Looking at Lower Back Pain

By Bruce Cohn
Boston Globe, July 15, 2004
 
Whether we are moderately active or sedentary, low back pain will afflict 80 percent of Americans at some point. Despite my work in the fitness field, I have battled back problems for much of my adult life. Over the course of that time, I have been exposed to many changing ideas and treatments for the problem. A brief look at the structure of the spine and the stress we put on it may help explain why this problem is so widespread.

The back is an incredibly intricate and delicate bit of engineering: 24 vertebrae, 23 of which are separated by fibrous discs which act as shock absorbers. Add in nerves, ligaments, muscles and the fascia that connect them and you have a host of structures increasingly vulnerable to pulling, tearing and a loss of elasticity. When we consider the forces that act on our spines, there is little wonder that so many people experience back problems.

The foremost of these forces is gravity, which we must overcome daily to remain upright. Throw in some extra body weight, which so many Americans have, and the muscles and connective tissue that support the spine are working overtime. And that is even if the muscles of your core--which include the muscles of the back and hips as well as the abdomen--are strong enough to do their job properly.

It is the amount of time we spend sitting-- at work, driving or relaxing-- that is the real culprit when it comes to back dysfunction. Orthopedic surgeons, chiropractors and other medical personnel might disagree on the best treatment for a back problem, but there is universal agreement that sitting increases the stress placed on spinal discs and leads to muscular imbalances.

Gray Cook is a physical therapist in Virginia and frequent lecturer who looks at the cause of low back pain as "a loss of the normal coordination between the muscles that protect the spine and the muscles that move the body." Bob Vinson, a massage therapist and Structural Integration specialist who practices in the Greater Boston area, agrees and notes that many back pain sufferers develop postural imbalances and tend to overuse muscles that are prone to tightness and disuse those prone to weakness. Mike Boyle, a strength and conditioning consultant who works with elite athletes, thinks the primary cause of back pain is poor mechanics coupled with weak legs. He cites Stuart McGill’s research that shows that people with back pain have stronger backs than people without back pain, although they have weaker legs. Boyle suggests that most people with back pain tend to bend at the waist instead of squatting because of this lack of strength.

Perhaps the simplest way to understand this is to look at the largest muscle in the body, the gluteus maximus, located in your butt. One of this muscle's main jobs is to extend the hip as we push off the ground when walking or running and decelerate against the force of gravity as we squat down or land. If a person has weak gluteal muscles or doesn’t know how to activate them--and most people don’t-- they end up substituting either the hamstrings in the back of the thigh or the erector spinae muscles that surround the spine. In this scenario the hamstrings and deep spinal muscles end up overused and tight resulting in low back pain while the butt muscle remains largely inactive.

It is this type of pattern--the substituting of postural muscles for ones that are designed for movement-- that inspires Vinson,Cook and Boyle to look at both movement and posture as the key to understanding how to help a client. All of them urge people to start moving, focusing on moving correctly and proficiently. In addition to his work on the body that focuses on deep massage, Vinson recommends that clients learn exercises that teach spinal stabilization, flexibility and strengthening. Cook has developed a series of five exercises in his book "The Athletic Body in Balance" that help people identify basic movement patterns that demonstrate how the body and the back work together. Boyle focuses on exercises that activate the gluteal muscles in the butt.

While all of this may sound confusing, the beauty of the message is that there are some relatively simple exercises to help you move more functionally and decrease the incidence of low back pain.

In the upcoming months, Getting Fit will explore core stabilization/strengthening exercises, lower body training and flexibility approaches that you can perform at home with these goals in mind.

Bruce Cohn is the Strength and Conditioning Coach at the Middlesex School in Concord. He runs FIT-TO-GO Total Sports Conditioning and is a nationally certified Strength and Conditioning Specialist. Bruce can be reached at 781-316-0061 or brucegym@rcn.com.