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By Melissa Tennen, HealthAtoZ writer
Back pain is nothing new. Each year, nearly 6 million Americans suffer from back or spinal problems, making back pain the most commonly reported health condition in the United States. Here to talk about back pain and how to manage and prevent it is Cedric X. Bryant, Ph.D., FACSM, chief exercise physiologist and vice president of educational services for the American Council on Exercise.
How common is back pain?
Cedric X. Bryant: Approximately 80 percent of the population experiences some type of lower back pain at some point in their adult lives. It's a common orthopedic injury. It can be anything from a lumbar sprain to an actual rupture of a disc.
What causes lower back pain?
Bryant: These injuries, or sprain and strain, are the most common causes of low back pain. Frequently, a combination of other factors may increase the likelihood of injury or disease such as poor conditioning, improper use, obesity, smoking and aging.
The natural effects of normal aging on the body, in general, and low back, in particular, are a decreased amount of bone, decrease in strength and elasticity of muscles, and decrease in elasticity and strength of ligaments. Although you cannot totally halt the progress of these effects, they can be slowed by regular exercise, proper nutrition and by not smoking.
You need to have that stability when the muscles support the core regions of the body. "Throwing out the back" happens when people are doing a dynamic movement. An older person reaches down for a pencil and pulls his back. It's the classic sudden bending, "I-threw-my-back-out" syndrome. Or a mom picks up her toddler and she throws her back out. That would be a lack of stability. Weak muscles are not able to provide the support and protection the back needs.
At what point in a person's life are they most at risk for back pain?
Bryant: We tend to see people as they reach middle age be more prone to back injuries. But we are starting to see it in younger people who aren't in good condition. We're seeing this increase in obesity, especially among younger individuals. So we're seeing more back problems. In obesity you have added weight on the body, and it causes the pelvis to tilt forward and puts added stress on the spine.
Does back pain have to be life-long?
Bryant: It doesn't have to be. That's the good news. Engaging in an activity program will help address this. Also, losing weight helps.
What if I do a lot of weightlifting? Won't that help?
Bryant: One of the mistakes that people tend to make is that they tend to focus more on developing strength. But what is really important is muscle endurance. It usually isn't because people have poor strength that they hurt their backs. When you are lifting something heavy, it puts stress on the natural corset. You need to have stability to support the load. Endurance has a more protective value than strength. When muscles get tired, they may not have as much stability. You are better off investing in low-load and long duration exercises than emphasizing strength.
What kind of endurance exercises helps keep my back strong?
Bryant: Exercise doesn't need to be complicated to benefit your back. Individuals can walk at lunch, bike with their family or go for a swim. These types of activities are endurance exercises that can help improve blood flow to the back and strengthen and relax the back muscles without jarring them.
What kind of pressure do we put on our backs?
Bryant: Basically, there are two types of loads to the spine: compression and shear load. In general, compression can be thought of as vertical loading of the spine such as what occurs from body weight, bending to lift an object, etc. Shear load, on the other hand, represents lateral loading on the spine from twisting and turning. Without stability and muscle endurance, you could injure your back while your spine is under these loads.
Many popular exercises that we do to build our abdominals can have relatively high compressive and shear loads of the spine.
What are back exercises that you recommend?
Bryant: The back is a unique structure. That's why it's challenging to come up with a single exercise for the back. You can't train the low back muscles the same way you do other skeletal muscles because they are supporting a very specialized architecture in the body.
With one exercise called the modified Curl-up, you are able to reduce compressive and shear stress while at the same time challenging your abdominals, which helps provide that stability. Lie flat on your back with one knee flexed. Raise your head and shoulders off the floor; alternate the bent leg midway through each set of repetitions. Pause and then return to the starting position.
Another exercise, the Side Bridge, works your oblique muscles. Strong abdominals are important for helping provide the spine with that good support for the entire corset surrounding your spine. Lie on your right side, bending your knees. Raise your upper body using your right arm to hold you up. Use the torso to lift the hips, being careful not to let the top hip rotate forward. Make sure to bend your elbow directly beneath your shoulder. Place your left hand on your hip. Hold this position for 10 to 15 minutes and then repeat on the opposite side.
With the Birddog, you are on all fours. Extend one leg and the opposite arm so that they are parallel to the floor. Hold this position for seven to eight seconds, and then repeat with the opposite arm and leg.
Those would be the three primary exercises to help with low back health. And as a warm-up, do the cat camel. It helps to lubricate the joints of the spine and restore flexibility to the spinal muscles and ligaments. The Cat-Camel also starts on all fours. Slowly alternate arching and rounding your back. Hold each pose for eight to 12 seconds.
These exercises can help prevent back pain and also help you get better sooner.
How often should you do these back exercises?
Bryant: Every day. We're talking five minutes a day to help save your back from injury.
If I injure my back, what should I do?
Bryant: Because every individual is so unique as far as the back is concerned, it really is hard to give a hard and fast rule. At a minimum, individuals should follow the simple exercise routine we've already talked about, but only after a doctor has cleared them for physical activity. When you have an injury, you should start moving as soon as possible. The old program was that you should stay in bed. Now the general recommendation is to try to get the person engaged in movement as quickly as possible. That can really reduce the duration of their disability.
The "no pain, no gain" mantra has no place. If you are experiencing significant pain prior or during the exercises, that's your body's definite signal that this is something you should avoid.
When should you see a doctor?
Bryant: You should get cleared for all physical activity by your doctor. People should seek immediate medical attention if their back pain is accompanied by weakness or numbness in one or both legs, pain going down one leg below the knee, back pain from a fall or injury, back pain accompanied by fever without flu-like aches, pain that continues to interrupt sleep after three nights, or back pain that remains after six weeks of home treatment.
What are some other ways to prevent back pain?
Bryant: Avoid sitting for long periods. Stand up at intervals while talking on the phone. Walk the aisles during long flights. During long car rides, stop periodically to walk around and stretch.
Lose weight, since carrying extra weight, especially in the abdominal region, can throw off a person's body off balance placing added stress on the back.
Avoid smoking because it appears that it may reduce blood flow to the discs and cause them to degenerate prematurely.
How long will it be before I can see results?
Bryant: People should hang in there. The vast majority of individuals can expect to see an improvement in functionality and reduction in pain in about six to eight weeks.
Do enough people take care of their back before injuries happen?
Bryant: It's been my experience that people don't appreciate the importance of good back health. People don't take the time to learn about it until something happens.
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External Source
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The American Council on Exercise
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This article was reviewed and updated June 2007.
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