The purpose of this article is to discuss some of the self-care practices that can prevent or address lower back pain. Lower back pain is not a general condition, but has many specific potential sources that cannot all be addressed in this article. This article will discuss self myofascial release (foam rolling) for maintaining tissue health and Stuart McGill’s Big 3 exercises for building a strong, well-rounded core.

Self myofascial release (SMR):
SMR is essentially the poor man’s massage. Massages are great for releasing knots and reducing creep. Creep is the low stretching of of muscle beyond their normal length that can come from slouching. Mike Boyle explains creep as slowly pressing your fist through a plastic bag. If you don’t apply too much pressure, the bag will stretch and retain that stretched length. Slouching does the same thing for the lower back. The muscles and connective tissue of the lumbar spine are slowly stretched and lengthen and become more dense. It was found that slouching as little as 20 minutes a day causes the ligaments of the lower back to lengthen (Boyle). The end result are lower quality muscles. SMR is especially important for the back side of your body because it reduces creep.

Importantly, SMR is perhaps the only area of strength and conditioning where “no pain, no gain” is actually true. For any SMR movement, roll out at a rate of about 1 inch per second and when you find a sensitive area hold that position while taking 3-5 deep breaths. The targeted muscle should be relaxed while rolling. If the muscle is flexed, transition to a softer tool.

Foam Roller Piriformis
The piriformis is an area I roll out daily. Put a foam roller, tennis ball, or lacrosse ball on the ground and sit down on it so pressure is applied against the butt cheek. You are looking for sensitive areas where back pocket of your pants would be located.

Other areas I like to focus on during SMR are my thoracic spine, levators, traps, quadriceps, and IT band.

Stuart McGill’s Big 3
Stuart McGill is one of the leading lower back pain researchers. If you would like more information on lower back pain, his articles are very highly regarded in the strength and conditioning community (Here is a great summary article on his system). McGill’s Big 3 movements are core exercises that increase core stability without risking your spinal health. They aren’t the movements you’ll see in the latest YouTube video on getting 6 six-pack abs or a slimmer waist, but they have the potential to build a healthier, more resilient torso.

Curl to Neutral (curl up)
The curl to neutral is similar to a sit up except the lower back stays on the ground. The purpose of the movement is to train the abs without straining the lower back like sit ups.

Side Bridge
The core is never really a massive generator of force. For most functional movements, it just transfers force generated by the lower body to the upper body. Thus, the core should be trained to remain rigid against extension and rotation. The side plank trains the core to remain rigid when a lateral force is applied. During the movement, everything should be flexed especially the hips, core, and lat of the bottom arm. For this movement it is important that the entire body remains straight (including the neck) and that the top shoulder stays back.

https://www.youtube.com/watch?v=dklb3Al6WCs&t=15s

Quadruped Position (Bird Dog)
The quadruped position is an anti-extension and anti-rotation movement. The user has to keep themselves from letting their back arch and stay balanced as their leg moves.

There are many progressions for each of McGill’s Big 3 movements depending on factors including goals, training history, injuries, and mobility limitations. Check out Prevail’s Torso Training playlist for a run through the different variations!

Torso Training Playlist

Alright! That sums up this series on lower back pain. If you read all 4 parts I am very thankful you stuck with it. I hope this information has been informative and useful. I’ve got your back! Get it?

Reference:
Stuart McGill’s Big 3

Joint by joint perspective revisited

The thoracic spine is especially relevant to the lower back because it is the joint directly above the lumbar spine. In Part II, we discussed the joint by joint perspective of training where the lower back primarily needs to provide stability while the hips and thoracic spine should provide mobility (Rusin). The hunched over position during sitting tightens the thoracic spine, which compromises our ability to maintain a good posture (Alexander).

Improving thoracic spine mobility

The press up is a valuable corrective movement that moves the user in back extension. The press up keeps the user away from flexion and counteracts the poor posture most of us assume when sitting. The bend in the spine should be distributed throughout the spine (the lower back does not articulate that much in this plane). The glutes should be relaxed. If practical, doing work while in the press up position (supported by elbows) can be helpful!

Furthermore, stretching the thoracic spine through multiple planes of motion is also beneficial. A lying spinal rotation stretch can help the thoracic spine improve its mobility. For the spinal rotation it is important to remember the emphasis is on the thoracic spine. The lumbar spine only has a rotational range of motion of 13 degrees and most people have decent lumbar mobility. The shoulder should be placed on the ground before the hips are rotated and the emphasis is on the twisting in the chest.

Misconception Correction: Some stretches are bad for LBP

A pillar of the prevention of future LBP is removing the movement that causes pain. For most people this movement is flexion. Oddly, some LBP patients stretch their spine by curling up and pulling their knees into their chest. This reduces their pain because it activates stretch receptors in the lower back muscles, but sets the patient up for worse future pain. The stretch is a flexion event that will trigger the pain mechanism they suffer from. Beware of stretches that are quick fixes to pain.

