Tuesday, May 5, 2009

Save Your Low Back

Back on the research tip here. Eric Cressey just did a fantastic article on low back health. In it he draws heavily on the research of Dr. Stuart McGill, someone who's advice I've used with dozens of clients.

If are a trainer or are someone interested in back health do yourself a favor and pick up one of Dr. McGill's books - follow the link above.

Back to the article there are a couple key points I'll quote.

Broadly speaking, you can classify the majority of back pain sufferers into extension-based or flexion-based back pain.

Extension-based back pain typically is worse with standing than with sitting. These folks will present with everything from spondylolysis (fractures), to spondylolisthesis (vertebral slippage), to diffuse lumbar erector "tightness." Typically, those who suffer from extension-based back pain will have short hip flexors, poor glute function, and a lack of anterior core stability.

Effectively, the hip flexor shortness and insufficient glute contribution leads athletes to substitute lumbar extension for hip extension in movements such as deadlifting, jumping, throwing, or any other task that requires hip extension. The end result is typically some very prominent anterior pelvic tilt, as seen in the photo at right.

Conversely, flexion-intolerant individuals have more pain in sitting, as they tend to have flatter backs and therefore increased stress on the posterior ligaments of the spine. This is your classic symptomatic disc pain patient — with or without radicular pain into the legs.

Flexion intolerance is very common in office workers and cyclists, and you'll typically see folks with poor psoas function. The psoas is the only hip flexor active above 90 degrees of hip flexion, and typically, these folks will substitute lumbar flexion for hip flexion in these positions.

Unfortunately, it's been my experience that correcting flexion-based back pain can be a long battle for the exact same reason it develops: it is difficult to get a person to stop sitting so much in today's world.

Most of my clients fall into the flexion-intolerant category because they are sitting so much, while those that have problems due to sports or yoga (I see more people messed up from yoga than you'd think) are extension-intolerant.

The next part addresses something I see all the time. When someone tends to use their low back to move, instead of their hips, chances are about 100% that they have back pain or will. You've got to learn how to use your hip muscles (including glutes) and not the low back. Period.

The premise is pretty simple: you want to move predominantly at your hips and thoracic spine, and while a small amount of movement at the lumbar segments is normal, you don't want to encourage extra motion there.

As I noted above, there are specific situations that call for individualized mobilization protocols at the lumbar spine, but in terms of what you can accomplish with your own training, the general principles of "mobilize thoracic spine and hips, stabilize lumbar spine" apply.

Here's where it gets interesting. The American Medical Association (AMA) still uses lumbar spine range of motion as the qualifying criterion for allowing lower back pain patients to return to work. In other words, you needed to attain a certain amount of gross lumbar spine rotational range-of-motion to be considered "safe" to return to work.

Surprisingly, as Parks, Crichton, Goldford, and McGill observed in the discussion of their 2003 study (5), there isn't a single study out there that shows the lumbar spine range of motion is correlated with having a healthy back; in fact, the opposite is true!

Those with high lumbar spine ROM and power are more likely to be injured, whereas those with better lumbar spine stabilizing endurance are the healthy ones. And, interestingly, there really isn't any way of knowing what an individual's original "normal" spine ROM was, so they have to assume that someone had "average" spine ROM.

Yes, that study from the world's premier spine researchers was published just over six years ago (meaning that the data was probably collected at least seven years ago). Meanwhile, the AMA hasn't caught on, and chances are many doctors haven't, either, as this has been the "standard" for decades (28 years, actually, to my knowledge).

Do your back a favor and read the article.

No comments: