Lower Back Pain Part I: Overview of the lower back anatomy and mechanics

Lower Back Pain Part I: Overview of the lower back anatomy and mechanics

Lower Back Pain Part I: Overview of the lower back anatomy and mechanics

One of my greatest fears in weightlifting is the development of chronic lower back pain. To me, developing chronic lower back pain would turn weightlifting into nearly a zero sum game. The vast majority of lifters need to stay healthy more than they need to increase in strength. Yet, athletes of all levels of competency develop lower back pain (LBP). The purpose of this four part series of articles is to discuss the causes, prevention, and self-care of LBP.

Part I: Overview of the lower back anatomy and mechanics

Part II: Causes and prevention of LBP in athletes weight training

Part III: Causes and prevention of LBP in sedentary people

Part IV: Self-care of LBP

Significance:

LBP ranks third in most burdensome causes of mortality and poor health (behind ischemic heart disease and chronic obstructive pulmonary disease from smoking) — over 25% of people have experienced it in the last three months (NIH LBP Fact Sheet). Most LBP is acute and typically a result of a mechanical problem, resolving itself in a few days. About 20% of people who suffer from acute LBP eventually suffer from chronic LBP lasting over 12 weeks. Furthermore, almost one-third of patients with chronic pain are clinically depressed (Watson, 2011). Staying away from LBP is critical to staying disability free and aging healthily as described in my last article (Paras, 2017).

General Anatomy:

The lumbar spine represents the lowest five unfused vertebrae of the spinal cord. The 121prevaillumbar vertebrae are the largest of the spinal column as they are built to carry the most weight while providing both stability and mobility (Davis, 2013). In between each vertebra there is a cushiony, spongy intervertebral disc that absorbs shocks to the spine. Notably, the spinal cord does not run through the lumbar spine. Instead, large nerves run through the lumbar spine and branch out in the sacrum. This includes the sciatic nerve, which has a larger diameter than most garden hoses (Eidelson, 2017)!

(figure source)

Torque and reasons the lumbar spine is vulnerable:

The lower back is surprisingly mobile considering it is a long stack of discs. It allows for forward and backward bends, twists, and movements in multiple planes simultaneously. However, this mobility comes at the cost of the stability necessary to maintaining proper posture. Common types of injuries are strains (e.g. muscle tearing, ligament tearing) and herniation (i.e. damage to a intervertebral disc).

The torque placed on the lower back is extremely high due to its long lever arm. The amount of force a muscle must produce to counterbalance a rotational force is proportional to the distance of the weight from the joint and the distance of the muscle’s attachment to the joint.The lower back is mechanically disadvantaged because a weight held at shoulder distance is very far away, while the lever formed by the muscle and joint is 12341prvailonly a few centimeters long. Therefore, the muscles of the lower back have to exert many times more force than the weight of any object it needs to support. For example, if a 180 pound person bends over 40 degrees to lift a 30 pound weight, the erector spinae muscles would need to generate 738 inch-pounds of force and experience a compressive force of 2214 inch-pounds just to maintain an isometric hold (Cornell University Ergonomics, n.d.). The massive torque placed on the lower back when lifting even light weights is one reason it is injury prone.

(Figure source)

Conclusion:

The lower back is a common injury site that can develop into a source of disability. It provides stability and mobility in multiple planes, but its multi-functionality makes it vulnerable to injury. Furthermore, the lower back is mechanically disadvantaged because weights are typically held far from the hip and thus, require many pounds of exertion for every pound carried.

Tune in next time for a discussion on the causes and prevention of lower back injuries in athletes!

12tylerTyler Paras – Prevail Intern

B.S. – Cellular Molecular Biology (Westmont)

Matriculating M.D. Candidate – University of Pittsburgh School of Medicine

Tyler was born and raised in Santa Barbara, California and began training at Prevail in October 2016. He attended Westmont College and will be attending medical school this fall. While at Westmont he graduated summa cum laude, led a student-run homeless outreach program, and volunteered with medical clinics in Mexico and Bolivia.

After Tyler’s mother was diagnosed with rheumatoid arthritis (RA), he became interested in the cellular mechanisms behind the disease. He conducted his Major Honors project at Westmont on the role of the microbiome in inflammatory arthritis and conducted summers of research at Harvard Medical School studying the role of macrophages in RA. His research has resulted in seven presentations, three at national medical conferences.

