We are designed to move, try not to stay in any single position too long

The Whys for this program

• 80% of the US population at some point complain of low back pain

• The spine is liken to a flexible rod which could buckle on itself with minor forces. What holds the spine in place is a series of ligaments and muscles which act like masts on a boat. Strengthening the ligaments and musculature and having them both in proper alignment is the key to back health and for that matter any joint’s integrity.

• Why stabilization exercises, can I just stretch or do yoga for back health? It has been a long held belief that high levels of lower back range of motion is protective, so much so it has been used to judge treatment programs. A study by Biering-Sorensen (1984) found that those with high levels of range of motion and low levels of lumbar extensor muscular endurance had an increased occurrence of low back troubles. Flexibility is important in certain muscles when it comes to back care but it may not be as important as muscular endurance. You can increase muscular endurance to the lower back through stabilization training. Another research group found that spine flexibility had little predicative value for future low back troubles (Sullivan, Shaof, and Riddle, 2000).  Furthering this point a study by Snook et al., 1998, which found that patients who removed lumbar flexion from early morning activities improved substantially. Despite this some are still instructed to pull their knees to their chest in the morning and perform toe touches.

• Why should one train at a variety of angles and focus on endurance over strength? The development of muscular endurance for those with back disorders makes sense since the back muscles are used constantly when the body is erect and moving. Strength development shouldn’t be neglected, but intuitively it makes sense to develop lower back endurance over strength. Many within the fitness community don’t develop the low back area. I have seen it all too often with serious gym goers and bodybuilders. Very few ever perform an exercise that works the low back and when they do they perform a low back machine and hyperextensions which can be problematic due to only one area being developed. Creating stability is the key to proper joint mechanics. Active muscles perform like stiff springs. This is vital towards joint stability. Too much muscular force can create a rigid joint, while modest levels of activation typically is enough in creating joint stability. Stabilizing muscles, both synergists and antagonists, must work in harmony to produce stability, for only one improperly activated muscle can produce instability. Therefore one must train at a variety of angles.

• Many ask why the neutral spine position when bending forward? There are a few reasons, one of which is the flexion relaxation phenomenon. Myoelectric silence (flexion relaxation phenomenon) in the back extensors with spinal flexion places the stress of motion on passive tissues and eccentrically acting hamstrings and gluteals. As the spine is flexed from a standing position large shear forces act on the veterbrae by the weight of the upper torso being pulled by gravity. These forces could damage ligaments and the discs. Therefore, torso flexion should occur through rotation about the hip with minimal or no spinal flexion to avoid the high shear forces and the myoelectric silence which occurs with spinal flexion. Gunning et al. suggests that a fully flexed spine is 20-40% weaker than when its in the neutral position. Stuart McGill, a world leader in back research, suggests that those with a history of low back problems are more likely to lift flexing their spines and not their hips which may increase of future back troubles. McGill suggests fully flexing the spine repeatedly or for a being in a fully flexed position for prolong period of time may cause disc herniation. He goes further to suggest that disc herniation is almost impossible with out full flexion. A great example of all of this is when Olympic weightlifters and powerlifters lift they almost always have a locked neutral spine position.

• Why is good posture important for back health? Body posture that maintains the spine's four natural curves decreases intervertebral disc stress. A shift in one spinal curve changes the others. Frequently, a person with excessive lumbar lordosis exhibits increased thoracic kyphosis. Kyphosis can create pain in the cervical area. Therefore, when possible always perform exercises keeping a neutral spine position.

• Why do you have people drawing their abdomen in? Sucking the abdomen in works the transverse abdomens. Much work has been done looking at the transverse abdominus (TA) as a low back protector, due to its ability to generate intra-abdominal pressure and a girdle type configuration around the spine. Researchers have shown an unusual delayed recruitment of the TA in people who have low back disorders.  The TA recruitment before movement makes the spine more stable and stiff. A loss in recruitment makes the spine more susceptible to harmful forces. The internal oblique joins with the rectus abdominus (the six pack muscle) make a enclosing loop around the spine. These muscles work with the TA to protect the spine through co-committed activity enhancing spine stability.

