Saturday, November 6, 2010

8 Steps to Helping You Alleviate Low Back Discomfort

8 Steps to Helping You Alleviate Low Back Discomfort

HFPN Editorial Team

Low-back discomfort is an increasingly common problem. In fact, according to the Centers for Disease Control and Prevention, low-back problems are the leading cause of disability in the workplace. To help alleviate low back pain, we suggest undergoing these 8 steps with your health and fitness professional.
Step #1: Undergo an Assessment
When it comes to low back pain, the one-size-fits-all approach to exercise programs is commonly unproductive and potentially dangerous. Therefore, prior to beginning an exercise program, we suggest undergoing a thorough assessment for causative factors. 
With respect to low-back discomfort, causative factors include muscle imbalances, instability, and movement deficiencies (see Tables 1 and 2).
Table 1
Common Muscle Imbalances Seen With Low-Back Discomfort
Short/Tight Muscles
Long/Weak Muscles
  1. Rectus femoris
  2. Iliopsoas
  3.  Adductor complex
  4.  Hamstrings
  5. Piriformis
  6.  Tensor fascia latae (TFL)
  7. Quadratus lumborum
  8.  Erector spinae
  9. Latissimus dorsi
  10. Soleus
  1. Gluteus maximus
  2. Gluteus medius
  3.  Inner unit musculature*
  4.  Posterior tibialis
* The inner unit consists of the transversus abdominus, multifidus, diaphragm and pelvic floor musculature.

Table 2
Common Movement Deficiencies and Instabilities Seen With Low-Back Discomfort
  1. Inability to hip flex or hip extend without excessive lumbar spine compensation during movement
  2. Loss of segmental control (inability to tilt the pelvis independently of the lumbar spine)
  3. Abnormal spinal flexion and/or extension when squatting or lunging
  4. Excessive abdominal protrusion during functional movement

Step #2: Begin with an Integrated Warm-up
An integrated warm-up can be defined as a group of exercises performed before specific activity. The benefits of a properly structured warm-up are many. They include:
  • increased body and tissue temperature
  • increased blood flow through active muscles
  • increased metabolic rate, increased speed at which nerve impulses travel
  • increased soft tissue extensibility 
Examples of possible warm-up components are listed in Table 3.
Table 3
Possible Components of an Integrated Warm-up
  • Self-myofascial release (SMR)
  • Static stretching
  • Neuromuscular stretching
  • Active isolated stretching
  • Dynamic stretching
  • Treadmill warm-up
  • Elliptical warm-up
  • Cycling warm-up
  • Versa climber warm-up

Step #3: Improve Your Core Control
To prevent back injuries, you must develop optimum levels of core stabilization, strength and power. In simple terms, thecore is defined as everything but the arms and legs. Core stabilization is defined as the ability to prevent sudden or excessive forces from straining joints and ligaments. Core Stabilization Training involves isometric holding of the spine and is designed to teach the body to properly stabilize the spine and pelvis when the arms and legs are moving.
Core strength is defined as the ability of the core to control the whole range of motion of all joints, including the spine. Core strength training replaces isometric holding adding movement of the spine and emphasizing eccentric control.
Core power is defined as the core's ability to transform physical energy into force at a fast rate. Core power training involves movements performed at high intensities/velocities and therefore requires adequate stabilization and strength.
Step #4: Achieve Optimal Levels of Balance
An extremely important component in preventing back injury is your ability to stabilize your center of gravity over your changing base of support. Traditionally, balance is considered more a static concern (standing on one foot) than a dynamic one (walking, running); however, balance is an extremely dynamic matter. For example, every time we move, we must control our center of gravity over a base of support that is constantly changing. In order to move safely and effectively, we must have the ability to control our joints and our overall structure in relatively unstable environments. This becomes especially important as the population becomes more sedentary, but also holds true when performing exercises in relatively stable environments (such as weight training machines).
Our bodies are extremely adaptable. However, if we never expose ourselves to these unstable environments, our bodies will not be able to respond effectively when these environments are encountered. Balance training will enhance joint stability as we move, thus decreasing stress on joints. It will also enhance our spatial awareness and improve our ability to stabilize ourselves in environments of instability.
Step #5: Enhance Your Muscle Reaction Times
Reactive training is essential because the nature of human movement involves a quick stretching, then contracting, of muscle-from an eccentric muscle action to a concentric muscle action. However, the magnitude and rate at which this training component is applied will depend on your individual capabilities. No matter the population or the activity in question, an individual's ability to react and generate force quickly is crucial to overall function and safety during movement.
Step #6: Improve Your Integrated Strength
Strength is defined as the ability of the neuromuscular system to produce internal tension and exert resistance against an external force. However, strength can and should be delineated into different categories for optimal results. Of the different categories available (absolute, maximal, endurance, speed, relative, stabilization, core, and functional strength) training for core strength, stabilization strength, endurance strength and functional strengthis the most applicable to back-pain prevention.
Step #7: Cool-down
A cool-down can be defined as a group of exercises performed after the workout which bring the body from an active state to a resting state. The main objective is to facilitate muscle relaxation, reset muscle length, promote removal of muscle waste products, reduce the chance of muscle soreness, and allow the cardiovascular system to adjust to lower demands.
Step #8: Make Sure Your Program Fits Your Capabilities
This means adjusting your acute variables to match your abilities and needs. Acute variables consist of repetitions, sets, training intensity, training volume, tempo, rest interval, exercise selection, , training duration, training frequency, and range of motion (to name a few). Believe it or not, ALL of these must be considered when creating your individual training program. In cases of low back discomfort, proper progression is paramount to providing results that last! So try to avoid moving into more demanding exercises too fast.