"If You Keep Picking At It, It Will Never Heal"

"If You Keep Picking At It, It Will Never Heal"

Recovering from a lower back injury is similar to any other injury.  If you fall and cut your knee, the healing process will be postponed if you constantly pick at the scab.  When you are rehabilitating from lower back pain, the more frequently you irritate the injury, the longer it will take to heal.  This means that you must protect your spine during everyday routine activities.  

Stu McGill describes your lower back as a savings account, advising you not to "spend" it frivolously.  If you continue to unnecessarily involve/mobilize the spine in activities that do not require its involvement/mobility, then when you do "need" the spine, it will not be there for you at 100%.  

One example of this is...click here for full article

Happy New Year

 

Happy New Year from KB Fitness!!!

Don't spend another year limited in what you can do because of pain!

Take the initiative to help yourself or a family member get rid of lower back, neck or knee pain!

 

 

 

  Order a Strength On Demand Physical Therapy Home Exercise DVD Today at

www.strengthondemand.com

 

 

Make sure you stick to your New Year's Resolution of being pain free!!!

 

 

This Tip Eliminated Most of My Back Pain

In previous posts, I mentioned how I had been diagnosed with a herniated disc at L4-5 ten years ago, and that I am still aware that this is my weakest link.  I can feel the ache first thing in the morning, and must avoid any type of flexion activities for the first hour that I am out of bed.  I focus my  training sessions on core recruitment and stabilization while training full body movement patterns.  To my knowledge I was maintaining a stable trunk and was protecting my lower back.  However, the day after my training session, I would feel an increase in lower back soreness and felt that I had to be extra cautious with certain activities to prevent an increase in pain.

The majority of my training deals with multi joint movement patterns rather than isolating muscles.  I make sure to do squats, lunges, and deadlifts, and ensure that I incorporate a proper hip hinge rather than spinal flexion when lowering myself.  But there was one technique that I had not focused on while performing these movement patterns until recently.  And since doing so, my lower back pain has dramatically improved.  I have spoken about "gluteal amnesia" in the past.  One of the causes of this "amnesia" is that upon performing a squat, we use our hamstrings to extend our hips and our lumbar extensors to extend our spines while transitioning from the squat position to tall standing.  Using the spinal extensors to do this compresses the spine, causing more back pain.  This is most likely why I would wake up the following day in more back pain.  Incorporating the gluteals to extend the hips while returning to a standing position from a squat will help reverse this "gluteal amnesia," and save the back.  So I decided to try this a few days ago.  To do this takes concentration but is not too difficult.  All you do is "spread the floor" with your feet.  So when performing squats, as I descended and ascended, I was gripping the floor with my toes as I was pushing my feet isometrically outward, as if I was attempting to spread the floor.  This technique engages my glutes which extends the hips, bringing me into the upright position while taking the strain off of my spinal extensors (and reducing spinal compression).  I decided to incorporate this throughout my day, not just during training sessions.  I initiated getting out of a chair by "spreading the floor."  Squatting down to pick up my daughter, I did the same thing.  This morning I woke up with almost no lower back soreness. 

Try this technique and you will be amazed at how your back responds.  I was taught that my "lower back is like a bank account.  There is only so much money in it.  So use it only when you need to."  To do this, we must use proper and efficient movement patterns to eliminate unecessary stress on the spine.

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. 

 



Common Morning Stretches May Be Detrimental to Your Lower Back

Common Morning Stretches May Be Detrimental to Your Lower Back

 

Below are two very common stretches that many of my lower back patients tell me that they perform regularly in the mornings.

Stretch 1

 

Stretch 2

 

 These stretches may feel good.  However, you may be causing more harm than good.  Throughout the day, your spine undergoes compression and shear forces.  Upon fully flexing the spine (Image 1), you create a "flexion-relaxation phenomenon."  With this, the lumbar spine extensor muscles "relax" and no longer protect the back from shearing forces.  Stretch 2 feels good because it applies a stretch to the gluteal muscles.  However, the further you pull your knees to your chest, the more your spine flexes, the less the extensors protect your spine.  I would advise not to do these stretches first thing in the morning, never to do Stretch 1, and to perform Stretch 2 only up to the point that you feel the stretch in the gluteals.

