Oh, My Aching Back!
Prevention, diagnosis, and rehab
by Lori Gross

You squatted 315 for four sets of ten reps like it was a toy. All eyes were on you as you went heavy on every leg exercise, feeling invincible and strong. Then you bent down to pick up your two-pound gymbag, and a sharp pain flooded your senses. You tried to turn around quickly, thinking that your ex-girlfriend was stabbing you in the back with a knife. But, alas, she was on the other side of the gym flirting with her next hapless victim.

Besides, you couldn't turn around quickly if your life depended on it. Hoping that no one was watching you now, you grab your lower back and slowly try to straighten your body. The gymbag now feels like you're deadlifting 700 pounds. "Someone just dumped kryptonite in Superman's shorts!" you say to yourself. How's it possible to be so strong one minute and so incapacitated the next?

Well, Superman, get an eyeful of these stats. Back pain is:

• Experienced by 70-85% of all people some time in life.
• The most common cause of activity limitation in people younger than 45 in the US.
• The second most frequent reason for visits to the physician.
• The fifth-ranking cause of admission to a hospital.
• The third most common cause of surgical procedures.(1)

Now throw in the fact that you push, pull, and otherwise lift hundreds of pounds of weights several days a week as a hobby. Chances are, if you haven't experienced a back problem yet, you will (fiendish laughter). Good thing I'm here to help you out, tough guy.

Factors Contributing to Lower Back Pain

Low back pain isn't really a diagnosis, but a symptom of an underlying pathology. Often, it isn't the large weight or grandiose movement that contributes to lower back pain, but the small weight or short movement, the proverbial "straw that broke the camel's back," that leads to dysfunction. Let's explore some factors that may predispose you to having lower back pain and look at what you can do to prevent and treat this injury.

Posture

Do you hear the echoes of your mother nagging you about your posture?

"Stand up straight, honey, and don't slouch when you sit."

Are you still ignoring her advice? Well this time, and maybe the time she told you to eat your veggies, your mother may be right. Spending your life in a flexed or bent-over position will stretch, fatigue and weaken not only the back muscles, but also the ligaments and intervertebral discs (shock-absorbing cartilage between the vertebrae). Additionally, stretched muscles on one side of the body lead to tight muscles on the opposite side.

Viewed from the side, the spine has four normal curvatures that make it look like a scary S-shaped hairpin turn. The cervical (neck) spine curves to the front of the body and is convex. The thoracic (middle) spine curves slightly toward the back and is concave anteriorly. The lumbar (lower) spine has a normal convex curvature like the cervical spine, and the sacrum and coccyx (bottom) are concave so we can bend it under us to sit. When we're in a slouched position, the normal cervical and lumbar curves flatten out and the thoracic curve is exaggerated.

You've seen a perfect example of what this bent-over posture can do in the long-term if you've ever been to Miami and seen all of the retired old blue hairs! Perfect posture includes maintaining, but not exaggerating, these normal spinal curves and is best obtained by conscious control of the postural muscles like the rhomboids and abdominals.

You can maintain correct upper back posture by pinching your shoulder blades together as if you had the winning lottery ticket safely secured there. Furthermore, maintain a slight anterior pelvic tilt by contracting your abdominals. This posture should be maintained at all times: during lifting, walking, and especially sitting, where we have a tendency to relax and sprawl out.

Flexibility

You've heard the song about the ankle bone being connected to the shin bone, and the shin bone being connected to the leg bone ? ad nauseum. But, if our body wasn't connected, we'd just be a lump in a lawn chair trying to hold on to a can of Schlitz, much like your favorite uncle. Everything in the body is attached and forms what we in the biz like to call a kinetic chain. Basically, this means that when one body segment moves, it has an effect on another segment, and so on. This is very evident when muscle flexibility is discussed. Since the large leg and hip muscles are attached to the pelvis, and the pelvis is attached to the spine, stretching these muscles will keep the spine and spinal muscles flexible.

When tight leg and hip muscles are called upon to stretch as they complete a movement, they either strain from the pressure or call upon the spine muscles to stretch. These muscles (if tight) can then strain to complete the movement, which can result in injury, or pull on their bony spine attachments and cause injury. For example, if your hamstrings are tight and you're standing up from a heavy deadlift or leaning over from a stiff-legged deadlift, your body can compensate by transferring the stress to the lower back muscles.

