jessephysio

 

Today’s blog post comes at the request of a few of my back pain patients. Over the past few weeks I have been talking with my patients about their back pain. I have come to realize that some of  these patients genuinely believe they injured their back from bending over to tie up their shoe, picking up a pen off the floor, or reaching for that jar at the bottom of the fridge (all real storey’s about “why” they hurt their backs)…and every time I hear a story like this I have to shake my head….

Patients must believe their backs are about as sturdy as a Jenga tower if they think those simple actions caused their backs to go out. I have to always tell my patients that 9 times out of 10, the pain they’re experiencing is due to many weeks, months, or years of misuse. It is only when the body is tired of trying to compensate for faulty movement (or lack of moevemnt) do they experience pain.  When asked about their gym routines (for the ones that actually go!), almost always do they proudly mention that they do sit ups and crunches as part if their core routine. This is a sure fire way to slowly but surely hurt the back.

Without getting into it too much detail, Dr. Stuart McGill out of the University of Waterloo has done the research and we now know that flexion based exercises (like sit ups and curls) are BAD for the back…and in reality, it doesn’t even train the core in a functional manner at all. Here is a quote from Dr. McGill’s book “Low Back Disorders”

“Too many exercises are prescribed for back pain sufferers that exceed the tolerance of their compromised tissue. In fact, I believe that many commonly prescribed flexion exercises result in so much spine compression that it will ensure that the person remains a patient. The traditional sit-up imposes about 730 lbs of compression on the spine at each repetition. The National Institute of Occupational Safety and Health (NIOSH) has set the action limit for low back compression at 730 lbs; repetitive loading at or above this level is linked to higher injury rates in workers, yet this is imposed on the spine with each repetition of a sit up!”

I said earlier that a sit up is functionally a rather stupid exercise. It trains the rectus abdominus to act as a thorax flexor. While the muscle does have the properties to act as a flexor, its real job lies in its ability to be an anti-extensor. The abs functional job in the human body is to control the rate of spinal extension as apposed to producing spinal flexion. For example, try leaning back while sitting on a workout bench. While leaning back, put a hand on your abs…they are firing like crazy! Why? Because they are contracting eccentrically to make sure you don’t fall off the back of the bench. This is their job in life and sport… the obliques, rectus, and transverse abdominus are ANTI-MOVEMENT muscles. They stabilize the spine and prevent spinal buckling or shearing from occurring. With this in mind, training them as flexor muscles is about as useful as training your biceps by only doing curls…sure you’ll make them look nice (nothing wrong with that!) but you’ll be missing out on all that they can do!

My patients always ask me then “Ok Mr.wiseguy physio, if I can’t do sit ups or crunches, how else am I going to work the core?” Here are my favourite (and safe!) core exercises listed in no particular order:

Chops and Lifts: LONG video demo by Gray Cook but I think it’s worth the time. He explains this far better than I ever could

 

McGill big 3 (plus stir the pot): Another great video with Prof. McGill explaining WHY these exercises are good…plus they are backed my tons of high quality research

 

Deadbug: Great exercise because it uses the core to stabilize the extremities while not putting any load through the back

 

In summery,

• Your back doesn’t “go out” from picking up a pencil, it was already dysfunctional but you just didn’t know it yet
• Functionally, the core acts as an anti-extensor and anti-rotation unit–not as a upper body flexor
• A good core exercise is one in which the extremities move against resistance while the core is stationary working to stabilize the back
• Sit-ups and crunches suck…they do more harm than good
• The exercises I listed above will not only make your core stronger, but they will in most cases help your back pain

As always, questions are always welcome

Jesse Awenus, PT

Oh, another HUGE reason for back pain is sitting too much at one time (hmm, I should probably get up). Here is a GREAT and simple exercise sheet you or your clients can use to help stay back pain free at work (courtesyof Dr. Craig Liebenson)