Importance of Proper Posture in Training

posture

Some experts estimate that as much as 80% of the population will experience back pain in their lifetime (Rubin, 2007). This estimation is bolstered by the fact that the American population spends at least 50 billion dollars each year on issues related to back pain (MEDTEP, 1994). Individuals should work towards prevention rather than treatment of back maladies. One of the best preventative measures is proper posture in the midst of exercise and activities of daily living to improve spinal health.

Most lumbar disc injuries occur when the spine is in flexion or extension (Callaghan & McGill, 2001). This is one of the reasons that coaches are adamant about cuing clients to find a neutral spine position before proceeding with activity (e.g. shoulders back, tucked hips, tightening glutes). In exercise, one never wants to compromise spine position for the ‘ability’ to load more weight in an exercise (Boyle, 2016). One should practice stability prior to incorporating movement or increasing one’s weight-load while being mindful of avoiding excessive flexion or extension. The middle portion of the available range of motion has previously been described as the neutral range — this has been purported to be advantageous for preventing injury and enhancing athletic performance (Herring & Weinstein, 1995).

The next time you step foot into a gym, check your positioning. Don’t wait for a coach to correct your spinal position. Take responsibility for your postural and spinal health by learning the basic body weight movement with proper mechanics first and from that point forward, challenge yourself a little more. 

3 helpful tips for back pain prevention:

  1. Warm up and stretch properly, paying special attention to the hamstrings and hip flexors.
    1. The hamstrings need to be stretched in order to relieve pressure off of one’s back and prevent anterior tilt of the pelvis. The same goes for stretching the hip flexors as tight hip flexors can produce a posterior pelvic tilt.
  2. Maintain a healthy body weight through proper nutrition and an active lifestyle.
    1. A high fat and caloric diet in combination with an inactive lifestyle can lead to obesity, a condition that can put stress on the back. Proper nutrition to maintain a healthy body weight helps you avoid unnecessary stress and strain on your back. It is important to get enough calcium and vitamin D daily in order to keep your spine strong. These nutrients assist in the prevention of osteoporosis, the culprit to blame in many cases of bone fractures leading to back pain.
  3. Warm up and stretch properly, paying special attention to hamstrings and hip flexors
    1. Having the hamstrings at a normal length can help to prevent a posterior pelvic tilt and having the hip flexors at a normal length can help to prevent an anterior pelvic tilt. Stretching these muscle groups can help to relieve unnecessary pressure off of the spine.

References

Boyle, M. (2016). New Functional Training for Sports (2nd ed.). Champaign (IL):

Human Kinetics.

Callaghan, J.P., and S.M. McGill. Intervertebral disc herniation: Studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin. Biomech. (Bristol, Avon). 16(1) :28–37. 2001.

Herring, S.A., and S.M. Weinstein. Assessment and nonsurgical manage- ment of athletic low back injury. In: The Lower Extremity and Spine In Sports Medicine (2nd ed.). J.A. Nicholas and E.B. Hershman, eds. St. Louis: Mosby Year Book, Inc., 1995. p. 1189.

In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD.1994.

Lee, J., Y. Hoshino, K. Nakamura, and Y. Ooi. Trunk muscle imbalance as a risk factor of the incidence of low back pain. J. Neuromusculoskeletal Syst. 7:97–101. 1999.

Rubin Dl Epidemiology and Risk Factors for Spine Pain. Neural Clin. 2007; May; 25(2):353-71.

“Handout on Health: Back Pain.” National Institute of Arthritis and Musculoskeletal

and Skin Diseases. U.S. Department of Health and Human Services, n.d. Web.

28 June 2017.

aysiaAysia Shellmire – Prevail Intern

B.S. – Kinesiology (Westmont College)

Aysia was born and raised in Burbank CA. She graduated from Westmont College on May 6th 2017 with a B.S. in Kinesiology. Aysia played 4 years of basketball at Westmont College under Coach Kirsten Moore. She was 3 time All-Conference and 3 time All- American athlete and she holds the Westmont’s All-Time scoring record as well as the career rebounds record.

Aysia became interested in Kinesiology when she had a strength coach in high school. She was able to see how her workouts contributed to her progress on the court. Westmont’s Kinesiology Department helped foster her passion for coaching and sports performance with the guidance of some amazing teachers including Prevail CEO Chris Ecklund and Trainer Alexis Anderson.