Unfortunately, the lower back muscles are much smaller than your hamstrings and not able to withstand such forces. Small as they are, they'll valiantly try to help you complete the lift. You might feel the strain right away during the movement or it may pop up the next morning as you roll cursing out of bed.

Body Mechanics

You squat with perfect form — head up, shoulders back, abs tight, back arched. Yet when you reach down to pick up your gymbag, you round your back like a turtle and keep your legs straight as sticks. What's up with that? Correct body mechanics should play a role in everyday lifting of objects, not just in lifting weights. Of course, it's most important to have perfect mechanics when lifting a large load, but if small loads are lifted incorrectly over and over again, it can create just as much damage.

So while you're lifting a bag of groceries, picking up your child or just getting your sweat rag off the gym floor, squat down with the perfect form of a powerlifter in a competition. Feel free to chalk your child to make him or her easier to grasp.

Weightlifting Belts

All right, you GQ gymrats with your fancy Velcro waist supports and name-branded leather belts, time to break free from your constraints. "What, take away my protection?" you cry. Don't worry, bud, I'm not talking about your Trojans, I'm referring to that piece of decoration holding in your fat belly.

Did you know that wearing a weight lifting belt is actually one of the worst things you can do to protect your lower back? Weightlifting belts were first used by Olympic weightlifters to prevent trunk hyperextension during overhead lifts, making it easier to lift heavy weights. Without any research behind it, industrial workers began using them to prevent lower back injuries and bodybuilders quickly waddled over and hopped on the bandwagon. We're so much smarter now, though, because we know that weightlifting belts don't prevent injuries and actually may cause lower back injuries.

Strong back and abdominal muscles should act like a natural belt, stabilizing the lumbar spine. One study showed that when weightlifting belts are worn during squats, lower back and abdominal muscles are used less. Why would you want to use a muscle less? Also, wearing a weightlifting belt has no transference to daily life or sports. What happens when your wife gets a bug up her ass for you to rearrange the living room, or you run out of gas again and need to push your car? You must know how to brace your abdominals to prepare your trunk for heavy lifting and dynamic movement situations.

If your body is used to wearing a weightlifting belt while lifting, what will happen when you lift and move without it? Obviously, the potential for injury will be increased. Actually, training with a weightlifting belt makes people dependent and ineffective in situations when the device is not used. People typically push out against the belt during a lift. Unfortunately, when the belt is removed, the body will remember pushing out the abdominal musculature, instead of correctly tightening them, and this can result in a lower back injury.

Fatigue and Overtraining

Getting back to our gymbag scenario, perhaps after our hero lifted so hard with such perfect body mechanics and fatigued his muscles so much, that lifting even the slightest weight resulted in injury. Overtraining can contribute to muscular fatigue, as well. It's well known that strenuous exercise causes muscle damage and that high intensity training requires longer recovery periods than low-intensity training. When high intensity training sessions are frequent and close together and recovery time isn't sufficient, the muscle continually breaks down. This can predispose a person to muscular injuries.

This paradigm can be applied to training a muscle group on a daily basis, say your abdominals. It's a typical musclehead belief that abs should be done every day. But your abs consist of the same muscle fibers as all of your skeletal muscles. You wouldn't train your legs or biceps every day, so why train your abs every day? They need time to rest and repair, too.

First-Aid Basics

Whenever you're hurt, it's a good idea to determine if the injury warrants professional medical attention. With lower back injuries, the warning signs that require immediate orthopedic medical attention include: numbness, tingling, loss of sensation or motor function for one leg, loss of bowel and/or bladder function (lovely thought, I know), and severe immobility. These symptoms are best diagnosed by an orthopedic surgeon.

Muscular or tendon strains (soft-tissue injuries) and ligament sprains are the most common causes of lower back pain and the focus of this article. They may require intervention by an orthopedist depending on the severity, but can initially be treated effectively in the home with the use of rest, ice and gentle stretching.

Lifter, Heal Thyself

With any injury, it's always advisable to rest the area for at least 24 hours and apply ice. Ice should be applied for approximately 20-30 minutes and taken off for 30 minutes to 1 hour. Reapplications can continue throughout the day and past 24 hours if the treatment seems effective. Remember that it's normal for ice treatments to make an area feel achy and numb. Heat may be used after 72 hours to warm the area before stretching and/or a workout. Ice can also be used to calm down any post-workout inflammation.

