What’s the deal with my back pain!

Sorry for not being consistent in the delivery of my posts.  As Heraclitus stated, “the only thing that is constant is change.”  From increasing my personal training hours, summer coaching duties, and working (interviews) to secure a permanent teaching/coaching position for the start of the upcoming school year in August, and of course doing my best to keep up with learning has kept me away from the world of blogging.

One of the books I am currently attempting to dissect and understand is from a world renown expert of the spine.

Doctor Stuart McGill’s book entitled Low Back Disorders is his first book I’m working to understand and apply.  He is a prominent expert in this area and has had an impact in the fitness community.  Don’t believe me?  Think about exercises we did for our so called abs 15 years ago.  It consisted of a bunch of crunches, sit-ups, and side bends, either done with our bodyweight, physioball, and/or machine.  Back then, no one heard of the plank exercise, or also referred to as the bridge.

Pre-2000 era traditional abdominal exercises

Post-McGill Abdominal Exercises

So how do we best train the so called ‘core’?  Well, like with all things, it all depends.  Before we get to that, let’s all get on the same page on what constitutes the ‘core.’  I like to describe it as everything that falls below the chest to above the knee.  And yes, there’s a lot of muscles involved.  Let’s take a look.

The Diaphragm

The lats (latissimus dorsi) used to be my favorite muscle until I learned the magnificent role of the diaphragm.  It’s a freakish muscle!  This massive tissue starts at the nipple level (T4-T5 rib space) and ends at the pelvis (fascially goes all the way down to the sacrum).  It makes up a large portion of the upper torso.  It attaches to our ribs, t-spine, lumbar spine, pelvis, our internal organs!! It attaches to everything for a reason and has the potential to take away your low back pain!  Say what??!!

It has 2 functions.  The first function is responsible for respiratory (the exchange of gases…no, not that kind, oxygen and carbon dioxide) and it does this through breathing.  The secondary function is stability.  Yes, STABILITY!

According to Sue Falsone (renown physical therapist), “when muscles are overtaxed, they can’t quite do their job for some reason (whether they are in a poor position and/or fatigue issues), the diaphragm has to make choices. Your diaphragm will always choose respiratory over stability.  So then, your body has to figure out how it’s then going to stabilize the trunk.  This is where we get into a lot of different patterns with our stability training when all we need to do is reconnect with our diaphragm and train it to make it both a respirator and a stabilizer, then we make our jobs a lot easier.”

So in a nutshell, if you’re not utilizing your diaphragm optimally and it can’t perform its secondary function as a stabilizer, your body will find it elsewhere.  Whether it’s your mid-upper back, thoracolumbar junction,  or elsewhere (such as the bony structure of your low back, specific musculature of the hips, etc), it’s going to find it to keep your trunk stable.

As a therapeutic exercise, Sue has her patients curl up into a ball (like a yoga’s child pose) and take in some nice deep breaths.  One of two things will happen.  You will either gain mobility of your ribs (expand the posterior aspect of your thoraco-lumbar junction) to try to get some more excursion for your diaphragm to work through.  The second thing that may happen is that you freak out because you can’t breath.  In that case, lay on your side to regain your breathing.

Another drill that Sue Falsone utilizes is to help teach her patients to use their obliques to stabilize the trunk through the expiratory reserve volume.  If you press your fingers into your oblilques, right below your rib cage and take in a deep breath as much as possible.  You want to then blow out the air as much as possible until you start feeling a bit uncomfortable.  You’ll start to feel those obliques kick in.  This helps bring the ribcage down and as a result it puts your thoracolumbar in a more neutral spine.  And once you are doing that and are able to maintain the rib position and breath, then your diaphragm is functioning the way it should be.

Low Back Stability

The general public assumes that their ‘core’ muscles are made up of a handful of muscles.  When you look at the musculature of the low back, there are many muscles involved.  Many.

Deeper Level

Outer Level

Top View

So when all of these muscles work together, it sort of looks like this.

Looks similar to a corset that women used to wear back in the days…

All of these muscles must work together to provide stiffness to the lumbar spine to keep it stable.  These muscles that make up your low back needs to have endurance because no matter what activity you are doing, as long as you’re moving, these muscles need to be on and working.  Dr. McGill states that for most tasks of daily living, approximately 10% muscle activation is needed.  (However, it largely depends on the task).

