Why Again Should I Avoid Bending and Twisting?

Why Again Should I Avoid Bending and Twisting?

 

 

Unless you live under a rock, everyone has heard not to bend and twist, especially when attempting to lift something off the ground.  But why?  What really happens to our backs that makes this such a "no-no?"  Here is a quick explanation. 

 

Below is a picture of our intervertebral disc...

If you look carefully at the annulus fibrosis, you can see that the fibers run in oblique angles, alternating directions with each layer.  Half of the fibers resist rotation to the right, while the other half resist rotation left.  All of the fibers resist flexion and extension.  But when you combine flexion with rotation to one side or the other side, only half of the annulus fibers provide protection of the nucleus, while the other half does not.  Doing this motion enough times will very likely cause a bulge or herniation of the nucleus pulposus.  

Clients With Lower Back Pain

Clients With Lower Back Pain

Many times you may begin training a client who states he/she has a history of lower back pain.  An XRay or MRI may not have been performed due to your client's hesitation to see a doctor or having poor insurance.  As a professional, you can hypothesize what the possible diagnosis is by asking a few questions:

1) What is the age of your client?  From the teens to the fifties, disc issues are most common, such as bulging or herniated discs.  After the fifties, arthritis and spinal stenosis is most common.  The symptoms of these diagnoses will present differently

2) Can your client remember a specific incident that brought on the pain?  When was it? This will tell you if it is due to a trauma and if it is chronic or acute

3) What positions or activities increase or relieve the pain?  Many times, someone with a bulging disc or herniated disc feels better standing and walking, while stenosis feels better with sitting and bending.  Use this information to help devise appropriate activities

4) What is a typical day like? Does your client have a desk job or a job that requires repetitive bending, lifting and twisting?    Many times people who repetitively bend, lift and twist will fatigue.  Motor control errors result and injury can occur, specifically disc issues

5) Describe the pain.  Does it radiate down the inside or outside of the leg and knee? Does it pass the knee and reach the foot?  Radiating pain may mean a disc is irritating a nerve root or that a bone spur is placing pressure on the nerve.

The above questions will help guide your treatment/training sessions so that it is customized for your client's specific needs.  For more training information regarding clients with herniated/bulging discs or spinal stenosis, go to: www.lowbackpainvideos.com.  The DVDs here provide step by step exercise protocols for these common back conditions.

Resting Between Sets

Resting Between Sets

 

If you have read the previous posts, you have noticed that I tend to avoid or at least minimize flexion of the trunk (particularly if you are not performing the hip hinge technique).  I advise this especially upon any type of resistance training.  In the gym, I notice many members training with proper form.  However, upon completion of a tough set, I see them in a seated slumped posture.

 

With the tissues and ligaments "warmed up," this type of flexion between sets may lead to further spine injury due to 'disc creep' and decreased vertebral shear control by the now 'silent' lumbar extensor muscles.  Don't bother working so hard during your set, if you are going to place yourself at further risk of injury during your rest.  Instead, take a walk to the water fountain, perform pull-up bar body decompression hangs, or lie on your stomach and prop up into a cobra stretch.  Perform extension, not flexion. 

 



Protect Your Lower Back By Engaging Your Core

Check out this quick video on how to engage your core during exercise.  Learn to use a feedback technique (your own hands) to make sure your core is contracted properly.  Now, it is your job to make sure you maintain this contraction throughout the entire workout.  No need to focus so much on timing your breathing during the positive/negative portion of the contraction (I'm sure you have all heard "exhale upon exertion") for spinal stability when you use this technique.  Mastering this skill will greatly reduce your chances of injuring your lower back.

http://www.youtube.com/watch?v=gGT8ckhUrE8

Morning Stretches

Many of my patients and clients have previously been diagnosed with lower back bulging or herniated discs.  They have become frustrated because they can not function the way they used to due to the back and sometimes radiating leg pain.  When I ask them what their normal daily routine is, they tell me they wake up in the morning and begin a short stretch routine that usually consists of getting out of bed and bending forward to touch their toes.  They say this makes them feel less lower back stiffness.  Unfortunately, I explain to them that bulging or herniated discs may actually worsen with this morning routine.  Most often, a bulging disc is triggered by a flexion or bending maneuver.  If it is a forceful flexion movement, the intervertebral disc may actually bulge posteriorly and laterally.  This may "pinch" a nerve root in your spine.  That is why you feel symptoms in your leg.  During the night, gravity is no longer compressing your spine so the discs reabsorb their fluid.  If you already have a problem with that disc level, flexion of the spine with a disc that has become "swollen" with its own fluid can cause the disc to protrude, exacerbating your back problem.  My advice is to minimize your lower back flexion activities and begin a core strengthening program.  Although flexion type stretches may feel good, it is only temporary and may actually be slowing your progress.