Introduction

Dr. Jordan Berry // #ClinicalTuesday // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, Spine Division lead faculty member Jordan Berry as he discusses the reverse hyperextension exercise as the go-to exercise for the low back. The reverse hyperextension provides a decompressive effect on the spine, often reducing symptoms, while simultaneously allowing for strengthening & mobility through the full range of motion of spinal extension & flexion.

Take a listen or check out the episode transcription below.

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EPISODE TRANSCRIPTION

JORDAN BERRY Good morning, PT on Ice Daily Show. This is Jordan Berry, Lead Faculty for Cervical and Lumbar Spine Management Courses. Coming at you on Clinical Tuesday, we are chatting today about why the reverse hyper is king. We love the reverse hyper when we're either building strength in the back, trying to modify symptoms and pain in the back, but we're gonna talk about today about all the different exercises and machines, equipment that we have in the clinic when we're talking about the lumbar spine, why the reverse hyper is king. Before we get into that, just a couple upcoming courses. We've got a few spine courses left before the end of the year. So if you're trying to catch cervical spine management, you've got two options left this year. You've got November 11 and 12 is going to be in Bridgewater, Massachusetts right outside of Boston. And then we also have December 2nd and 3rd out in Hendersonville, Tennessee. So two options left for cervical spine. If you're trying to catch lumbar before the end of the year, you've got three options. You've got Fort Worth, Texas coming up November 4th and 5th. And then two options, December 2nd and 3rd. We've got Charlotte, North Carolina, and then Helena, Montana. So a few options left before the end of the year. We've got a ton of dates on the books already for 2024. So hoping to see you at one of those live courses either before the end of the year or maybe sometime in 2024. So let's dive into the content today. THE REVERSE HYPEREXTENSION So again, chatting about the reverse hyper and why the reverse hyper is king. So let's define king to start with. So when I think about an exercise, ideally it would do three things. So it would do a combination of reducing someone's pain, improving the mobility in the lumbar spine, and then building strength and endurance in their back as well. Like if I had one exercise that could do those three things, that's what I would consider king. So reducing pain, improving mobility and building strength and endurance all at the same time. And so yes, there are multiple techniques and exercises that we have that are incredible for reducing low back pain. but they don't do an awesome job at improving someone's mobility or strength. And then we've got exercises that are awesome for range of motion. However, they don't do a good job at reducing pain. And then of course we have some awesome exercises for building capacity and building strength in the lumbar spine, but maybe they don't do a lot for improving range of motion. What I'm saying is the reverse hyper is the king of all three of those if you package that up into one exercise. And so to start with, If you're not familiar with the Reverse Hyper, I would say YouTube it or look it up or try to find one even better and test it out in person. But if you're not familiar with that machine, there's a, essentially you're laying on a platform. So it's elevated a few feet in the air, almost looks like a GHD machine, but you're laying across it and you're holding it with handles in the front. So your torso's laid out on the area. and then your legs are essentially hanging off the side of it. So the pad that you're laying on hits right around the hip crease, legs are laying off the machine, and then it's plate loaded. So you have this pendulum underneath that you can load with weight, load with plates, and then the strap goes around the lower leg. And the exercise is essentially just contracting the posterior chain. So you're lifting the legs up and down, And then it's taking your lumbar spine through full flexion and full extension. And again, hard to explain verbally, um, on the podcast, but look it up on YouTube, um, get out to a gym that has one and test it out. But I want to talk about the three reasons why I think this exercise is king. STRENGTHENING THROUGH THE FULL RANGE OF MOTION So the first one is it's strengthening through full range of motion. Now, if we're just talking about building capacity and strength in the lumbar spine, no argument, the deadlift is king. The deadlift is an incredible exercise for building strength and capacity in the posterior chain. However, the deadlift doesn't utilize a lot of range of motion in the lumbar spine. Like, when we coach the deadlift, what we want to see is essentially straight lines. Straight lines or strong lines. So, we coach it to have a neutral spine position throughout, so the lift is more efficient, right? But, we're not actually utilizing a lot of range of motion for the lumbar spine. And we would never treat another joint like this. So, you know, if you're only utilizing hip hinge type of movements, then you're missing a ton of range of motion. And think about treating an Achilles tendon or rotator cuff. We would never utilize just a very small amount of the range of motion. We always talk about strengthening through the full range of motion. So why is the spine any different? So the reverse hyper, as you kick those legs up and down, right, you're taking the lumbar spine through full flexion and full extension. and you know an exercise similar to the Jefferson Curl in a way where we're utilizing a lot of range of motion of the spine but Jefferson Curl is much easier to cheat on because if you have really good posterior chain mobility then you can essentially do one massive hip hinge on the way down. And it looks like you're really utilizing lumbar flexion, but you're not. The reverse hyper, because you're locked in laying on the