• Why the sidebridge exercise, it awkward and it is hard to do? The quadratus lumborum is like the transverse abdominus in not being known or considered as important by the fitness community as other muscles. Many are not aware of these muscles when I speak of them. The quadratus lumborum attaches to the pelvis, rib cage, and all lumbar veterbrae transverse processes bilaterally, which bolsters the spine. Besides assisting in spinal stability its involved in lateral bending and assists in protecting the lower back during the flexion/relaxation phenomenon (bending over with spine flexion). This points to utilizing  exercises, like the sidebridge, that activate this muscle as well as others.

• Why the psoas and other hip stretches? The psoas has been implicated in low back pain due to its attachment to twelfth thoracic and every lumbar veterbrae and its ability to elicit high compressive spinal forces. These compressional forces are only present when the psoas is activated which seems only to occur with hip flexion. Psoas tightness can occur in those who sit a lot like office workers and truck drivers, these people are at risk (see below). Caution is warranted when training an individual who has low back pain or disorder with exercises which have high psoas involvement (leg raises and full sit ups). That is why the full sit up is not recommended for most especially those with low back issues. Tightness in the hamstrings can effect the spine by altering the position of the hip due to tightness as well.

• What is the best seated posture? In certain respects none. Epidemiological data has linked disc herniation with sedentary jobs and prolonged seated postures (Videman et al. 1990). Jobs such as truck drivers and office workers are at increased risk due to prolonged seated positions. A solution is to have susceptible individuals stand, move around, or change seat positions periodically every hour so that the spine can regain it’s neutral curves. Stuart McGill suggest that there is no perfect seated postures. Individuals need to move throughout the hour to avoid low back problems.

• Is there a difference between core training and stabilization training? Stabilization and core training have been used extensively among fitness organizations. Stabilization training develops the muscular and motor control systems increasing the stability of joints as well as the entire kinetic chain. The core typically refers to the torso musculature. It is a form of stabilization training.  Many exercises have be deemed stability and core exercises (ball training, side bridges, plank positions). The theory behind these exercises is they create stiffness around joints protecting them at specific times. Any exercise can actually become a stability exercise if it’s incorporated in a way that protects the joint. The key to good stability exercises is grooving the motor patterns so that the muscles are activated at the right time to ensure stability. When performing any exercise concentrate on co-contracting the abdominal, maintaining a neutral spine position, and co-contracting the muscles surrounding the joint being stressed. For example during the leg extensions the spine should be positioned in a neutral position, abdomen should be co-contracted, and the entire quadriceps should be activated. 

We are designed to move, try not to stay in any single position too long

Floor stabilization exercises

Perform 1-3 sets of sidebridges, bridges, and planks

2-4 days  a week

Crunches

Perform Crunches

1-3 sets for 15 to 50 reps, 2-4 days  a week

Floor Stretches

Seated Stretches

Hip Flexor Stretch

Try to follow the lower back rule in whatever you do.

    exercise program

    occupation

    activities of daily living

Proper Posture and Spine Mechanics

Essential while performing activities of daily living, while at work, and during exercise.

Lower back disorder prevention conditioning

A combination of stretching and stabilization training a couple of times a week goes a long way in preventing back pain and dysfunction.

The key to low back physical conditioning and the prevention of low back disorders I feel consists of stretching, abdomen exercises (crunches), and especially stabilization exercises.

The key is easy as 1,2,3-The three stabilization exercises.

1) Stabilization exercises

1. bridges

2. sidebridges

3. planks

2) Abdomen exercises

1. 1.crunches
   

2. 2.versions of a crunch
   

3) Key stretches (hamstrings, hip, and back)

1. Seated stretches

2. Floor stretches

3. 3.Hip flexor stretch See Videos
   

Stabilization and abdomen conditioning should be performed 2-4 days a week. Stretching should be performed more frequently, almost daily.

Lower back rule (the neutral rule)

Always bend from your hips and not your waist, keeping the lower back (lumbar area) neutral.  A neutral position is where the lower back has a slight natural curve (see diagram). Try to keep your abdomen in by sucking your navel inwards. This helps stabilizes the spine, which protects it. Try to keep your abdomen in not just when you are exercising but when performing activities of daily living. Keeping your neck neutral is a neck saving technique as well.

Keep moving rule (avoid prolong seated postures)

Stand, move around, or change seat positions periodically every hour so that the spine can regain it’s neutral curves.