Back pain ? Why one exercise doesn’t fit all.
Article by Rocco Venizelos
“If someone has a really strong opinion over a single exercise there is usually something being sold” Dr. Stuart McGill
If I had a pound or a dollar for every time I heard someone saying they had pain in their back, I would be a millionaire. Back pain is considered a short lasting condition, that when rested (God knows what that means) you tend to feel better. But do you really feel better? Or when you go back to the provocative exercise, the pain comes back ? Research suggests that up to 80% of adults will experience lower back pain (LBP) (Peng 2013) and in 30% of cases, acute LBP will become chronic (Strong et al 2013).
LBP is considered to be a recurring or persistent condition with a fluctuating course over time (Lemeunier et al 2012). What causes LBP? Well, there are many causes, the scientific literature evidence is strongest for mechanical causes (Cholewicki et al 1996). Once pain shows itself for the first time, the nervous system is sensitized. How each person reacts to the pain is modulated by a sea of variables that can increase or decrease the pain sensitivity. Biology, adaptation, previous injury history, posture all influence the reaction to load magnitude, repetition and duration.
I had an amazing interview with Dr. Stuart McGill who specializes in spinal biomechanics, regarding spinal health and LBP. Through his experience he says that the majority of low-back pain begins from the cumulative damage caused by bending forward at the waist. That motion causes the vertebrae toward the base of the spine to pinch together; if you're not careful about maintaining proper form, it can lead to problems like herniated disks
To understand the mechanism, think of the discs in your spine as cushions or even shock absorbers. Imagine your spinal disks as jelly doughnuts. When you bend forward, the vertebrae get closer together and the back of the vertebrae to opens up. If the back is moving as it should the doughnut remains in place. But with repetitive incorrect bending movement or sharp twisting motions to one side, the doughnut gets squeezed and the jelly squirts out.
“Sorry what? Too much bending hurts the back?” someone would say.
If the source of back pain is due to disc dysfunction, then bending forward (flexion) won’t easily be tolerated. So why do people have pain when they bend backwards/arch their back too much? Another very common cause of lower back pain is known as Facet Syndrome (Hestbaek et al., 2009). The facet joints are what make up the back (posterior aspect) of the spine. It is a painful irritation, particularly common in the lumbar spine due to the shape of the curve, which causes swelling of the surrounding structures and irritation to the nerve roots. The human spine is designed to equally distribute the weight of a load between the discs and the facet joints. Too much bending forward stresses the discs, causing flexion intolerance, whereas too much bending back increases the load through the back of the spine, irritating the facets and causing extension intolerance. Another reminder of why good form is so important (Van Kleef et al., 2010).
So we need a strong back! That’s basically what we hear or what we say but that’s not exactly what we mean. What our lower back needs is muscular endurance, as opposed to muscular strength, which has been shown to have the strongest positive effect to a healthy spine. So our training program should focus utilizing higher repetitions and lower resistance with the emphasis on technique. Coaches, trainers, clinicians be specific when you say that getting stronger makes an athlete superior. What we need to keep on board is that strength must be balanced with ROM, good technique to be in charge of the forces that go through the body and elasticity. There are a lot of variables to enhance performance in specific goals and that’s where a good practitioner will seek to have the optimum and injury free body (McGill,2016).
Since there are many causes of LBP, there is no one exercise fits all; the program should be individualized on the person’s profile.
- Side Plank or Side Bridge
This is a great exercise to challenge stabilizing spinal muscles. It Integrates both the quadratus lumburum and the abdominal wall. It can also be performed from the knees, or if balance is an issue, you can place the top foot directly in front of the bottom one for more stability.
- The Bird-Dog
This exercise targets not only the back and hip extensors, it also challenges an individual’s balance whilst using shoulder and hip movement with a stable spine. Kneel down on all fours and raise opposite arm and leg simultaneously. Keep in mind not to raise the arm/leg higher than the horizontal plane.
- Cat – Camel
This is a gentle motion of exercise and is important to remain within the pain free ranges of motion and not push out of comfort zone. To perform the exercise, arch the back with the head looking up (cat) and then progress to rounding the back with the head looking down (camel).
In conclusion …
I will end this article with a great quote by Dr. McGill “ A clinician’s aim should be to expand their patients biological capacity, not to cross it.” We need as professionals to have lots of tools in our toolbox and people that suffer from Lower Back Pain need to be more mindful of where they get their information from.
- Cholewicki, J., McGill, S.M. (1996) Mechanical stability of the in vivo lumbar spine: Implications for injury and chronic low back pain. Clin. Biomech.11(1): 115
- Hestbaek, L., Kongsted, A., Jensen, T. and Leboeuf-Yde, C. (2009). The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors. Chiropractic & Osteopathy, 17(1), p.2
- Lemeunier, N., Leboeuf-Yde, C. and Gagey, O., 2012. The natural course of low back pain: A systematic critical literature review. Chiropractic & Manual Therapies, 20 (1), 33.
- McGill, S. (2016). Low back disorders. 1st ed. Champaign, IL.: Human Kinetics.
- Peng, B.-G., 2013. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World Journal of Orthopedics, 4 (2), 42.
- Strong, J. A., Xie, W., Bataille, F. J. and Zhang, J.-M., 2013. Preclinical studies of low back pain. Molecular Pain, 9, 1744–8069–9–17.
- Van Kleef M. et Al., Pain Originating from the Lumbar Facet Joints. Evidence based medicine, World Institute of Pain, Pain Practice, Volume 10, Issue 5,p 459–469