Back trouble is a health topic I’ve rarely discussed, because I’ve personally never had trouble with this area of my body; as a result I take for granted this vitally important body structure. But if you’re someone that has back trouble you're reminded of its importance every waking moment of single every day.
As my resident guest blogger Dr Les Davidson says below, summer is the time of year when most of us get outdoors and participate in a wide variety of physical activities requiring a healthy spinal support structure. As with all aspects of your personal health, don’t neglect your spinal health just because you don’t have back issues today.
The best course of action is to take proactive measures today by making your back health a priority, so you don't have to be reactive in the future when back trouble becomes an issue.
Enjoy the Ride…..Rob
Seven Steps to Spinal (Pelvis, Lumbar, Thoracic and Cervical) Stabilization
Dr. Les Davidson
Typically, summer sparks an increased level of activity; cycling, golf, tennis, baseball, water sports, gardening…. Each summer I treat people who are injured because their bodies are not prepared for this increased level of activity. A major consideration in preparing is having a stable spine.
A healthy spine is stable as it moves, so that no harmful shifting or sliding happens within each spinal segment. Technically spinal stabilization is defined as the ability of the spinal column to survive an applied perturbation (input energy). If this energy is greater than the potential energy of the column (stored in discs, ligaments, muscles and tendons), equilibrium will not be attained increasing the vulnerability of the spine to injury.
In an ideal world, there would be no conscious thought to spinal stabilization. It would be intuitive. By design humans are created for upright posture and ambulation. The synchronicity of the nerves, muscles, ligaments and skeletal system allow us to walk, run, jump, carry heavy loads and reach for objects. Effective use of our extremities in reaching, lifting and kicking requires tremendous central (core)strength and there is a direct correlation between being able to engage our central strength at the instant it is needed and spinal stabilization.
Unfortunately, spinal stabilization is compromised by our modern lifestyle.
Our modern lifestyle involves too much sitting and too little physical activity. Trauma incurred from contact sports and MVA (motor vehicle accidents) as well as spinal degeneration and disease compromises spinal stabilization. Finally, the stressors of life put our nervous system into a sympathetic dominated state which creates a fight or flight protective posture. This is a position of flexors being overactive, creating the commonly seen rounded shoulders and forward head posture.
Bone and ligaments can only manage a fraction of the loads our spines are subjected to on a daily basis; therefore the importance of spinal muscles becomes evident. If the muscles are not strong enough or not properly coordinated to do their job, the loads put extra strain on the structures of the spine. This strain manifests as low back, upper back, neck pain with the associated signs and symptoms. Strengthening exercises and aerobic fitness are important components in preventing LBP (low back pain) and rehabilitating chronic low back pain. Staying active is currently the recommended, evidence-based intervention for low back pain. (Note: For acute low back pain, exercise is less effective than other conservative therapies such as manipulation and anti-inflammatory medication. Exercise therapy is not the same as activity.)
This review identifies the concepts and exercise options that are supported by research. This is a complex topic which is continually evolving as the intricacies of the anatomy and integration of function is better understood.
Seven Elements to Consider When Optimizing Spinal Stability
Each element should be considered sequentially and then concurrently.
1. Basic health factors- address the systemic issues of obesity, inflammation and stress
Optimally the spine is aligned straight front to back with well-balanced curves when viewed from the side. The most common postural faults are the upper-crossed syndrome with rounded shoulders and forward head carriage or the lower-crossed syndrome with a forward-tipped pelvis, increased low-back curve and a weak, forward-protruding abdomen.
3. Joint play
Each vertebra should be free to glide in what are known as joint-play movements. These are not active or volitional movements, but instead subtle, passive movements necessary for a joint to accommodate the active joint ranges of motion. Too much play and the joint gets worn from instability; too little play limits the function, necessary to move nutrients to joint tissue or provide input to our nervous system from stretch receptors that occurs with freedom of movement. Chiropractic adjustments are effective at restoring these joint play movements.
Of the more than 20 muscles associated with respiration, almost all of them have a postural function. The ability to maintain stability while breathing normally is important. Many people breath using the chest and not the abdomen which combined with the common forward head posture creates a shallow frequent pattern of breathing that overworks the lower neck and upper back muscles and weakens our diaphragm. This can be improved by taking conscious control of your breathing and practicing how to abdominal breathing. Also, when lifting heavy optimizing breath control may provide increased segmental control of the spine through the production of increased intra-abdominal pressure.
5. Motor control
Although it is generally accepted that there is a relationship between LBP and alterations in motor control of abdominal and low back musculature, the exact mechanism remains unclear. Individuals with LBP have been demonstrated to have increased activity of the large outer, superficial trunk muscles, while activity of the deep inner trunk muscles is delayed and attenuated. There is a need, therefore, to reverse motor control deficits that occur after back injury or degenerative change. The most significant finding is that people who do not retrain their deep stabilizing muscles are 12.4 times more likely to have recurrence of back pain than those people who learned how to use the deep inner muscles properly. Learning how to identify and engage these muscles can be taught by a chiropractor, physiotherapist or personal trainer.
This is the contraction of the longer, larger outer-unit muscles to stiffen the spine. It is the ability to hold rigid the region between the lower margin of the rib cage to the top of the pelvis. These muscles are primarily phasic helping us move but also have a significant role in stabilizing our spine and pelvis. Their ability to hold our body rigid with eccentric contraction protects the small inner muscles against heavy or sudden movements. The deep inner muscles contract and preset prior to the larger outer muscles contracting. Unfortunately, if the inner muscles are not doing their job efficiently the larger outer muscles might be in a state of constant contraction and not just firing at the times needed for bracing.
7. Sling exercises
Functional units known as myofascial slings are formed when individual muscles link via fascia. Multiple muscles working in a sequential manner, support the coordinated mobility required to create movement in the transverse, frontal, sagittal or oblique planes.
These four muscle teams act together to provide stability across the lumbar spine and pelvis. They enlist the co-ordination of all the outer unit muscles to ensure correct movement patterning, while maintaining stability. Training of these groups of muscles requires more complex resisted motions such as chopping, stepping forward or back with a rotational component. If all the muscles in the team do NOT work efficiently, other muscles are overworked which leads to early fatigue, poor performance and increased risk of injury.
In his blog, Don’t Just Do It, Do It Right, Rob wrote that one of the best ways to achieve fitness goals is to organize workouts so that the exercises work together to build the body and support recovery. I agree.
Everyone has basically the same component parts but we all have significantly different levels of function. The challenge of helping patients move along this functional continuum, motivates me in my practice each day.
Hopefully, you also will be challenged to assess your existing level of functional stability, discover where you are on the functional continuum, which of the elements listed above may be compromised and then establish a corrective program so you can enjoy all your fun in the sun activities injury free.
Adding Life to Your Years....Dr Les.