by G. John Mullen, DPT 2011
Imagine you are working at a desk job for 20 years (or writing an article once a week) and out of left field your low back begins to hurt. Now imagine you’re trying to impress an individual of the opposite sex by picking up a box of their weights and body building trophies and all of a sudden your low back is killing you. Next imagine you’re playing a pick up game of basketball, you have your Chris Sabo rec specs on, and as you’re running down the court you twist to grab a pass and your low back starts to hurt. All of the above are common ways of injuring your low back.
Stat Fact: $86 billion is spent annually on the treatment of low back pain.
There are many structures located in your lower back that can cause low back pain including bony vertebrae, intervertebral discs, ligaments, muscles, nerves, and your spinal cord. Any one of these could be causing a variety of problems (very scientific, we know). We will talk about some of the most common problems and a few ways to help strengthen and protect your spine. The three scenarios described above are the most common back injuries, but there are many more ways to injure your low back (obviously). It is important to note that if you already have back problems it’s probably a good idea to talk to your doctor or an exercise specialist about it because if the exercises below are done in an improperly things can get worse rather than better. Now let’s tackle the most common causes of low back pain.
1. Herniated Nucleus Pulposis (bulging disc) is a disease that occurs when the jelly-like center (the nucleus pulposis) of the shock absorbing disc located in between each vertebrae ruptures through the tough, fibrous outer portion (the annulus fibrosis) of the disk. One way to think of this is similar to a jelly doughnut: the nucleus pulposis is the jelly, the dough is the annulus fibrosis, and the bulging disc is the delicious, jelly exploding through the wall of the doughnut. This bulging can put extra pressure on the spinal cord and lead to tingling or numbness in your legs. Some treatment options include: epidural injection, physical therapy or surgery. Surgery is always a last resort, so we’ll go over a few stabilizing exercises that would be used in the physical therapy clinic to prevent the need for surgery.
2. Degenerative Disc Disease is a decrease in the volume of the intervertebral disc. The nucleus pulposis and annulus fibrosis break down over time and cause a narrowing of the canal through which your spinal nerves pass and the space between each vertebrae. This may irritate your joints as the vertebrae sit closer together and possibly rub on one another. This condition occurs for a variety of reasons:
As stated, lifestyle is one modifiable variable in the mix. Poor posture is frequently one of the causes. It is important to think of your spine as the game Jenga. All of your muscles and ligaments are your Jenga pieces and as you begin to slouch (the popular choice for poor posture), you are removing key supporting pieces causing your spine to lean and eventually fall. This is what we call degenerative disc disease.
Stat Fact: There is a high prevalence of dehydrated discs (i.e. breaking down of the intervertebral discs) seen as early as the third decade of life in both men and women.
3. Muscle Strain is another common lower back injury and can be caused by a several of different accidents, the most common being improper lifting. Proper lifting technique is as follows:
Bend with your knees and keep your back straight from your butt to your neck
Bring the object close to your body
Come straight up while pushing through your legs
The most important treatment for an acute muscle injury is rest. The amount of rest depends on the severity of the injury. Depending on the severity of the injury, the rest period can be anywhere from 2 weeks to 3 months! While resting your muscles, it is also vital to improve your flexibility. When a muscle becomes injured, its natural reaction is to tighten up (which we call “muscle guarding”) ultimately leading to other injuries and impeding the healing process. Regular, targeted stretching can prevent this further damage during the healing process.
Stat Fact: Roughly 1/3 of all workplace injuries occur while lifting.
Now for the fun part: preventing and treating your back pain with exercises. Once again, if you currently have back pain it is recommended to see a health professional before completing these exercises. These exercises are few examples of many options available for back strengthening.
Abdominal Bracing is used to find a safe and supportive position for your lower back. The exercise involves pulling in your stomach by tightening your abdominal muscles (trust me everyone has them in there…somewhere) but not flattening your back to the floor. This exercise should be completed in three sets of 10 repetitions, holding for 10 second each repition.
As you may have guessed, this exercise involves making your legs look like a table top. Lie on your back and begin by bracing your abdominals as mentioned above. Next, lift both legs up creating a 90 degree angle at your hips and knees. Perform this exercise three times for 1 minute each time. Technique tip: Don’t arch your back!
Dead Bug is an uncoordinated individual’s nightmare because it involves alternating arms and legs. Don’t worry, practice makes perfect. To start, implement the abdominal bracing from above and bend your knees and hips to 90 degrees. Now, extend one leg at approximately a 45 degree angle and raise the opposite arm overhead (see the picture to get a better idea of this position). Hold this position for one minute. After a minute, return to the starting position, pulling your hip/knee toward your chest and returning your arm back to your side. Repeat the same leg extension and arm flexion on the other side. You should feel this exercise in your things and abdominals. Perform this for 3 sets of 1 minute on each side per set.
Position yourself on your hands and knees and begin with your abdominal bracing. Your hands should be under your shoulders and your knees under your hips. Once this position is obtained, use a mirror or a partner to help gauge if your back is straight and flat. Start by raising one arm at a time and alternate these movements. When you are comfortable with this movement, advance the exercise by including your legs. Extend the leg on the opposite side of your body from the arm you are extending. Once your arm and opposite leg are extended, hold for 5 seconds. After 5 seconds, return to the resting position. Do not lift your arms or legs above your trunk during the exercise as this will excessively arch your back. Perform 3 sets of this exercise with 10 repetitions on each side per set.
The plank is one of our favorite exercises! Start by lying on your stomach and then lifting your body up, resting on your forearms and knees (beginner) or feet (advanced). Your body should form a straight line from your ankles to your hips to your ears. Hold this position for 30 seconds maintaining your abdominal bracing the entire time. Repeat this 30-second hold 3 times, resting for a minute between each plank.
The back is one of the most commonly injured parts of the body, most of which are preventable with proper mechanics and muscle strength. With the help of your health professional and a little personal motivation and commitment, you can prevent low back injury and help us save some of that $86 billion we’re spending every year!
Mair S, Seaber A, Glisson R, et al. The role of fatigue in susceptibility to acute muscle strain injury. Am J Sports Med 1996,24:137-43.
Martin BL, Deyo, RA, et al. JAMA. 2008; 299;656.