Introduction
At
some point in the fitness world, looking better became more important
than feeling better. With respect to chronic pain problems,
anyone who has dealt with them knows the importance of living a pain
free existence. It’s easy to ignore for many of us, but not
if you have pain constantly reminding you that you’re orthopedic
health is suboptimal. Lower back pain is, of course, one of the
most common culprits. Today I’d like to give you some
background on lower back pain, and offer some tips to deal with it,
thus improving quality of life and performance in the gym as well.
What
Causes Low Back Injury?
In
a more general sense, orthopedic pain is often caused by something
called a directional susceptibility to movement (1). In
essence, this is when a joint has a tendency to move in a particular
fashion whenever it is put to use, even if that’s not the joint
articulation that was intended to occur. Over time, this
excessive motion in a particular direction repeatedly stresses the
same tissues in the same way. It’s like hanging a door
improperly on it’s hinges, such that it sits at a slight angle and
rubs the door jamb in a particular spot. Even though you don’t
want the door leaning into the door jamb every time it’s open and
closed, it does so because it is misaligned and moves in an improper
fashion. Over time, this wears away at the door and door jamb
where the rubbing occurs. Now, imagine that the door is your
knee, and the door jamb is some other tissue in your knee, such as
the meniscus, or a ligament. You can see how over time this
could create an issue.
Directional
susceptibilities to movement occur from mobility deficits and poor
motor control, and they should be avoided if at all possible.
Imagine yourself bending over to pick something up. You
have to flex your knees, hips, and spine to get low enough to pick up
an object off the floor. However, there is a certain amount of
range of motion each of these joints should contribute to the
movement. Under a condition of poor motor control, one might
bend the lumbar spine far more than needed (Image 1 on the
left). Thus, the lumbar spine is showing a DSM into flexion, a
tendency to move into flexion all the time. This could even
extend to movements where no lumbar spinal flexion is needed at all.
Image
1 - Left: Excessive spinal flexion / Right: Appropriate spinal
flexion
Every
tissue in the body has a failure tolerance. At some point, if
subjected to enough load, the tissue would be damaged. However,
as illustrated by the point I made above with the door jamb analogy,
this doesn’t have to be one large load. Although a very high
load applied all at once can damage the tissue (e.g. a car accident),
so can repeated low level loading over a long period of time (2).
How many people have you heard of injuring their back bending
over to pick up a pencil, or turning to grab the phone? Think
about it: did bending over to grab the pencil really injure the
person? No, under normal circumstances the tissues subjected to
load during this action should have been able to handle the stress
just fine. However, after repeated low level loading from poor
movement, the failure tolerance for a tissue becomes drastically
reduced (2). This leads to a situation where it appears as
though a straw broke the camel’s back all by itself. In
reality, there was a lot of low level tissue stress leading up to
that.
It’s
not just repeated motions that can create issue. As well,
sustained postures of virtually any kind can lead to injury over time
through a phenomenon called tissue creep (2). Although sitting
all the time is a problem, sitting isn’t necessarily a bad thing if
not performed to excess. Even though white collar workers who
spend the majority of the time sitting show increased risk of lower
back injury, blue collars workers who are more physically active show
reduced risk of injury if they increase the amount of sitting they
do, suggesting that changing posture is more important than finding
an ideal posture (2). That said, with respect to lower back
pain, positions of excessive lumbar flexion tend to be more dangerous
because, as stated by Dr. Stuart McGill, they cause “myoelectric
silence in the back extensors, strained posterior passive tissues,
and high shearing forces on the lumbar spine. (3)” Translation:
deep flexion posture causes the muscles that extend the spine to shut
down, increase stress on tissues on the rear part of the spine, and
generate a lot of sliding forces on tissues in the lower back (Trust
me, this is really bad).
Too
Much Science... How Do I Get Better?!
Now
to the good stuff. I’m going to offer some general tips with
respect to reducing and preventing future incidents of lower
back pain. Notice the word general: these tips are not meant to
replace medical intervention. Not all back problems are the
same, and they shouldn’t necessarily be treated as such. However,
you may find this information a very valuable adjunct to medical
advice.
Stop
Stretching Your Lumbar Spine!
The
lumbar spine is an area of the body that is made for stability. It
is not designed for lots of range of motion, especially not rotation
(1). As stated previously, going too deep into flexion, even if
the lumbar spine is capable of it, is a bad idea because it causes
inactivity in muscles very important for dynamic support of the
spine. Yes, it may feel good at that moment, but that’s only
because of the sensory input overpowering the sensory input of pain
at the very moment. In the long run, you are doing more harm
than good. Instead, a lot of the motion should come from either
the hips or the thoracic spine, especially the hips during forward
bending (1).
