional synergistic movement pattern. The use of multiple joint actions and multiple muscle synergies helps to reestablish neuromuscular control, promoting coordinated movement among the involved MUS Che sitet sterner ‏ص دعاس سل‎ 

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® urthermore, it is known that multijoint motions promote and require greater intermuscular coordination to achieve the desired outcome and is often the reason for their use (1). 1. Enoka RM. Neuromechanics of Human Movement. 3rd ed. Champaign, IL: Human Kinetics; 2002 © Intermuscular coordination: the ability of the neuromuscular system to allow all muscles to work together with proper activation and timing between them. 

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۲: 12 1-6 (۲ O : ۳-۲ (۱ © KEY APPLICATION POINTS FOR-SELF-MYOFASCIAL RELEASE : °. Outetctes proper posturd ‏وم اب سم‎ GOR, * 0, ‏موه(‎ | drawtecte ameuver ot dl thoes to provide stdbliy to te keobo-pebic-hip powrlex, 9. The cleat way we hie pr her pxirewties to dlr the amount oF wet oo he treckoedt ord, Roll the device shy over the treokvedt aed to decrease the risk oP Purher tose exctoicc. ©. Rekoe oad wot tchied up while Wworkteg oo om aed. Teosioa ta he true betay trevied wil ‏اج‎ ‎he roler Prow pevetrotieg hip the deeper kyery oP eo tour. ©. Pause te rolog wien per poPl afer voto “reese” ts Pel ta he aed pr the poto subsides wad the tome spew (rok OO sevouds wi waxed pds eras ond OO sevoads Por bower pas tberoure) (©). 

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Corrective Exercises for Hyperlordosis Daily (unless specified 1 ‏وله‎ Hold tender spots for 30 to 90 seconds otherwise] depending on intensity of application Self-Myofascial Release (دارمط۴۵ مساع0) ۴۱۵0۲ ون 

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‎od‏ او ایا رای ‎ ‎Daily (unless specified n/a 1-4 20- to 30-seconds hold otherwise} ‎60-seconds hold for older patients (265 years) ‎Example Static Stretches: Static Kneeling Hip Flexor Stretch ‎ ‎ ‎ ‎ 

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Static stretches Erector Spinae 00۲5 وباطاکوناها 

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Rata eae Gate epetition | Contraction: 7 to 15 seconds | Stretch: 20-30 seconds | Intensity: submaximal, approximately 20-25% of maximal contraction —_— +ممواع مزيا Daily (unless specified otherwise) 

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ACUTE VARIABLES FOR ISOLATED STRENGTHENING Frequency Sets Repetitions Duration of Rep 3-5 days per week 1-2 10-15 2 seconds isometric hold at end-range and 4 seconds eccentric Step 3: Activation Key activation exercises via isolated strengthening exercises and/or positional isometrics include the gluteus maximus and abdominal Standing gluteus maximus, [J Standing gluteus maximus, ۳ ‏ون‎ es ۹ 

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۱ Cld CCl 

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Example Isolated Strengthening Exercises: Abdominals/Intrinsic Core Stabilizers Quadruped arm/opposite leg raise, start ‏و۱۳۱‎ ue see hee iu 0 واة رت 

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Frequency Sets Repetitions Duration of Rep 6, 50%, 75%, rest between | As needed 1 4 4-second isometric holds at and 100% MVC (2 second contractions) 

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ACUTE VARIABLES FOR INTEGRATED DYNAMIC MOVEMENT 3-5 days per week 1-3 10-15 Slow and controlled © Step 4: Integration © An integration exercise that could be implemented for this compensation could be a ball squat to overhead press. CURT Take) Ball Squat to Overhead ‏(طعتصاع) ووعمم لت ترا‎ 

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متسه :۶ موی ۰ © This exercise will help teach proper hip hinging while maintaining proper lumbo- pelvic control. Adding the overhead press component will place an additional challenge to the core. The individual can then progress to step-ups to overhead presses (sagittal, frontal, and transverse planes), then to lunges to overhead presses (sagit-tal, frontal, and transverse planes), and then to single-leg squats to overhead presses. 

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© There is high prevalence of hyperlordosis and there are lot of related complications, so the importance of addressing this abnormality is cleared. © There is a relationship between lordosis and age, gender and sports, which must be considered while developing a corrective exercise program. © Common causes should be addressed in order to achieve a effective and persistent goal. © A corrective exercise program is only as good as the assessment process. 