Tune in next time for a discussion on the self-care of LBP! It will be a more practical article with a healthy array of foam rolling and corrective exercises.

This article is on the causes and prevention of lower back pain (LBP) in athletes. LBP can result from several different kinds of causes that cannot all be addressed in a single article. My goal for this article is to provide a foundational understanding of the motifs that can contribute to LBP.

Prevention is the most important component of keeping your back pain-free. The best predictor of a new injury is a previous injury. One of the founders of chiropractics, B.J. Palmer, said “The preservation of health is easier than the cure of the disease” (Palmer). For this reason, time invested in prevention will yield more benefit than time spent on rehabilitating an injury that could have been avoided.

Back pain may not be rooted in back issues. When looking at the primary needs of our joints beginning at the ankles and ascending to the shoulders they alternate between needing mobility and stability work (see table).

The alternating pattern comes from observations that joints like the ankle have a tendency to become stiff and need additional mobility work, while joints like the shoulder have a tendency to move sloppily and need stability work (Cook). Most people have good mobility in their lower back, but are poor at maintaining its stability.

The significance of the alternating pattern is that a deficit in the primary needs of the joints immediately above and below lumbar back forces the spine to compromise its ability to stabilize (Boyle, 2007). A lack of hip mobility is a common cause of LBP because it forces the lumbar spine to compensate by providing mobility. The lower back cannot provide maximal mobility and stability in the same moment.

When these errant patterns are repeated and become habits, it becomes more difficult to engage the hips without also losing a neutral spine position. A joint by joint view of training suggests that the early signs of LBP may reflect inactive hips and preventative work may be best focused on joints above and below the lower back.

The Cook Lift is a good test of whether an athlete activates their lower back when they engage their hips. Here is a video of the Cook Lift demonstrated by Peter Blumert!

https://www.youtube.com/watch?v=UAPXpx-yWpE

A good progression for the Cook Lift is a set of 8, then 10, then 12 reps.

The cause of back pain results from cumulative trauma rather than a singular event.

LBP originates from thousands of flexions of the lumbar spine which causes disc herniation at a microscopic level through nucleation and delamination (Tampier et al., 2007; McGill, 2010). These preceding events occur without giving athletes an indication a future injury is looming. An important idea is that the lumbar spine only has so many bends before it breaks (McGill, 2014). Use them wisely for essential everyday activities instead of sit-ups that place a large load on intervertebral disks (Reynolds, 2009). Simply substituting the curl-up for the sit-up takes a lot of the stress out of the back.

Movement quality and endurance are the keys to preventing LBP.

Between strength, endurance, mobility, and movement patterns, the quality of the movement patterns appears to be the most significant difference between patients with lower back injuries and asymptomatic controls (McGill, 2014). Patients with LBP lift more with their back causing unnecessary lumbar flexions. A common flawed movement pattern involves “gluteal amnesia” where athletes present with tight hips, hamstrings, and hip flexors and do not activate their glute complex to the necessary degree (McGill, 2007). These patients often do not improve with typical therapy methods because general back pain programs do not focus on developing the hips. Furthermore, the endurance of the lower back is more critical than its strength because technique is more likely to breakdown after several, light movements compared to a few heavier ones (McGill, 2007).

Misconception correction:

Balance is not stability. YouTube and gyms everywhere have a population of lifters that rely on the bosu ball (half ball) and fitness ball for their workouts. Their core argument (get it?) is that the instability of the ball provides more stability training than traditional lifts. Squatting, pressing, and rowing on the bosu ball improves balance, but does not improve spine stability (McGill, 2014). Instead, spinal stability is improved by practicing stiffening the core to allow force to be transferred through it more effectively. Practice abdominal bracing during your big lifts to improve your core stability.

Our next article will discuss lower back pain developed from sitting and standing.

Further Reading:

A Joint-by-Joint Approach to Training

Designing Back Exercise: from Rehabilitation to Enhancing Performance

Lower Back Disorders, 2nd Edition

One of my greatest fears in weightlifting is the development of chronic lower back pain. This recurring condition would transform my, and many others’, main source of strength training into a zero sum game. Regardless of level of ability, a vast majority of lifters unnecessarily develop lower back pain (LBP) due to a larger focus on increase in strength versus a focus on staying healthy. 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).

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 needed to produce a rotational force is proportional to the distance of the weight from the joint and 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 only a few centimeters long.

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 practical article on the causes and prevention of lower back injuries in athletes!

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 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. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.

In the first installment we discussed what posture and ergonomics are from a general perspective and how to begin addressing them.

