Lessons about low back pain (part one)

I had the pleasure of spending two days at a Dr. Stuart McGill seminar about “Building the Ultimate Back”. Dr. McGill is a spine biomechanist at the University of Waterloo, an internationally renowned speaker about low back dysfunction, an equally renowned clinician, and the author of Low back Disorders and Ultimate Back Fitness and Performance.

Because Dr. McGill covered so much amazing information, and because back function is such an important topic, I have split this into three articles. This first article provides what I view as the 4 basic points he addressed.

The basics:

  1. Everyone knows that bulging discs are caused by a single heavy or awkward lift, right? Not true, according to Dr. McGill. Discs can be damaged by a single traumatic event, but this typically results in a complete rupture of the disc, or even an end-plate fracture. Disc bulges on the other hand, typically happen as a result of repeated small movements. Remember the wafer thin mint from Monty Python’s the Meaning of Life? This is why so many people claim to have put their back out from picking up something incredibly light.Why does this happen? Because when our low back bends forward (flexion), the load we are carrying (including our body weight) is completely supported by the structure of the back (the discs and the vertebrae), not by the muscles. Muscles get stronger from repetitions, but discs do not; they get strained. Is there a way to reduce the risk of low back injury and reduce the symptoms of an already injured back? Absolutely: Stop flexing!I wonder how many people have been told that the best way to keep their back healthy is to do crunches or situps? Both are flexion exercises and both are bad for your back. Now, the idea behind it is a good one: strengthening the core. Strengthening your core is a fantastic idea. But find better ways, and don’t limit yourself to just the rectus abdominus (“six pack” muscle). Some good core strengthening exercises include bird dogs, planks, side planks, cable chops and glute bridges.
  2. For people suffering from back pain, it is often difficult to exercise because they get tired or sore very quickly. Sometimes just sitting, standing or walking causes pain. Even though there may be a disc injury present, in most cases the underlying problem is postural.To demonstrate this concept, Dr. McGill asked us to put a hand on the low back an inch or two to the side of the spine either seated or standing (try this at home!). With the hand on the back, adjust your position forward and backward; gently sticking your chin out and back; and try to find the “sweet spot”, or the point at which the back muscle feels relaxed. When you move out of this position, you’ll feel the muscle activating again. If you don’t feel this, try again with your hand on a few different spots on your back.If you sit or stand anywhere but your “sweet spot”, the muscles in your back are constantly working, which means they are getting tired and when they are tired, they get weak. Weak back muscles are not capable of stabilizing your back properly, and so your back is left unprotected and susceptible to injury.

    In addition to finding the sweet spot when sitting and standing, Dr. McGill teaches walking as if you “own the world”. What does this mean? When you walk, straighten your back, rotate your thumbs out (with elbows relatively straight) and keep rotating until you feel your chest open up (with shoulders pulled back). From this position, swing your arms and walk “like you own the world”.

  3. Most people who have had low back pain have been told to do knee to chest exercises first thing in the morning. Guess what? Knee to chest exercises in the morning are bad for your back. I attended this conference with a room full of physiotherapists and chiropractors, and they were all surprised to hear this, but once Dr. McGill explained himself, they all seemed to be in agreement. When you bring your knees to your chest, your back rounds slightly. In this rounded (or flexed) position, your discs change shape slightly in response to the position of the vertebrae.While you sleep, your back hydrates so that by the time you wake up your discs are filled with liquid. Think about your discs as water balloons. If they are only half full, you can push on one side of the balloon and the water will just move over to the other side without any trouble and then move back when you let go. But if the balloon is completely full of water, when you push on one side, the balloon will burst. This is essentially what can happen when you flex your spine first thing in the morning.This risk is reduced significantly after about an hour as most of the liquid leaves the discs. So think about avoiding bending in all your activities first thing in the morning.

    So why does it feel good? That good feeling is a neurological result of the stretch reflex. Am I right that the good feeling lasts for less than 20 minutes and then the pain returns? Try going a few days without this movement and you should see an improvement.

  4. When we sit the ligaments in our back stretch! Because the ligaments are important stabilizers, when they are stretched they leave the spine less stable. It can take up to 30 minutes for the ligaments to return to their normal length, which means for 30 minutes after sitting, your back is at risk. This is particularly important for people who perform heavy labour shortly after sitting at a desk or in a car. To reduce the risk of back injury, it is best to try to plan your day so that you have a bit of time to walk around between sitting and lifting.Think about this the next time you watch an NBA player get off the bench and right into a game and then they have a 7-foot tall opponent leaning on their back to get the rebound. Some teams now realize this hazard and will call players they want to sub a few minutes in advance so that they can walk around a bit and start getting their spinal ligaments back to normal.

Here is the second “teachings of Dr. McGill” article, which will provide more depth about exercise physiology related to low back dysfunction. The third article will come out the following week and will address performance training.

7 thoughts on “Lessons about low back pain (part one)”

  1. There is a great share of your knowledge in the field on this page. I like how you put things. I’ve added the feed to my Google Reader RSS subscriptions and will give you a mentioning over at my blog. I did have an issue with how quick the website loaded. Might be an issue to fix.

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