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© 1. Magee, David J. (2006). Orthopedic Physical Assessment (4™ ed.). saunders elsevier: Philadephia © 2. National Academy of Sports Medicine. (2011). NASM Essentials of Corrective Exercise Training. Baltimore: Lippincott Williams & Wilkins. © 3. Gross, Jeffrey M; Fetto, Joseph, and Rosen, Elaine. (2009). Musculoskeletal Examination (3" ed.). Wiley-Blackwell. © 4. Lowe, Whitney W. (2009). Orthopedic Massage: Theory and techniques (2° ed.). Mosby Elsevier. © 5. Youdas, James W; Garrett, Tom R; Egan,Kathleen S; Therneau,Terry M. Lumbar Lordosis and Pelvic Inclination in Adults With Chronic Low Back Pain. Physical Therapy . Volume 80 . Number 3 . March 2000. ©» 6. Patel, Kesh. (2005). Corrective Exercise: A Practical Approach. London: Hodder Arnold. 

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سنا © 7. Borg-Stein J, Dugan S, Gruber J. (2005). Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil;84. © 8, Min H. Kima, Chung H. Yi, Won G. Yoo c, Bo R. Choi. EMG and kinematics analysis of the trunk and lower extremity during the sit-to- stand task while wearing shoes with different heel heights in healthy young women. Human Movement Science xxx (2011) xxx-xxx. © 9, Malgorzata Grabara, Andrzej Hadzik, (). Postural variables in girls practicing volleyball. Biomedical Human Kinetics 2009; 1, 67 - 71. © 10. Editoral Borad. Performance Conditioning Volleyball 2006; (13):3. © 11. Nissinen M. Spinal posture during pubertal growth. Acta Pediatrica 2008; 84(3): 308-12. © 12. Bahrami M, Farhadi A. The investigation of the incidence and causes of deformities in upper and lower extremities of teenagers’ boy and girl between 11-15 year-old of Lorestan province. Journal of Scientific Research of Lorestan University of Medical Sciences 2006; 8(4). 

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© 17. Nazarian AB, Daneshjoo AH, Ghorbani L, Ghaedi H. The prevalence of lordotic and kyphotic deformities among different age groups. Research in Rehabilitation Science 2009; (5)1. © 18. Cintia Zucareli Pinto Ribeiro, Paula Marie Hanai Akashi, Isabel de Camargo Neves Saccol and André Pedrinelli. Relationship between postural changes and injuries of the locomotor system in indoor soccer athletes, Rev Bras Med Esporte 2003; (9)2 . © 19. Mika, Anna; Oleksy, Lukasz; Edyta, Mikotajczyk; Marchewka, Anna. Evaluation of the influence of low and high heel shoes on erector spine muscle bioelectrical activity assessed at baseline and during movement. Medical Rehabilitation 2009, 13 (3), 1-10. © 20. Hainline B. Low back pain in pregnancy. Adv Neurol; 1994. 64: 65-76. 

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© 21. Kargarfard M, Mahdavinezhad R.,Ghasemi Gh.A.,Rouzbahani R.,Ghias majid, Mahdavi Jafari Z.,Dehghani Mahdi. Assessment of Spinal Curvature in Isfahan University Students. Journal of Isfahan Medical School (i.u.m.s) 2010; 27(102):762-776. © 22. Tsai, Li; Wredmark, Torsten; Spinal Posture, Sagittal Mobility, and Subjective Rating of Back Problems in Former Female Elite Gymnasts. Lippincott-Raven Publishers. © 23. VL MURRIE, H WILSON, DCR, W HOLLINGWORTH, NM ANTOUN, and A K DIXON. Supportive cushions produce no practical reduction in lumbar lordosis. The British Journal of Radiology, 75 (2002), 536-538. © 24. C. KISNER, and L. A. COLBY.(2007).Therapeutic Exercise: Foundations and Techniques (5" ed.). F. Philadelphia: F.A. Davis Company. 

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0 © 25. Katherine K. Whitcome, LizaJ. Shapiro, Daniel E. Lieberman1 Fetal load and the evolution of lumbar lordosis in bipedal hominins. Vol 450] 13 December 2007| doi:10.1038/nature06342. © 26. Fahrni, 1976; Finneson, 1981; Kendall, 1983; McKenzie, 1981; Wiles, P., and R. Sweetnam,1965( ©27. Gharahgouzlou, F. Investigating the prevalence of upper extermities postural anomalies in lifting load workers in behshahr industrial factory. Behbood, summer 2000; 4(1):58-64. © 28. Lasjouri Gh.,Mirzaei B. The prevalence of postural deformities in pupils aged 11-13 and their relationship with age, height and weight factors. research on sport science spring 2005; 3(6):123- 133. 29. Willner S, Johnson B. Thoracic kyphosis and lumbar lordosis during the growth period in children. Acta Paediatr Scand. 1983 Nov;72(6):873-8. 

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© 30. Youdas JW, Hollman JH, Krause DA. The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain. Physiother Theory Pract. 2006 Nov;22(5):229-37. © 31. Milne, J.S.1; Lauder, I.J.cAge effects in kyphosis and lordosis in adults. Annals of Human Biology, Volume 1, Number 3, Number 3/July 1974 , pp. 327-337(11). © 32. A Review on Postural Realignment and its Muscular and Neural Components Young, 2001) © 33. Watson, A.W.S. (1983). Posture and participation in sport. Journal of Sports Medicine and Physical Fitness, 23: 231-239. 

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#34. Forster R, Penka G, Bésl T, Schi . Climber's back-form and mobility of the thoracolumbar spine leading to postural adaptations in male high ability rock climbers. Int J Sports Med. 2009 Jan;30(1):53-9. Epub 2008 Jul 23. #35. Neville V, Folland JP. The epidemiology and aetiology of injuries in sailing. Sports Med. 2009;39(2):129-45 doi: 10.2165/00007256-200939020- 00003. "36. Wojtys EM, Ashton-Miller JA, Huston LJ, Moga PJ. The association between athletic training time and the sagittal curvature of the immature spine. Am J Sports Med. 2000 Jul-Aug;28(4):490-8. 587. Uetake T, Ohtsuki F. Sagittal configuration of spinal curvature line in sportsmen using Moire technique. Okajimas Folia Anat Jpn. 1993 Aug;70(2- 3):91-103. 

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© 38. Lee CS, Oh WH, Chung Ss, Lee SG, Lee JY. Analysis of the Sagittal Alignment of Normal Spines. © 39. Opila, K.A. Gender and somatotype differences in postural alignment: Response to high-heeled shoes and simulated weight gain. Clinical Biomechanics . Volume 3, Issue 3, August 1988, Pages 145-152. ® 40. Franklin ME, Chenier TC, Brauninger L, Cook H, Harris S. Effect of positive heel inclination on posture. J Orthop Sports Phys Ther. 1995 Feb;21(2):94-9. © 41. Widhe T. Spine: posture, mobility and pain. A longitudinal study from childhood to adolescence. Eur Spine J. 2001 Apr;10(2):118-23. 

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42. Pelker RP, Gage JR. The correlation of idiopathic lumbar scoliosis and lumbar lordosis. Clin Orthop Relat Res. 1982 Mar;(163):199-201. 43. Bendix, tom md; sorensen, steen schou; klausen, klaus. lumbar curve, trunk muscles, and line of gravity with different heel heights. march 1984 - volume 9 - issue 2 . lippincott-raven publishers. ©44. Song SH, Yoo JY, Ha SB. Comparison of Gait Analysis Using High- heeled Shoes and High-forefoot Shoes. J Korean Acad Rehabil Med 21(5):1003-1009 Oct 1997. 45. Brent S. Russell, The effect of high-heeled shoes on lumbar lordosis: a narrative review and discussion of the disconnect between Internet content and peer-reviewed literature. Volume 9, Issue 4, Pages 166-173 (December 2010) gournal of chiropractic medicine. 

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کاشانیان اکبری و علیزاده. ورزش بر میزان کمر درد * و قوس کمری زنان حامله. دانشگاه علوم پزشکی ایران؛ 45-40 :)69(16 ۰ دانشمندی, علیزاده و قراخانلوءحرکات اصلاحی» سمت: 1387 ۰ ‎elt.‏ حسن جزوه منتشر بشله ن.کمالی؛ م. حاجی احمدی, م. کشانی و . محبوبی. تاثیر جنس و چاقی روی دانشگاه علوم پزشکی بابل» ۱۳۸۲؛ 0۳(0: ۲۳-۱۸.اندازه لوردوز کمر ‎ ‎ 

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