pad, it's much harder to cheat. And so we love this exercise for strengthening through the entirety of the range of motion. DECOMPRESSIVE EFFECT Now, second, there's what we call a decompressive effect. So on the actual reverse hyper machine, not a variation on the actual machine, you have this pendulum weight underneath that is plate loaded. And as you lift the legs up and down, that plate swings pretty far under. And so as you're flexing the low back, because the weight is underneath and has some momentum to it, you almost get this decompressive traction like effect. Now, why this is so awesome is this exercise can work for someone who has almost any levels of irritability. So, for high levels of irritability, like when someone's back is really jacked up and they have a lot of pain, it can sometimes be challenging to find an exercise that relieves symptoms and feels really nice. And you'll be surprised to find that for those individuals that can't tolerate other forms of exercise, they will really like the Reverse Hyper. And even the heavier you go on it, the better it feels sometimes because it's more weight underneath that is almost tractioning the spine. And in my mind, what I think is happening here is we're essentially creating a pump. So when we have that pressure gradient that we're creating, when you contract and relax and contract and relax, And that pressure gradient is going to essentially pump fluid and water into the lumbar spine. And I think about the couple of research articles that we referenced in lumbar management, they're both from Paul Beatty, 2010 and 2014. And he's looking at diffusion weighted MRI. And in the first study, we're looking at interventions like prone press-ups and lumbar PA mobilization. Second study four years later, lumbar spine thrust manipulation. But what they found in both studies is the individuals that had a significant symptom reduction, so a massive pain reduction, following the intervention, we saw an increase in hydration, the diffusion coefficient, in the discs in the lumbar spine. So essentially the discs brought in fluid, brought in water content, and that matched up to who had a significant reduction in pain. What do I think is a massive, massive pump that we could utilize in the clinic? It is the reverse hyper. So I can't prove that there's no research for that, but I would love to see something like that in the future. But I really believe that's what's happening is one of the ways that we're reducing symptoms is the diffusion coefficients. We're creating that pressure gradient is drawing in fluid to the lumbar spine and helping to reduce pain. I think that's why some individuals they have pretty high levels of pain, pretty high severity, are able to tolerate that type of exercise. SCALING THE REVERSE HYPEREXTENSION And then lastly, the third reason why the reverse hyper is king is it's easily scalable. So yes, the actual reverse hyper machine, the official true reverse hyper machine is a bit harder to find in commercial gyms, but there's a scalable option for pretty much anyone. You know, you could regress it anything from a GHD machine where you're on the backside of it. So you're holding with your hands where the feet would go and lifting the legs up and down. You could throw a band around the bottom of it and have some banded resistance. We could utilize just a bench. We could either lie on the bench and so the end of the bench would hit the hip crease and have our legs hanging off. Or we could go on top of a physio ball on the bench to get more of the curve in the lumbar spine that mimics the true machine. Or something as simple as just holding something at home. Like sometimes in the clinic for my clients that don't have a lot of equipment at home, I'll have them just lay across our coffee table or a bed or some sort of table that they have where the edge of the table hits the hip crease and they can just lift their legs up and down in its simplest form. It's an awesome exercise for, again, not only increasing range of motion, reducing pain, but also building strength and endurance in the lumbar spine. So there's pretty much a variation for anyone where you can mimic this type of movement. CONS OF THE REVERSE HYPEREXTENSION The pushback with the reverse hyper over the last few years has really been two things. Number one is the cost. The traditional reverse hyper machines were a couple thousand dollars and they took up a significant amount of space. So if real estate is an issue in the clinic, a lot of the old reverse hyper machines took up the space of about a squat rack. And so because of that, not a lot of gyms and not a lot of physical therapy clinics utilize that. But thankfully, a lot of companies are solving that issue. A couple companies like Rogue and Titan and a couple smaller ones are now making reverse hypers that are not only significantly cheaper, but are more compact as well. Some of them even fold up. So they take up pretty much no real estate in the clinic. So because of that, That is why we think the Reverse Hyper is the king of exercises for the lumbar spine. So again, there are exercises that yes, might be best for pain, might be best for building range of motion, might be best for building strength for any N equals one. But I'm arguing if you gave me one exercise that could do all three, I'm taking the Reverse Hyper all day. That's what I've got team. Thanks so much for taking a few minutes to listen. I would love to hear some thoughts on this. So if you're utilizing the reverse hyper, either in your personal training, um, just from a performance standpoint, or if you're utilizing it, um, in the rehab setting, I would love to hear comments, how you're using it, what you think about it. Um, drop those in the comments and, uh, and we'll chat about it. But other than that team have an awesome Tuesday in the clinic. Um, if you're coming to a cervical or lumbar course in the future, I will see you soon. Thanks team. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. 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