Aysia plans on getting her CSCS this fall and possibly continue to play semi-pro basketball overseas.

Unveiling the Science Behind Creatine – Part 2

The Issue: My biggest problem with creatine has been the barrage of supplements claiming to ‘boost exercise performance.’ It is hard for me to decide which products I should purchase and which I should avoid. Of course, when going to your local Vitamin Shop/GNC, the employees will urge you to buy the latest and greatest; they want you to spend money. Before incorporating a new addition into one’s nutritional plan, one must explore both the positives and negatives of the suggested supplement. Does creatine really help? What harm can it do? Do I need it?

Research Perspectives: Allegations against creatine have been made with complaints of muscle cramps and gastrointestinal ailments. A problem with these complaints is a lack of evidence and the fact that the issues experienced are common symptoms that occur in the general population, not just with those who consume creatine. Studies show no change in functionality of the liver & kidneys in healthy subjects supplemented with creatine compared to those without supplementation (Kim et al. 2011).

A superfluous amount of creatine (i.e. over the recommended amount) may cause those who have pre-existing renal disease or those at risk for renal dysfunction to be at a higher risk of experiencing related issues (Kim et al. 2011). Controlled creatine intake is imperative along with proper knowledge of potential high-risk factors to one’s health and well-being. Vandenberghe et al (1997) states that long-term creatine intake is beneficial to performance during resistance training. Young women (n=19) were tested for 10 weeks and performed resistance training for 3hrs a week. The women were divided into two groups, a placebo group and creatine group. After 10 weeks of training an intake of 20g/day increased phosphocreatine concentration by 6%. Furthermore, Muscle PCr (Phosphocreatine) and strength, intermittent exercise capacity, and fat-free mass subsequently remained at a higher level in the creatine group. This study was able to conclude that long-term creatine supplementation enhances the progress of muscle strength during resistance training in sedentary females. (Vandenberghe et al, 1997).

My Personal Experience: Just as doctors recommend we need more vitamin C or higher calcium intake, it can be suggested that if you want to become stronger, an increase in creatine consumption will help you reach your goals. As a collegiate baseball player, I want to be the best athlete I can become. As such, I lift 4-5 days a week. Each day I strive to exceed my performance from the prior one, paying attention to proper form and avoiding unnecessary training gaps. Although progress begins and grows in the gym, proper supplementation is also essential to improving athletic performance. I have been using creatine before & after each workout and I personally have noticed improvements in my performance. I have shown improvement in my bench press, back & front squat, and RDL since taking creatine versus before. I have seen significant improvement in my bench press, where I was stuck at 205lbs for a long while; I have now reached 220lbs two months after I began incorporating creatine.

Conclusion on Creatine: Despite my positive experience with creatine, I still hesitate to quickly agree with the famous claim of “boosting exercise performance.” It may contribute, but its contribution is towards the progress of muscle strength. Upon looking at research, I have concluded that I am not an individual at-risk from creatine intake; however, I am glad that I am educated and aware of which individuals should refrain from this supplement. As my plans included a CSCS certification, I find it more important than ever to be aware of not only what I put into my own body, but also what I recommend that others put into theirs. Incorporating supplements into one’s training can help improve performance, but only with proper product knowledge and adherence to a training program that offers both safety and growth opportunity. I will continue to include creatine in my training. Should I choose to venture out and consider new additions into my plan, I will be sure to know the science behind the product and its potential effects on my health and well-being.

References

Kim, Hyo Jeong, Chang Keun Kim, A. Carpentier, and Jacques R. Poortmans. “Studies on the Safety of Creatine Supplementation.” Amino Acids 40.5 (2011): 1409-418. Web.

Vandenberghe, K et al. “Long-term creatine intake is beneficial to muscle performance during resistance training”. Journal of Applied Physiology Vol. 83. 1997.

http://jap.physiology.org/content/83/6/2055.short

1justinprevialJustin McPhail – Prevail Intern

B.S. Candidate (Kinesiology) – Westmont College

Justin was born in Huntington Beach, California and moved to Long Valley, New Jersey when he was eight years old. Justin will graduate with a B.S in Kinesiology in May 2018. Justin currently plays baseball Westmont College under head Coach Robert Ruiz.

Justin became interested in Kinesiology because of his involvement in baseball. He loves the idea of working with athletes and helping them to become faster and stronger and reach their full potential.

Justin plans to get his CSCS and attend graduate school after Westmont.

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