MOVE better PLAY better LIVE better

I for one complained about the lack of snow in November. I’ll admit it.  And while I am super happy to be able to ski now, I can’t say I look forward to the driving and walking related issues that snow brings.

For many, shoveling is the big frustration.  It’s hard work if you have a big driveway.  I’m not sure if this is a surprise to anyone, but emergency rooms fill up after big snow falls.  Okay, I’m sure that doesn’t surprise anyone.  Many of the visits are from falling injuries – slippery sidewalks, ski or snowboard tumbles, and of course toboggan injuries.  But did you know there is also an increase in cardiac incidents? It turns out that shoveling is both frustrating and dangerous.  This is likely due to otherwise sedentary people heading out and suddenly doing intense exertion – that snow can be heavy!

Now did you also know that there is an increase in back injuries?  When I heard this, I assumed it was due to the excessive bending.  Interestingly, it might actually be related to the heart incidents.  Or so goes the theory presented by Dr. Stuart McGill, spinal biomechanist at the University of Waterloo:  your back’s greatest protection is the core muscles that brace it, but some of those muscles – notably the obliques – are also involved in breathing.  Because of that, there is a point just after you finish exhaling when these muscles are relaxed.  And when those muscles are relaxed, they are not able to do their other job – supporting your back.  So if you happen to lift a really heavy shovel-full at the end of your exhale – maybe your back is bent and twisted which happens frequently when shoveling – your back is going to take the full load with no support.  And that is how back injuries can happen.

As it turns out, you can turn this crisis into an opportunity (“cropportunity!” as Homer would say).  Why not turn your shoveling “job” into a safe and fun workout?  Yes, I did say fun and workout in the same breath. Not convinced? Think of it this way:  Shovel your driveway my way you’ll be less likely to hurt yourself, and you’ll be more fit when you are finished.  And if you start with a smile, you’ll probably end with one.

So what kind of workout can you get shoveling?  Think of it as a two-part workout:  an arm plus core workout and a leg workout.  Before heading out, start with a warm-up in the house.  It doesn’t have to be long, but make sure you get some movement in your legs, your hips, and thoracic spine area.  If you have some favourite warmup exercises, do them, or doing 10 tall side reaching reverse lunges would be a good choice.

Here’s a video of the two parts of the shoveling workout. When doing the shovel scoop sprints, walk back to the starting point so that you have the energy to do another line.  For the Lift and Toss, try 10 reps on one side and then 10 on the other and then take a little break.  As it says in the video – don’t twist your back, and don’t forget to engage that core to prevent the relaxed breathing muscles from compromising your back!

This week’s post is a follow on to last week’s post with some basic information about low-back pain, covering some slightly different topics and getting into a bit more detail.

The post will primarily address whether and how much we should bend, extend and rotate our backs.

Dr. McGill has lectured and written extensively on why flexion is bad for our backs, and yet what exercise does your physical therapist give you to address your low back pain? Crunches! Somehow in the last 20 years it has become a universal truth that situps are bad but crunches are good. Take a look at these two photos.

One is a crunch and the other is a situp. Do you see much difference in flexion? I don’t.

Some people would argue that we need to flex in training because there are some sports, such as mixed martial arts (MMA), where athletes need to perform in a flexed position. So we should really train the muscles that help us flex. But here’s the thing: the flexor muscles (rectus abdominus, obliques and multifidus) use more force in other exercises like planks, stability ball rollouts and bird dogs than they do in crunches or situps. Should you train your flexor muscles? Absolutely! Just don’t do it in a flexed position.

Another movement that can cause problems in the low back is extension – or more accurately hyper-extension. Frequent hyperextension of the back can cause spondylolisthesis, which is a stress fracture of the pars (part of the vertebral column). Spondylolisthesis is common in cricket bowlers and gymnasts who require repeated extensions to perform their sport. The training concept here is similar to the approach for flexion: work the muscles without straining the structure. Think about exercises that strengthen your extensors without hyper-extending them: glute bridges, bird dogs and even back extensions; just take a look at your back position periodically to make sure you are not extending too much.

This “anti-movement” approach does not stop with flexion and extension; it also applies to rotation. Think of a golfer or tennis player. There is a lot of potential rotation in every swing or stroke. These athletes need to train the muscles responsible for rotation, but in a friendly “anti-rotation” way. There are several great options for this including

• Cable push/pull

• Cable anti-rotation press

• Landmine twists

I mentioned “potential” rotation for golfers and tennis because ideally these athletes will have enough hip mobility to provide all of the rotational movement for their swing or stroke. In fact hip mobility is an important variable in preventing and managing low back pain for everyone.

The reason this is important is that limited mobility in the hips usually results in the back being recruited to take over. For golfers or tennis players, the problem is often lack of hip rotation. If you are unable to properly rotate through the hips, then your spine will need to absorb the forces from your swing. And how many times in a tennis match do you swing your racket? That is a lot of rotations!

Now think about sprinting. Your hips flex as you lift the your up to start the stride, then the foot pushes into the ground and then extends as you finish your stride. A certain amount of hip flexion and extension is required just to run, but if you do not have that mobility, the movement will come from somewhere else: your back.

Try this experiment: Stand facing a wall with your arms straight and hands on the wall; Lean forward slightly and take one hand and put it on your lower back to feel its position. Adjust to make sure your back is neutral. Now lift one knee up as if in the start of a sprint stride. What happens to your back as you do this? Does it round a bit? For many people, this simple movement causes back flexion. Now extend the same leg back and away from you as if finishing a stride. Do you feel your back extending? Think about how many times you do these two movements when you run or play a game of soccer or baseball? That’s a lot of flexions and extensions!

Guess what else can force you into unnecessary back flexion and extension? Tight pants. Try the experiment above but with tight pants on and see how much additional back movement you need just to move.

The solution? Work on your hip mobility! This can be achieved in a variety of ways, and the best approach will partly depend on your specific body and condition, but here are a few suggestions. Make sure you can do a “hip hinge”, which essentially means that you can bend forward at the hips without having to flex your spine. There are many daily activities, like bending forward to brush your teeth, that should be done by hip hinging instead of back flexing. A good exercise to train this pattern is to do a Romanian deadlift with a dowel touching your head, shoulders and buttocks (see the photos below for beginning and end of this exercise.

Stretching the hip flexors with a variation of a lunge stretch is another good idea, as is strengthening your external hip rotators (glute medius) which you can do in many ways, including mini-band clamshells.

The conclusion? You can go a long way toward preventing and reducing back pain by strengthening your back with anti-movement exercises, and by increasing your hip mobility with both stretching and strengthening exercises.

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.

Stay tuned for next week’s 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.