Epidemic of Back Pain in U.S.
Back pain is an epidemic in U.S. and other industrialized nations. Nearly 31 million Americans are affected by some type of back pain at any given time and a third of American adults had back pain in the last thirty days. The Institute of Medicine reports that value of lost productivity from low back pain is in the hundreds of billions annually. Why is back pain so prevalent and why, as a society are we finding this problem so difficult to fix?
Hip Hinge Rounding If You Have Back Pain, Don’t Sit and Exercise (click on the picture to enlarge)
There has been a tremendous amount of attention in recent years on how unhealthy sitting for prolonged periods can be. Some research even shows that if you hit the gym every day, sitting the rest of the day may still be bad for you. Here are some things that scientific research has taught us about sitting and how it affects our low back.
- Spine Neutral Position is the safest and most powerful position for the spine and low back. Standing in good posture with ears above the shoulders and shoulders directly above the hips places 1x our body weight compression on the spine.
- Sitting compresses (or loads) the spine. Funny, you would think that we sit “to take a load off”. Sitting actually compresses and loads the discs of the spine by 1.8x our body weight. Kneeling places similar compression loads on the spine as sitting. Sitting in forward flexion (leaning over a computer desk) increases the load on the spine even more.
- Pathology involving the spinal disc’s annular fibers cause it to be more susceptible to injury when loads are placed on it. When we twist, at 45 degrees we lose half the strength in the spinal discs. So, if we are sitting, and loading the lumbar spine by 1.8x body weight, when we go into a popular torso rotation exercise the discs are experiencing a shear AND they lose their strength by 50%. A compressed spine makes us vulnerable to injury, not only in the spine, but in our shoulders, ankles, knees, etc. Also, facet joints in the back desensitize after 20 minutes of sitting, which leads us to our next point.
- Viscoelastic creep. It may sound complicated but is relatively easy to understand. In effect, if a muscle is placed in a lengthened position for a long period of time, it loses its visco-elastic properties, or its ability to spring back into its normal tension state. Unchanging posture leads to decreased fluid and nutrition exchange in the disc. If you spend a lot of time bent over a computer desk the muscles in your back are being held in a lengthened position, which will eventually compromise their ability to return to their normal state. This makes you more susceptible to minor traumas as a result of normal movement; for example, you are more likely to hurt your back on small and light loads out of position. Studies have shown that if you spend 15 minutes in a forward flexed posture, it takes 3 times as long or 45 minutes for your muscles to return to their original state. Dr. Shawna Heber, DC, BSc (Kin). This means that if you have been sitting for a prolonged period of time, the last thing you want to do is get up and lift or move heavy weights.
- Research shows that core muscle strength is not as important as core muscle endurance for maintaining a healthy back.
- There are muscles in the body that have feed-forward properties. What this means is, before your body initiates movement, there are certain muscles that become activated and contract before the movement is actually made. These muscles have stabilizing properties that prevent injury. One such muscle is called the multifidus, the most important of your spinal stabilizing muscles. If any of the core muscle belt muscles get lazy and do not activate, then the multifidi will activate more powerfully and eventually fatigue (and shut down).
- Core muscles mostly shut down when we sit. According to clinical research, core muscle activation is limited while performed in a seated position. Rectus abdominis registered 81% lower in bilateral seated versus standing. http://www.ncbi.nlm.nih.gov/pubmed/21877146
Three simple things are needed to develop and maintain a healthy back.
- Motion: motion into the spinal joints is needed to deliver nutrients into the joint and remove waste. Waste can be inflammation, scar tissue, etc. After the age of 18 we no longer have a blood supply to the spinal discs. The discs then get their nutrients from subtle motion. But, this motion should also be safe motion and not create shearing of the discs.
- Core Muscle Integration: core muscles working together, 360 degrees around the spine, are necessary to support and protect the spine and low back. Not muscles working in isolation, but our entire core belt of muscles activating simultaneously. Isolating abdominals teaches our brain to ignore our obliques and low back (multifidus) thereby rendering instability to the low back and spine. When all of our core muscles that surround the spine activate at the same time, these muscles then stabilize and protect the spine from trauma or injury.
- Neuroplasticity: after about a month of training your core muscles to activate together it will become a habit. You won’t have to remember to or focus on core muscle firing, it will become automatic, like a reflex.
- Sitting places harmful compression loads on the spine and low back
- Sitting with movement on the spine creates shearing of the discs
- The discs retain only 50% of their strength when in a twisted state. Rotation, simply for the sake of rotation may not be the answer
- Sitting for extended time creates viscoelastic creep which makes the low back vulnerable to injury well after we get up
- Sitting deactivates core muscles: more prone to injury and a less powerful position to be in
- Stretching exercises done in a sitting posture renders the exerciser at a higher risk for a disc or low back injury
- Co-activation and recruitment patterns are more influential in combating low back pain than muscular strength
- Training core muscles to activate as a habit creates more efficient and effortless movement
Why would we ever want to sit while exercising? Since we know what scientific research has taught us, why are there so many seated exercise machines on the market?
According to Dr. Stuart McGill, world renowned expert in spine function, injury prevention, and rehabilitation, “the staples of most back rehab programs should be eliminated because of the tremendous compressive loading forces that they create through the discs of the spine.”
Sitting, loading and compressing the spine during exercise is not a good idea. Training core muscles to activate and stabilize the spine during each exercise is a good idea. Using the Core Activator will engage the core muscles and groove proper muscle activation patterns. The user is placed in spine neutral position and engages core muscles all the way around the spine. Continued use will exercise proper neural pathways and through the concept of neuroplasticity, these pathways become stronger and more efficient.
“THE SCIENCE SPEAKS FOR ITSELF. WHEN WE DO TRADITIONAL CORE EXERCISES WE PUT UNNECESSARY LOADS ON THE SPINE – TIGHTEN THE CORE EQUIPMENT ALLOWS US TO EXERCISE THE CORE MUSCLES, IN THE PROPER SEQUENCE AND ALSO TAKE THE LOAD OFF THE SPINE. THAT’S A WIN-WIN EXERCISE”. Dr. Michael Torry, PhD / Director, Biomechanics Laboratory, Illinois State University