Forget your "balls to the wall" attitude about "no pain, no gain." Working through some types of pain isn't the best way to get better. Your body needs time to heal and any additional trauma (even microscopic) could delay the entire process. However, immobilization will cause tissue to heal in a shortened state and leave you with less range of motion and, consequently, more pain. This means that without a good stretching routine, you could end up losing flexibility, perhaps even permanently. Therefore, a proper sequence should be followed to help you heal, decrease your chance of further injury, and allow you to continue your workout regimen.

Stretching

You must stretch and maintain flexibility of the calves, hamstrings, glutes, quads, and hips. In addition, stretches should be performed on the lower back spinal erector muscles, the mid-back rhomboid muscles, and the cervical muscles because they're all attached to the spine. Here are a few sample stretches for these areas:

Low back spinal erector muscle stretch) Lying on your back, flat on the ground, bend both knees with your feet in contact with the floor. Gently pull one knee toward your chest, while the other knee is still bent and your foot is in contact with the floor.

Mid-back rhomboid stretch) Clasp your hands in front of you and extend your arms straight out at shoulder level. Now push out or "punch" ahead and let your shoulder blades spread out across your back.

Cervical stretch) Drop your ear to your shoulder while looking straight ahead. Don't lift your shoulder to reach your ear. You can gently pull on the top of the head with the same arm that you are bending toward.

Hold these stretches for 20-30 seconds and alternate with the other side where applicable. Perform these stretches three to five times.

Stretching should never be painful and should follow a progression from gentle (when injured) to more aggressive (when healthy). Functional stretches done during a pre-lifting warm-up can include performing the specific movement with a barbell or stick and slowly progressing in range of motion.

Abdominal Exercises

The basis of strengthening your abdominals is to learn how to perform a pelvic tilt. Start by lying on your back on the floor with your knees bent. Try to flatten out the lumbar curve by rotating the lower part of your pelvis toward your bellybutton. Your back should not be arched, but pressed flat against the floor. The position should look like this:

This is the base from which all abdominal strengthening should progress. While performing this "abdominal brace" you can do crunches, reverse crunches, and diagonals. Once you've mastered the basics, try all of the challenging ab exercises that T-mag has posted. Swiss balls are another good option and can be used for ab work and stretching. Using a variety of techniques, you'll develop a stabilized core in no time.

Low Back Exercises

Muscles of the lower back are very frequently undertrained or not trained at all. Thus, they need individualized exercise to increase their strength and endurance. For instance, lower back extension should always be performed with a pelvic tilt to enhance stabilization.

It's not to hard to perform a pelvic tilt, but it is hard to keep a pelvic tilt and tight abs when performing movements with the extremities. That's why so many people hurt their backs. They perform a task without a pelvic tilt and without tightening up their abs. In effect, they ask their lower back muscles to compensate in order to complete the task. These muscles are short and thin (in most people) and not anywhere as thick and as strong as the abdominals are.

In order to teach your pelvis and abs to cooperate, perform a pelvic tilt and hold. Breathe in as you raise your arms over your head. Breathe out as you place them back on the ground. Perform three sets of ten repetitions. Add weights in your hands if this movement is easy and your back doesn't leave the ground as your arms go over your head.

Fun With Your Bed

Get your head out of the gutter. We're talking about mattress selection here. Believe it or not, this is an extremely important issue for an athlete. I know that I love a hard-as-shit bed, but I think that everyone has a different preference. Whatever gets you to sleep is the best. However, if you have back pain when waking up, I'd suggest trying the opposite of what you currently have. If you've been sleeping on a soft bed, switch to a firmer one and vice versa. It's also important to flip a mattress every other month and turn it on the other months to distribute the wear and tear. (And yes, you should do this even if the last time you gave your bed some "wear and tear," Reagan was still in office.)

The only bed I don't recommend is a waterbed. They have absolutely no support. We've all heard how important the "core" is to athletic ability as well as to everyday life. Hopefully, I've shown you how to develop yours, so whether you're ripping 600 pounds off the floor in the deadlift or taking out the garbage, you'll be doing it safely and efficiently.

About the Author

Lori is the president of Human Performance Specialists, Inc., a "think tank" for research in enhancing human performance. She's active as a writer, speaker, personal trainer, and rehabilitation professional. She consults for many high school, collegiate, and professional athletes. Lori can be contacted for individualized training programs and consultations at her hpsinc@mediaone.net e-mail address.

References

1) Andersson GB. Epidemiological features of chronic low-back pain. [Review] [46 refs] Lancet. 354(9178):581-5, 1999 Aug 14.

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