Tuesday, October 20, 2009

Low Back Pain.. Popular Misconceptions.

Often when we experience an "injury." we assume that one particular event created the problem, or pain. How many times have you woken up with a stiff neck, or shoulder, and thought- "I must have slept on it wrong."Or bent over to pick something up and "thrown out your back?" Often these isolated circumstances are not the true culprits to the painful situation. They are part of a much larger picture, an ongoing "mechanical" problem in day to day living. Often it is continuous overload in various positions/ postures that compromise the tissue. These "positions" you may not even realize contribute to the break down of the tissues, creating a weakness, leading to pain and disfunction.
Our bodies are remarkable at adapting to situations, sometime a little too remarkable. If placed in the same "unnatural" (not anatomically correct) position for too long, the body will adapt to the position. It will assume this position, create a new habit of holding itself this way- the muscles will "adapt" to the environment that it is placed in. Often when an individual has a desk job, for example, the will assume certain "postural" tendencies from the seated position at their desk. The individual may develop shoulder problems, and low back problems in conjunction with the chronic" position that their body spends their time. We lose our optimal alignment. These alignment problems influence the entire body. The skeletal system, muscular system, and motor systems are all effected. This created imbalances- imbalances create pain.
If left unchecked, these imbalances create larger imbalances. They can even lead to "inhibition", or loss of function entirely.
Being that each individual is unique in their circumstances, there is no one exercise that fits all. Each persons history (health and injury), age, work environment, nutrition, hydration, hobbies and habits, emotional state and various other factor, effect the approach to be taken. However, there are certain precautions that can be taken to avoid trauma to the tissue(s).
Often we hear of an approach that worked for someone else, and we are compelled to follow suit. Unfortunately, many of these approaches are unscientific, with no real basis. Kind of a "feel good" philosophy. Such feel good approaches would be:
1) Stretching, lifting and twisting first thing in the morning to alleviate "stiffness. While it may "feel" like a great idea,it has no scientific basis. Your spine, during the course of the evening, obtains water through a process called osmosis. You are actually a little taller in the morning when you get up! Stretching with this additional water will not only stretch your muscles, but increase the incidence of damage to discs and also your ligaments. Adams, Dolan and Hutton (1987) noted that disc bending stresses were increased by 300%, and ligament stress by 80%. (Low Back Disorders, McGill PhD 2007). The is an actual loss of up to 19mm in height through the course of the day, 54% of this loss occurs in the first 30 minutes of raising. Full spinal flexion, or bending over, and twisting should be avoided first thing in the morning.
2)Muscles strengthening exercises are required for a "bad back." Although it does "feel good"
to work the large muscles in the area, and there is a school of thought that has created the misconception that the back is "weak" and need strengthening, this too is unscientific. Research has proven that muscular endurance is more protective than muscular strength (Luoto and Colleagues, 1995). There has been no correlation between muscular strength and back pain. There are exercises devoted to spinal endurance that have been scientifically proven to improve, and prevent, low back pain.
3)Bent knee sit up are "good for the back. This is a large misconception. While abdominal muscles are part of the "hoop" system that helps stabilize and protect the low back, bent knee sit ups are NOT the answer to obtaining them, or helping your back pain. One single double leg sit up, or "crunch" is potentially enough compression to damage your spine....ONE. "Each sit up produces low back compression levels close to the National Institute for Occupational Safety and Health (NIOSH) action limit of 3300 Neutons (N),and repeatedly compressing the spine to levels higher than the NIOSH limit has been shown to increase the risk of back disorders... Thus making this an ill-chosen exercise."(Axler and McGill, 1997) Other exercises to be avoided, based upon these standards (Compression in excess of 3300 N) would be:
a) Straight leg sit-ups. 3506 N.
b)Prone (facing down) extension (on machine.) 4000 N (or 890 lbs.)
c) Prone (facing down) extension with arm and legs lifted off of the ground. 6000 N (or 1300 lbs.)
d) Single arm push ups. 5848N.
e)Alternating push ups. 6224 N.
f)Hanging, bent knee. 3313 N.
As mentioned earlier, a single exercise, or exercise program is not the cure all for all cases of low back pain. Many personalized factors need to considered and evaluated. Obviously, previously considered "cure- alls" have been shown to have no real scientific basis, quite the contrary. A proper full assessment is a prerequisite for any program, no matter what the goal is.
I hope that this article has provided you with some insight into proper care, prevention and care for your spine. I found some of this research to be life changing in regards to the way I train my clients, and approach my own personal exercise programs.

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