Therapeutic stair climbing

Effects

Preparation

Special preparations are not required, as most working ranges are around anatomically zero. In the case of contracted hip flexors, see the details.

Follow-up

Diagnostics

Instructions

1. Find a sufficiently long staircase, depending on the weather and your taste in the great outdoors.
2. Place your first foot fully on a step and start climbing the stairs by lifting your body onto the next step using the strength of your hip extensors and leaning slightly forward. Then turn the same leg into a standing leg and place the other leg on the next step, etc.
3. For each subsequent step, place your foot fully on the ground and avoid pushing forward and upwards from plantar flexion in the ankle. Continue to avoid falling into a swinging ascent, but take each step powerfully one after the other.

Details

1. Perform the steps to the next level with consciously powerful hip extension, avoiding any supportive plantar flexion in the ankle joint of the rear leg when this is at the end of the supporting leg phase, as the triceps surae would then take over part of the propulsion that does not have to and cannot be performed by the hip extensors. It is particularly important to use the gluteus maximus powerfully, which tilts the pelvis slightly backwards, which reduces the lordosis of the lumbar spine towards a steep position or, rarely, even causes flexion of the lumbar spine. With the subsequent swing of the leg forwards and upwards from the force of the hip flexors, the inertia of the leg generates a torque in the hip joint at the same side, which tilts the pelvis forwards at the top, i.e. in the opposite direction to before, so that the pelvis alternately tilts forwards and backwards at the top. These forces must be absorbed as well as possible by the autochthonous back muscles accompanying the lumbar spine in order to provide the leg and pelvis with a stable abutment for propulsion. This is the same mechanism as in sprinting. The resulting work of the regional musculature can alleviate the best hypertonus and at the same time put hypotonic muscles under higher tone and strengthen them, thus counteracting muscular imbalances in two ways.
2. Avoid getting into a forward-upward swing so that the hip extension that accelerates the body forward-upward must be performed as forcefully as possible. It is as if you were taking a 1/16 pause between each step.
3. In addition to the effect on the muscles directly involved in stabilizing the pelvis for its support function, this complex movement process has an effect on other muscles in the lower trunk, hip region and legs, which counteracts the tendency to tension that often arises secondarily as hypertonus resulting from pain avoidance.
4. If the hip flexors are contracted, which regularly increases the tendency to lumbar complaints, as the resulting hollow back leads to hypertonicity of the muscles, the pelvis will tilt backwards less than desired at the end of the standing leg phase, especially if more than one step is taken at the same time. It is possible that the pelvis will remain permanently tilted forwards, which reduces the effect of the exercise and is not very suitable for reducing the hypertonicity of the muscles affected by the hollow back. In these cases, a short program to stretch the hip flexors can be performed as preparation.
5. It is advisable to start with one step per stage. In particular, if the pain triggering is still very early (in terms of the range of movement) and the pain intensity is still very high, the initial exercises will have to be limited to this. Later on, however, more than one step can be taken at a time. Depending on the execution and level of training, this can already approach basic cardiopulmonary training. This can be calculated using the usual methods for calculating the training zones as a function of maximum heart rate, i.e. age and possibly other factors.
6. The effect of climbing stairs can be increased if the speed is increased (without swinging!). In the same way, the pelvis can be deliberately tilted a little excessively forwards or backwards with a certain number of steps, but care must be taken to ensure that the tilting process is not strictly synchronized with the movement of a particular leg so that no one-sided effect occurs. The tilting must therefore be synchronized to an odd number of steps, for example in such a way that the pelvis tilts forward every 3 steps and backward every 4 steps (or vice versa), so that the odd number results in a regular change of side in the dominance of the odd number. It helps to count this in your head.
   In cases of a bending disc that tends to react adversely to flexion of the lumbar spine or a facet syndrome, spinal canal stenosis or spondylolisthesis that react adversely to extension of the spinal column, the tilting movement must be omitted or may only include the painless possible range. It is therefore important to differentiate between the pain phenomena typical of these disorders(neuroradicular or pseudoradicular pain) and the muscular complaints of lumbago.
7. It is not only in the case of shortened hip flexors that there can be a tendency to constantly tilt the pelvis more forwards at the top, i.e. to keep the hip joints in greater flexion than necessary. A lack of strength, particularly in the hip extensors, can also lead to this tendency. Another important reason is pain avoidance: it may be that lumbago-associated pain does not occur in further lumbar spine lordosis, but if the pelvis is only slightly tilted forward or consciously held upright, with the affected muscles regularly exceeding a certain geometry or a certain sarcomere length. If this is the case, it is advisable to approach this effect cautiously and try to utilize its effect, assuming that the resulting stretching stimuli on these muscles will cumulatively bring about an improvement in the symptoms.
8. Therapeutic stair climbing, like walking uphill, is well suited for muscular disorders such as lumbago, but also for less acute lumbar pain phenomena.
9. In cases where therapeutic stair climbing is used for lumbago, it is essential to ensure that any sweaty skin is dried and kept warm at the end of the exercise so that the muscles underneath do not cool down and cause the condition to worsen. In addition, a few stretches should be undertaken at certain intervals for the previously strained muscles.
10. If you want to continue climbing the stairs after reaching the end of the staircase, you need to get to the beginning of the staircase. This can often be done via the stairs or by taking a less steep detour. Depending on the condition of the back, the second option may be the easier method to avoid pain in the lumbar region. After all, descending a flight of stairs is fraught with moderate impacts if you descend the stairs as usual and not particularly gently. On the other hand, the usual descent can always be used as a status check of the lumbar region.
11. Disorders of the knee joints, hip joints or even a pronounced PHT can be a contraindication for this exercise. In the case of PHT, it is often not possible to take more than one step at a time. If this one step also triggers the pain typical of PHT, you can try to generate some of the propulsion from the plantar flexion, i.e. the triceps surae, contrary to the instructions above, which of course also reduces the benefit of the exercise slightly. If there is a disorder of the knee joints, a differentiation must be made according to the type of disorder; a disorder of the quadriceps including its tendon ( quadriceps insertiontendinopathy) prohibits the usual descent on the stairs more than the ascent. The same applies to retropatellar cartilage disorders(PFPS). Meniscus lesions will also make descending the stairs particularly painful.