Our second installment discussed how posture is a product of habits, not exercise. Exercise can support or hinder postural change.

In this installment we deal with the “other stuff” that is typically overlooked and under discussed.

First: sleep! We need it.

Though it’s received a fair amount of press and research over the past 10 years, we constantly overlook its importance and relevance to our health, recovery, reduction of pain, body fat and weight levels, and the proverbial stiff neck.

So how should we sleep?

From a postural standpoint, we might be in a sleep posture for anywhere from 1-10 hours. Think about how we would feel if we were in a seated, slouched posture for 10 hours; it would likely cause some pain or discomfort. If we are in ill-advised postures for that long during sleep, they are likely to cause some similar effects. If, however, we set ourselves in good sleep postures, we can reduce spine and intradiscal pressures from 25-75%, allow discs to rehydrate more effectively, and muscles to rest and recover at appropriate length-tension relationships. See the picture inserted1 for some basic recommendations that assist in good sleep postures.

What about when we wake up?  I have found this to be another commonly overlooked arena of musculoskeletal and spine health.

• Caffeine and sugar
• The “Bucks”
• Loud and immediate noise with blaring alarms
• Rushing, being late
• Jamming in too much during our morning routines
• Hyper speed, super intense morning workouts before work

…and the list goes on for our typical American schedules.

Well then, what is there to consider that might influence a change in the routine mentioned above?

• Spine Hydration: your spine is HYPER hydrated (that’s a good thing)^2,  Avoid:
  • Aggressive bending in any direction for at least 60 minutes (that include cracking your neck and back and extreme spine extension or flexion)
  • Prolonged sitting (try to move a little)
  • Heavy lifting for at least 60 minutes
  • Morning shock (alarm)
• Spine Activation: get stuff “turned on” before asking it to work
  • Chin Tucks before getting out of bed ⁴
  • Glute Bridge before getting out of bed
• Myofascial Health:
  • Light and slow ROM: “Stretching”
  • Plantar fasciitis??? (stuff gets tight and cold during the night)
  • Full body motion/twists/turns
  • Light massaging, foam rolling, LAX ball on foot
  • Fascial rolling on tight areas

If you’d like to get a Biomechanical Analysis to assess your posture so you know how to integrate a proper corrective program that will support your Health, Golf, Tennis, Strength and Yoga practice, please get in contact with us a.s.a.p. so we can help!

1. http://yorback-5c4c.kxcdn.com/wp-content/uploads/2017/06/sleepingposture.jpg
2. http://buffalorehab.com/blog/3-ways-to-ruin-your-back-before-9am/
3. Wilke, Hans–Joachim, et al. “New in vivo measurements of pressures in the intervertebral disc in daily life.” Spine 24.8 (1999): 755-762.
4. http://www.drnick.ca/neck-mobilization-and-stability-program/

For:    The Divot
By:     Chris Ecklund, MA, CSCS, TPI, PES, USAW

In the first installment we discussed what posture and ergonomics are from a general perspective and how to begin addressing them.

As I review what these are and how they impact us all on daily basis with people, the common response I get is, “Chris, I’ll just fix my posture with my exercise program.”

Eh…maybe not.

The reality is that posture is a product of habits, not exercise.

Exercise can’t fix posture just like hard workouts won’t fix poor nutrition.

Exercise can either CONTRIBUTE to the problem or REINFORCE the good habits.

Think about it:

• Average person exercises 2x/week
• Average Workout (strength) = 45m
• 2 x 45m = 90 min / week
• Average amount of other minutes during week with bad posture = 9,990

90 minute versus 9,990 minutes…who will win?

It’s simple math, really.

And, if you exercise as many do, these are the types of activities that are engaged in with the hope of creating good posture and core stability:

Do we see a theme (and maybe a problem)?

These activities are not intrinsically poor, but there should certainly be questions related to IF we do them, HOW should they be done.

Motor programming and learning is often said to take place over the course of 3,000 repetitions (we often refer to this as movement becoming muscle memory). Think of how many swings it takes to implement a new golf stroke, a new tennis serve.  Posture is no different.  It takes time and repetition…in every facet of life!

Furthermore, look at the great positions we commonly put our spine/discs in while we lift weights!

Check out the 220%, 275% and 210% areas highlighted by red.  These are all typical workout positions.  The percentages are telling us what research has found as intradiscal pressures.  Said simply, the higher the number them more disc pressure exists (and perhaps more injury development).  Hmmm.  Hopefully it makes us think about what lifts we are doing and HOW we are doing those lifts…

Big deal (we often think). What could that lead to?

It could lead to this beauty.  Ah the wonderful Upper and Lower Crossed postural distortions.  Said simply: some things get short and hypertonic while others get weak and long (and maybe hypertonic or hypotonic).  Basically, stuff starts to hurt because it’s at the wrong length and tension.