Improve
Mobility in the Hips and Thoracic Spine
To
prevent unwanted motion of the lumbar spine, you need to be capable
of generating the necessary range of motion somewhere else to perform
normal activities. The nearby structures of the hips and
thoracic spine are the best places to start. This certainly
doesn’t mean mobility deficits elsewhere are unimportant, but these
are common offenders. In terms of rotation, much more rotation
should occur at the thoracic spine relative to the lumbar spine, and
bending over should happen primarily at the hips (1). Once you
regain this range of motion, make sure you implement it and be aware
of excessive motion in your lumbar region. Check out this video put out by Eric Cressey, a well respected strength
coach and trainer in the industry, to get some ideas on drills that
improve mobility in these areas.
Improve
Stability in the Lumbar Region
Core
work gets a lot of press these days. However, most core work
needs to be focused on preventing movement rather than creating it.
As indicated above, movements that typically occur where your
lumbar spine is involved need more motion to come from either the
hips or thoracic spine. Well, not only should you make the path
of least resistance easier by improving their mobility, but you
should also make the path of least resistance more clear by making it
harder to move the lumbar spine! You can classify theses as
anti extension, anti lateral flexion, and anti rotation. Classic
examples of anti extension and anti lateral flexion are the plank and
side plank respectively. However, anti rotation exercises tend
to be implemented less often. Here is a video showing some
examples put out by Bret Contreras, another highly respected trainer
in the industry.
Move
Around!
As
referenced earlier, sustained postures can be damaging to tissues
similar to the way that poor movement patterns can be. Thus,
you would be wise to change your posture as often as possible. Every
30-60 minutes stand up tall, stretch for a minute, or walk around the
office. One piece of advice I offer to clients of mine is to
take all their phone calls at work standing up. It’s an easy
way to start incorporating a different posture into your daily
routine at work. As frequently as you can, reposition yourself
to shift around tissue stress and stretch. Just find something
that insures you are regularly changing your posture; there is no
right way to do this.
Avoid
Spinal Flexion Early in the Morning
Upon
rising, the spine is a more fragile structure. The discs of the
spine are hydrophilic, and as such, fill with water overnight. The
result is that when you first wake up the discs are more prone to
injury (1). Avoid any stretching routine that places your spine
in deep flexion early in the morning, and avoid bending over as much
as possible for the first 1-2 hours you’re awake. If you’ve
ever had back pain, this may sound intuitive to you. A lot of
people report that the pain is more pronounced when they first wake
up, and diminishes as they move around and the day progresses.
Try
the Golfer’s Lift
Another
spine saver is the golfer’s lift. This is a move that
utilizes the back leg as a counterweight when bending over to avoid
spine flexion and reduce spinal loading in general. Image 2
below shows this alternative method of grabbing stuff low to the
ground.
Image
2
Improve
Glute Activation/Hip Extension
As
a trainer, I see people move in a way that doesn’t maximize gluteal
activation very often. It’s something I take a look at in all
my new clients. If someone has a lot of spinal flexion when
they bend over, it also means they need a lot of spinal extension
when they stand back up. This happens in lieu of much of the
hip extension that would normally occur. If you don’t
understand what this means, the essence of the idea is that people
stand up with compensation, using too much lower back musculature and
not enough hip (e.g. glute) musculature to produce the motion. There
are plenty of rotational/lateral movements that should occur more
from the hip that can cause issue if motion is produced from spinal
musculature. The bottom line is that you want to insure you’re
using them properly. Improper function of the glutes during
daily activities is referred to as “gluteal amnesia,” and is
implicated in back pain. Check out this video for some
ways to make sure your glutes are firing during some of the basic
movement patterns.
A
Synthesis of the Information
As
stated before, the nature of any back problem cannot be assumed to be
the same as another. However, these general tips allow you to
avoid sustained stress on the same tissues over and over again. The
bottom line is that improving the way you move, limiting extraneous
stress on the spine, and providing a variety of movements and
postures to your body will avoid overloading any one particular
tissue. This should help, to some extent, almost any back
problem out there. If you’re really diligent about creating a
healthier environment for your spine, I bet you’ll be surprised at
how much of a different it can make. This isn't just for people who
have problems either; a lot of this information is also prophylactic
in nature. So, go do your back a favor and try out these tips!
References
(1)
Sahrmann, S., (2002). Diagnosis and treatment of movement impairment
syndromes. St. Louis, MO: Mosby.
(2)
McGill, S. (2002). Low back disorders evidence-based prevention and
rehabilitation. Champaign, IL: Human Kinetics.
(3)
McGill, S. (2006). Ultimate back fitness and performance. (3rd ed.).
Ontario, Canada: Wabuno Publishers.