So when you understand the number of muscles involved to stabilize the spine, there isn’t any one of them that is more important than the other.  According to McGill, “every study that has actually quantified stability of the spine has reached the same conclusion – all muscles are important, implying that a clinical focus on one muscle and not the whole system is detrimental.”

I know stabilizing exercises has been a fad ten years ago because people took the term ‘functional’ to the extremes.  In terms of the low back, what are stabilization exercises?  The fact is that any exercises can be a stabilizing exercise.  McGill states, “an exercise, repeated in a way that grooves motor patterns and ensures a stable spine, constitutes a stabilization exercise.”  On one end of the spectrum, those with bad backs, will select stabilization exercises that imposes the lowest load on the damaged spine.  The other end, for high-performance athletes, stabilization exercises will involve grooving dynamic and complex motion patterns while ensuring sufficient spine stability (especially when breathing hard and where diaphragmatic breathing is of importance).

So when all of the muscles that make up your low back provide sufficient stability through proper motor control to create sufficient muscle stiffness, it looks like this…

Low back stiffness

So with this understanding, which exercises do you feel are better choices?

Side-bends

 OR

Tall Kneeling Pallof Press

 

Machine sit-ups

 OR

Pushup Plank Shoulder Taps

When focusing on developing the ‘core’ muscles, the best exercise choices will include the words ANTI! These muscles are designed to prevent excess motion, not create it!  This will enable you to develop and train your entire ‘core’ to create the stiffness it needs.  Want to know more, read this article by Dean Somerset, HERE.

  • The diaphragm is an important and large component of your ‘core’ so don’t neglect it!
  • There are many muscles that make up your ‘core’ and its function is to keep your low back stable, so train them to work together!
  • To train the ‘core,’ use anti- exercises.  Read Dean Somerset’s article, HERE.

That is why I love my carries!  One of the most effective exercises that is seldom used, unless you train with me.

Another important piece of information I would like to pass along that I learned from Stuart McGill is how detrimental sitting can be for your low back.

Is there any way to make seated work less demanding on the back?

This applies to people who spend their work day sitting and for most of my high school athletes (they are sitting all day in class and at home).

Epidemiological evidence presented by a study documented the increased risk of disc herniation in those who perform sedentary jobs characterized by sitting.  Remember, humans (homo sapiens) have been in existence for almost 200,000 years and prior to the 1950s, we moved to survive (or at least the majority).  Humans by physiological design were created to be efficient movers.  We can walk, jog, sprint, throw, catch, swim, climb, jump, and so much more!

Unfortunately, this is 2014.  And for some of us, we have no choice but to sit down on a chair to make a living.

Simple strategies to reduce back troubles during prolonged sitting:

  1. Use an ergonomic chair and use it properly.  There is no ideal sitting position.  The ideal sitting posture is a variable one; one that you change every 10 minutes.  Why? Tissue loads must be migrated from tissue to tissue to minimize the risk of any single tissue’s accumulating micro trauma.  So change up your sitting posture!

    Various sitting positions

  2. Get out of the chair!  There is no substitution for it!  Stand up, get your arms to reach for the ceiling and inhale deeply to allow the back to decompress a bit. 
  3. Perform a basic exercise routine at some time during the midday of the workday. (A squat, deadlift pattern, carry, pushups, etc).

Also for my athletes, sitting on the bench with a flexed lumbar spine is problematic because it creates or exacerbates a posterior disc bulge (or both), and it causes loss of the benefits obtained from warming up.

Training program that develops the ‘core’

So with every comprehensive training program, there are 5 stages that McGill suggests.  And not surprisingly, my training programs I develop for my clients and athletes look very similar (I steal and copy from the best).

  • Stage 1: Groove motion patterns, motor patterns, and corrective exercise
  • Stage 2: Build whole-body and joint stability (focusing on spine stability)
  • Stage 3: Increase endurance (musculature of the low back)
  • Stage 4: Build strength
  • Stage 5 (athlete-specific): Develop speed, power, agility.

Yes, there is a systematic approach to it and I know a lot of my male readers in particular think they are ready to move to stage 5.  Without your ability to keep the spine stable, you’re not going to get any stronger on the big movements such as the squat, deadlift, press, bench, chin-ups.  You’re not going to get faster or change directions smoothly like Barry Sanders.

Develop a strong foundation first and watch your overall strength increase.  Send a message if you have any questions.

If you’re a fellow nerd and want to learn more, grab Dr. Stuart McGill’s book!  Great resource!

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