Question: “Chris, we just need to stretch, right?!”

Answer: “No.  And stretching can make this worse, unless you are STRETCHING THE CORRECT STUFF!”

For some folks, stretching upper trapezius and hamstrings might help.  But for most others, it will only reinforce the issues or even make them worse.

Remember: Posture isn’t a product of exercise. Exercise can’t fix bad posture. And, if not done well, it can definitely make it worse.

If you add STRENGTH to DYSFUNCTION then you will STRENGTHEN the DYSFUNCTION!

If you’d like to get a Biomechanical Analysis to assess your posture so you know how to integrate a proper corrective program that will support your Golf, Tennis, Strength and Yoga practice, please get in contact with us a.s.a.p. so we can help!

References:

2. https://3.bp.blogspot.com/-jPOhHlUAc3s/V_uO_8oLzRI/AAAAAAAAA6g/4PH3bSPERPgRxPuZN1lhxz33JZHkHDL6gCLcB/s1600/disc%2Bpressure%2Bin%2Bsitting.png
3. https://consciouslifenews.com/how-bad-posture-affects-your-mood-brain-function-and-how-to-easily-improve-it/11107380/

The purpose of this series is to provide readers with an understanding of how stabilizing groups of muscles work. The more a client knows about how muscles work, the more they can learn from their trainers. This series aims to provide some of that fundamental knowledge.

During the final block of medical anatomy, my classmates and I learned the muscles of the arms and legs. It quickly became difficult to remember exactly what muscle did what and in the company of which other muscles. I found the most effective way to learn how muscles work is to learn about disorders that target specific muscle groups and see what symptoms present in patients.

This article focuses on the insanely interesting (to me) gluteus medius and gluteus minimus, which are knocked out in the Trendelenburg gait. Trendelenburg gait is a irregular walking pattern in which the hips sway excessively side to side due to lack of hip stability.

Key Terms:

Abduction: raising the leg to the side, away from the midline

Internal Rotation: twisting the thigh so the kneecap points towards the midline

Gluteus Medius and Gluteus Minimus at Prevail

Many at Prevail Conditioning train their gluteus medius and gluteus minimus whether they know it or not. They are primary stabilizers for walking and all single leg exercises. Many warm-ups include banded movements, like clamshells, that target the gluteus medius and gluteus maximus. Lateral band walks and single leg banded hip extension with external rotations also target the abduction and stabilizing roles of the gluteus medius and gluteus minimus.

VIDEO:

https://www.youtube.com/watch?v=Udkhn7_yxpM&list=PLQIblP9oJNhC2ftPcZZ2IY6g6wQa1FIC_&index=2

Anatomy

The gluteus medius and gluteus minimus lie deep to the gluteus maximus. Their function is to abduct and internally rotate the thigh. The gluteus medius is particularly important because it is the strongest abductor of the hip muscles. Both muscles begin at the outside of the hip and descend to the lateral, posterior side of the femur (see figure).

In the video above, we can see that whenever the patient plants with her left foot, her left hip lurches outward, showing a weakness in the gluteus medius and gluteus minimus. This is a common pattern in runners where it can lead to knee and lower back injuries as the hip tilts from side to side every step (Davis et al, 2016).

Conclusion

The gluteus medius and gluteus minimus are essential to every step we take. They are the primary hip abductors and critical to athletes’ stability in all single leg exercises.

Sources:

Washington University Musculoskeletal Atlas

Stanford Medicine 25

Davis IS, Futrell E. Gait Retraining: Altering the Fingerprint of Gait. Physical medicine and rehabilitation clinics of North America. 2016;27(1):339-355. doi:10.1016/j.pmr.2015.09.002.

Souza RB. An Evidence-Based Videotaped Running Biomechanics Analysis. Physical medicine and rehabilitation clinics of North America. 2016;27(1):217-236. doi:10.1016/j.pmr.2015.08.006.

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 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. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.

For Part II of the Muscle KO series we’ll be looking at the serratus anterior, the “boxer’s muscle”, which is incredibly important for stabilization during pushing movements. In the figure, Manny Pacquiao’s serratus anteriors are the dagger shaped muscles that run along his rib cage. The most important function of these muscles is to protract (shift forward) the scapula.

Work Cited

University of Pittsburgh School of Medicine Anatomy Course 2017

https://www.crossfitinvictus.com/wp-content/uploads/2009/11/Serratus-2.jpg

http://www.backoutofwhack.com/wp/wp-content/uploads/2012/04/boxer-muscles.jpg

https://upload.wikimedia.org/wikipedia/commons/f/f9/Protraction_Retraction.png

http://www.safeandhealthypeople.com.au/wp-content/uploads/2014/06/scapular-winging.jpg

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 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. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.