 

What Caused My Spine to Develop Arthritis?

What Caused My Spine to Develop Arthritis?

 

It has been documented that disc damage almost always precedes facet arthritis in the spine (Butler and colleagues 1990).   This can be explained by the following: the disc damage creates an instability in the spinal joints.  The body responds to the instability with arthritic activity in order to create stability.  This arthritis causes pain and limits mobility.  So arthritis in your back may be in response to tissue damage in the spine.

 

 

For Lower Back Physical Therapy DVDs, check out www.strengthondemand.com



Morning Exercises

Morning Exercises

 

 

A study in 1998 advised that people should avoid full lumbar (low back) flexion activities in the morning in order to minimize back symptoms.  The reason?  At night when you lay in bed, gravity and body weight are no longer compressive forces on your spine/discs.  The discs "refill" and expand with fluid that was "pushed out" throughout the day due to the compressive forces.  The increased fluid in the disc lengthens the spine and causes it to become resistant to flexion.  Ligament and disc-bending stresses are thought to increase 80% and 300% respectively in the morning when compared to the evening.  During the day when you are up and active, pressures placed on the spinal discs push fluid out of the disc.  This narrows the space between each vertebrae which reduces tension on the ligaments.  Approximately 54% of this decrease in disc height occurs 30 minutes after you get out of bed in the morning.  Less disc height means less tissue stresses.  Therefore, it is advised that you wait at least 30 minutes after getting out of bed to safely bend forward and perform your daily activities or exercises.   

The Sit-Up and Your Spine

The Sit-Up and Your Spine

 

 

 

Here's a quick FYI!  The National Institute for Occupational Safety and Health set a limit for low back compression to 3300 Newtons.  This means that if you repetitively load your spine above this level, an injury is more likely to occur.  What's scary is that each repetition of the CRUNCH exercise produces this much force on your spine.  Some believe by bending the knees and performing the crunch, the compressive force is reduced.  According to a study by Dr. Stu McGill, this is not correct.  Dr. McGill recommends the Side Bridge Exercise for the abdominals and obliques.

 



Be Cautious When Training Your Glutes

Be Cautious When Training Your Glutes

 

 

The gluteus maximus muscles act to extend the hips.  Many times I will see both men and women training their gluteal muscles with either straight leg hip extensions or flexed knee hip extensions (minimizes the hamstring involvement).  Their goal may be to gain hip strength, or to "shape" their butt muscles.   

 

The normal hip extension range of motion is 10-30 degrees from the neutral position (neutral being when the ankle is in line with the hip and the shoulder).  People tend to over-extend the hip's available flexibility.  By doing this, additional movement is "taken" from the lower back.  So not only is the hip extending, but segments of the lumbar region are also extending.  This may lead to lower back pain or may worsen existing conditions.  

 

Try to avoid accessory motions at the lumbar spine when training your hip extensors.  Focus on maintaining core muscle recruitment (trunk stability) while extending your hip.  You will feel your gluteal muscles contract prior to your lower back extending.  Stop here and return to neutral.  If you feel your lower back extend, you went beyond your hip's available range of motion.
 

More for Fitness and Physical Therapy Rehabilitation information, go to www.strengthondemand.com



Recruit Your Core: Stage 1 of Lumbar Stabilization

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

This video will be the first in a series of videos explaining the progression of Core Stabilization Techniques/Exercises.  You must first train your client/patient on how to engage their core and maintain its recruitment throughout an exercise in order to preserve the stability of the lower back. 
     The normal progression begins with static stability exercises in which there is no motion, just control and maintenance of one 'set' body position. 
     Next will be dynamic stabilization in which the trunk remains static, but the upper extremities are moving.  Here, the trunk is exposed to a force (developed by the moving extremities), and it must resist motion.  
     Even more difficult, the next challenge is to "control" the lower back/trunk, maintaining a 'stable' spine while moving it throughout its available range of motion.  This controlled or "stable" mobility is necessary in all sports and when performed correctly, will prevent injury.  Watch this video to get a feel of engaging your core.

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.