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Low Back Pain – Prevention 2

October 4, 2010

Your back hurts.  It has now on and off for some time.  You’re not as young as you used to be and you know that you’re not in as good of shape as you could be.  You also know that with some exercise you could strengthen your core muscles, give your back some better support, feel better, and prevent that annoying back pain from returning.  It’s decided then:  from now on there will be a new regime.  Sit-ups and crunches every day.

Hold on just one minute…

Let’s review:  yes, there’s a good chance that you’re not in the best shape of your life and that it could be contributing to your back pain.  And yes, incorporating some regular exercise into your routine would be beneficial to prevent the occurrence of your back pain.  But that last bit – the one about sit-ups and crunches – let’s look more closely.

Many of the traditional core (stomach, back, obliques) training exercises, including sit-ups, back extensions, crunches, leg lifts, twists are well intentioned but mechanically flawed.  While there’s no doubt that those exercises work the muscles of the core, improving their strength and endurance, they do so at the cost of some of the main supporting elements – namely the discs and the ligaments of the lumbar (lower) spine.

To simplify things a bit, we’ll focus in on the disc.  The disc is the jelly doughnut-like part of the spine sitting in between each vertebrae.  Each disc has a tough, elastic outer layer and a soft, jelly inner layer.  Together, these two components provide both support and cushioning for your spine.  When kept within normal ranges of motion under normal forces the discs are great at doing their job.  When we start to ask the discs to do things outside of their job description, however, they become susceptible to injury.

Research, conducted by Dr. Stuart McGill at the University of Waterloo, indicates that traditional core exercises are beyond the job description and safety zone of the disc.  The studies show that the forces the discs are subject to during those exercises are far beyond what is safely recommended for daily exposure.  As we saw in last weeks post (Low Back Pain – Prevention 1), a one-time exposure to a force may not be a big deal, but it’s the repetitive nature of the exercises – repetitive flexing/bending/twisting – that can lead to microtrauma inherent in most back pain.

And once again we come back to the concept of normal motion.  We often feel when our back is sore that the problem is one of flexibility.  And why not?  Your back feels stiff.  While it’s true that your back should be able to move smoothly and evenly, it’s main purpose is one of support and stability – not extensive flexibility.  Your back should provide a base of support from which your arms and legs can move around.  In fact when people talk about being flexible in their low back, what they should be more concerned with is hip flexibility.  I hesitate to use high performance athletes as an example but in this case it illustrates the point well.  When watching an Olympic lifter perform a lift, all of the movement happens around the hip and shoulder joints while the back stays virtually locked in position (more on training for health vs performance in the future).  Again, the back provides the base of support for the body to move.

Now this doesn’t mean that there should be no movement and flexibility in the spine (far from it.  See Low Back Pain – The Nuts and Bolts).  But it does mean that in order to keep your back healthy you should train it in a way that encourages and enhances its normal motion.  We’ll get to exercises that do just that very soon.

(By the way, this post is a good starting point but doesn’t do Dr. McGill’s work justice.  If you have nothing else going on this weekend and want to curl up with a good book on the biomechanical basis and injury mechanisms for low back pain I recommend his book Low Back Disorders.  Good times.)

For more information on exercise and back pain contact your Guelph Chiropractor at Clear Path Chiropractic Health Centre.

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