Back Pain Part II: The Facts

Side plankTo recap from Back Pain Part I, eight out of ten people suffer from back pain. That’s a lot. Yet, in a world of misinformation, it can seem impossible to find reliable advice when it comes to back pain. The mainstream, the new age, and even science have led us astray time after time. What’s important is helping those in pain find relief by getting down to the facts:

Anatomy
Your spine is a miraculous network of layered soft and dense connective tissue. Each layer has a purpose and needs to be protected. Spinal anatomy from the inside out is as follows:

  • Spinal Cord → relays signals between your brain and the rest of your body
  • Vertebrae → bones from your skull to your tail bone. Each vertebra has a perfectly shaped hole which the spinal cord passes through
  • Intervertebral Discs → Squishy pads between each pair of vertebrae that lubricate your spine and allow ease of movement
  • Ligaments → Connect each vertebra to the bone above and below it. Four ligaments – left, right, front and back – protect and stabilize each segment of your spine
  • Tendons → Attach vertebrae to surrounding muscles, allowing your spine to move
  • Muscles → You have three main layers of muscle that make up your abdominal wall: the transverse abdominis, internal and external obliques. Lesser talked about core muscles include: paraspinals, quadratus lumborum and diaphragm.

Tissue Quality is of the Utmost Importance
The human body is designed to function perfectly, and like most things good and perfect, we imperfect humans find ways to mess it up. We feel back pain when our nerves send pain signals, which occurs when something impededs the perfect synergy throughout the spinal column. The imbalance could be a fractured vertebra, a herniated or ruptured disc, a sprain, a strain… the list goes on. The moral of the spinal anatomy story: be kind to your tissue and it won’t retaliate. Some of the most effective ways to protect your tissue are counterintuitive, but your spine will thank you.

Keep Back Stretching to a Minimum
This is normally the hardest habit to break. When you hurt an area of your body, instinct tells you to stretch. Dr. Stuart McGill, a low back pain rock star from the University of Waterloo, shows in his book “Ultimate Back Fitness and Performance” that stretching your back initially causes pain relief because stretch receptors are stimulated, easing the pain signal. Unfortunately, this temporary pain relief can cause long term damage. Once your muscles reach their furthest point of stretching, the stretch will begin to pull on your connective tissue — tendons and ligaments. My old anatomy professor likened stretching muscles to stretching rubber bands – they are pliable and return to their original length easily. On the other hand, tendons and ligaments are more like plastic grocery bags. They will stretch, but once they do, they do not return to their original length easily. Spine stretching is not the devil, but you need to be very careful about how often and how long you stretch your back.

Stability and Endurance Are Key
In the course of my work in physical therapy I’ve come to disdain the word “strength.” Don’t get me wrong, I love strength training, and I think everyone should partake in it.  But in a post-surgical setting, I’ve come to learn that strength training is not an important factor for spinal health. After surgery the body needs to reactivate muscles. Surgery is very traumatizing and the nervous system often does not communicate well with the muscles in the injured area. The principles that apply in a post-surgical situation also apply to reducing back pain in general.  To promote a healthy spine and reduce back pain, consider implementing these steps (with the approval of your doctor):

  • First concentrate on activating lazy muscles. After surgery, the usual advice is to voluntarily tighten the muscles of the injured area. The same goes for core training. You must learn to contract all of your core muscles simultaneously. You can accomplish this by practicing bracing: lie on your back with your knees bent and feet on the floor. Simply contract your abdominals and all surrounding muscles. Most people have the tendency to flatten their lower back into the floor while do bracing. Do not flatten your back. You want to brace with a normal lumbar curve. This will protect all of the tissue in and around your spine. Hold bracing for ten seconds for five repetitions. Maintain normal belly breathing throughout.
  • Once you are comfortable with bracing, move onto more difficult stabilization exercises like bird dogs and side planks. While executing these exercises maintain normal spinal alignment and brace hard. If you apply bracing to every exercise, you’ll see nearly instant improvements in many lifts.

Strength has little to nothing to do with decreasing back pain. It is a catch phrase to say “strengthen your back!” McGill’s research has demonstrated that strengthening the muscles around your spine have no positive improvement on pain. Stability and endurance training, however, are both shown to have significantly reduce back pain.

A Final Note
I would never say that a Child’s Pose or a crunch will kill your back, but I personally recommend stretching and stabilizing the midsection in different ways. A good alternative to the Child’s Pose is the Cat/Camel. The Cat/Camel will take your spine throughout its full range of motion, but due to the fact that you do not hold the extreme ranges, you will not experience tissue damage.

Also the term “endurance” is often misunderstood in fitness. Most people believe that doing a five minute plank is considered very impressive endurance. It may be impressive, but it’s impossible to maintain good form for that long. When it comes to increasing spinal endurance, McGill recommends doing many sets of shorter repetitions with short breaks. For example, instead of doing a plank for a minute straight, do six sets of ten seconds with a three to five second break in between each set. This will allow you to brace very hard and never lose form. Fear not, the minute-long endurance benefit is still there.

Sources
All of the references in this article are from Stuart McGill’s “Ultimate Back Fitness and Performance.” It’s an amazing read for anyone who is interested in this subject. If you would like supplemental readings, look up Gray Cook, Mike Boyle, Mel Siff, Craig Leibenson, and Shirley Sahrmann. McGill is a researcher so he looks at everything from a lab setting. These individuals are strength coaches, physical therapists and chiropractors so they have their own very unique ways of applying anatomical principles.

Originally posted 2013-09-02 19:44:58.

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