All posts by andrewstemler

personal trainer, crossfit london uk trainer, Lower back pain researcher

6 muscles of the back are functionally different from limb muscles

Limb muscles create movement, torso muscles create stability.

The simple act of walking requires spine stability. There are no agonists and antagonists in the torso they are all required to stabilise force generated elsewhere in the body.

If your therapist treats your core muscles in the same way as limb muscles, they are simply going to extend the pain in your back

Elite performers generate force in their hips, and it is transmitted through a stiffened core.

Spinal Control: The Rehabilitation of Back Pain: State of the art and science
edited by Paul W. Hodges, Jacek Cholewicki, Jaap H van Diee

Do you slump?

I fix the backs of sedentary people and of several elite athletes, also middle range  Crossfit athletes.

One thing Ive notice about those with bad backs is their ability to push themselves beyond the call of duty.  In fact they have the reputation of being hard workers, motivated and always on the go!

The reality is , once the doors are closed, they  can head for the settee and slump. For hours!!!! They can happily stay in bed if allowed, and they can be very , very lazy.

Hard ( some would say obsessive) work can sometimes be matched by back destroying  activity elsewhere.

The twist. Is it deadly.

Several researchers have suggested that  twisting of the trunk is associated  with low back pain. the 1st issue we need to deal with is to distinguish  the idea of twisting  from generating twisting torque.

Torque  in the torso can be achieved  whether or not the spine itself is twisted.

In general moderate twisting isn’t dangerous. over the years the debates have included  twisting quickly and breaking the speed by hitting the end range of motion,  back in 1970, Farfan  suggested disc twisting  could damage  the collagen fibres  in the annulus, especially if a neutral arch had been lost.  Other reports say that twisting is less dangerous as the facet forms a mechanical stop , thus its the facets that can get injured.

What is  Twisting torque? Imagine a twist that applies or transmits force!.As no muscle  is designed (as a primary function),  to create twisting torque all muscles are  contracted, this increases compressive load. 50nm of extension, creates 800 newtons of spinal compression.

Generating high torque, when the  spine is twisted  is problematic. In short are you twisting… well, Ok!  or are you twisting through your spine to load up an axe swing … probably not so good!

Ill show you in a future “Note” how to generate force through your hips and not through your back. But for now, repeated spine flexion will, according to Aultman et al ( 2005), will lead to discogenic trouble.

“Back In the Office” campaign

While supporting any and all well meaning people who want to help back pain, I find myself at odds with one recommendation of the forth coming “back in the office” campaign promoted by the Charity Back care (6th -12th October 2014)

Whilst i endorse most of the aims of this campaign

  • Stand not Sit while you work
  • Stretch your back at your desk at least every half hour
  • Set your workstation just right
  • Ergonomic furniture, a hype or a necessity?
  • Use headsets and stop straining those neck muscles!
  • Take regular breaks especially if you work long hours
  • Employers guidelines

I think based on current research, that the “stretch your back ” suggestion, is probably  best  treated with caution

Stretching , twisting and cracking your back?

 

If you stretch twist and crack your back I have one message for you: pack it in!!

“Soft tissue injuries result from excessive tension, so excessive tension in the rehabilitation situation is counterproductive…stretching of …chronically tight tissue is counterproductive. It may give an initial sensation of relief because the muscle spindles have been deadened, but this practice…weakens the tissue further because of the weakened proprioceptive response.”

Boo Schexnayder

“stop trying to Stretch and mobilise! Let tissues settle and regain their proprioceptive abilities so they tell the truth”

Stuart McGill

Specific Causes of Back pain

Specific causes of back pain: some ideas from European Guidelines for the management of Chronic non specific back pain (2004)

There is  little relationship  between  low back pain symptoms, pathology  and radiological findings.

In 85% of people (Deyo 1988), pain has no relationship  to any time of physical abnormality.

*4% of people seen with low back pain in primary care have compression fractures

*1% have a neoplasm (Deyo et al 1992).

*5% develop at least one vertebral fracture in 4 years (Kado et al 2003).

Spondylarthropathies have been reported to occur at a rate of 0.8 to 1.9% of the general population (Saraux et al 1999).

Spinal infections are rare, and chronic spinal infections are particularly rare. Infectious diseases of the spine should be considered if the patient has fever, has had previous surgery, has a compromised immune system, or is a drug addict.

Spondylolysis and spondylolisthesis are often classified as non-specific low back pain because a considerable proportion of patients with such anatomic abnormalities are asymptomatic (Soler and Calderon 2000)

Back and leg pain after surgery represent a major problem addressed at specific conferences for failed back surgery.

Failure rates range from 5-50%. Based on a failure rate of 15%, it was estimated that 37500 new patients with failed back surgery syndrome would be generated annually in the US (Follet and Dirks 1993).

One of the causes that is consistently reported in the literature includes poor patient selection (Goupille 1996, Van Goethem et al 1997).

“This means that patients with non-specific back pain are operated on for radiologically diagnosed disc bulging, herniation or degeneration, which turn out not to be responsible for their pain.”

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