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November 19, 2009

Back pain, what can you do?

Scott Stockdale

Scott StockdaleIn an interview with The Canadian Charger, Dr. Stuart McGill said that generic exercise for those with back pain will not be successful. McGill is professor of spine biomechanics at the University of Waterloo.  

“Exercise prescription becomes quite a science, particularly for bad backs. First, there is no such thing as non-specific back pain – it has a cause and a reason why it is not subsiding. Those with back pain need to be assessed to determine their specific cause and classified into subcategories to best prescribe the most appropriate exercises. An exercise that will help one person may hurt the next.”

It takes Dr. McGill about two hours with a patient to sort out the cause of the back trouble and identify patterns that need to be changed, together with determining what exercise will be helpful.

He added that some exercises such as yoga may help some people with back pain and hurt others.

With our increasingly sedentary lifestyles and aging population, it's not surprising that Dr. McGill said a lot of middle aged people develop discogenic back disorders: That is back pain from a disc, which Dr. McGill says is exacerbated quite often by too much sitting.

“This condition results in spine flexion intolerance. Driving and gardening can exacerbate it. If you have this, the first step is to avoid flexing the spine.”

As an example, he said pulling your knees to your chest is the worst thing you can do.

“Stretching the muscles (in the back) may make you feel good for 15 minutes, but the pain quickly returns. This paradox results from the stretch stimulating the stretch receptors in the back muscles, which can be relieving; but more damage is caused to the discs, insuring that the patient remains a patient.

“In many cases the patient is also inducing nerve pain because they stretch the sciatic nerve and making it more sensitive and painful. Many patients benefit from stabilization exercises and exercises to mobilize the hips, thus stretching the hips and not the back. This requires precise patterns of movement. Back pain is caused by the way people move. We try to build on movement that's not painful for the back.”

He mentioned a couple of common exercises - sit-ups and riding a stationary bike – that often cause more back trouble.

Sit-ups require bending the back, and Dr. McGill said the discs only have the capacity for so many bends, so eventually the discs will wear out. Riding a stationary bike develops the quadriceps and hamstrings in the legs, but Dr. McGill said it's the gluteal (butt) muscles that need to be developed, if people have discogenic disorders.

He explained that the limb muscles create motion and the torso and spine muscles stop motion. And it's the torso and spine muscles that keep the spine in place.

“It's like having a stack of oranges. If you squeeze the stack, they'll fly apart.  The muscles all around the spine hold the back in place.” 

Sciatica – irritation of the sciatic nerve, which goes from the back down to the thigh and to the foot – is another common back problem Dr. McGill studies.

“Most of the time it's caused by inappropriate posture or inappropriate movement. We have to figure out the cause; and then if we can decrease the (inappropriate) movement, we can decrease the material pushing on the disc.  Then we often use neural flossing on the nerve roots being impinged to make them less sensitive. This creates more room for nerve movement, reducing the pressure and pain.

While he continued to stress that there is no ideal way for everybody to exercise, he showed diagrams and outlined three exercises that challenge the torso. Conditioned torso muscles are important, Dr. McGill said, because they ensure a stable spine and allow you to preserve good spine posture during all daily activities.

In the first exercise, I lay flat on my back on the floor; with my hands under my lumbar region (lower back) because Dr. McGill said allowing the back to flatten into the floor predisposes it to injury. Next, he told me to stiffen my abdominal muscles and lift my head and shoulders off the floor.

“Pretend they're (head and shoulders) on a bathroom scale,” Dr. McGill said. “Lift them so the weight is zero (but not enough to raise them more than an inch off the floor) and hold for 10 seconds.”

The second exercise requires the person to lie on his or her side and support the body up with one arm, while either the person's feet or knees remain anchored to the floor. This exercise strengthens the lateral torso muscles, which Dr. McGill said are essential for spine stability, but he stressed that each case is different.

“We want exercise that is within a person's tolerance. We don't want to surpass the tolerance level. Stress is good, but too much stress is harmful, so it's finding the correct level that's essential.”

The third exercise, called the birddog, requires the person to kneel with hands and knees on the floor, then situate the torso parallel to the floor with one arm stretched forward and the opposite leg stretched back.

“This is good for ensuring a conserving spine load,” Dr. McGill said. “It guarantees stabilization in the back and challenges back muscles.”

Dr. McGill said most patients follow a cascade of injury and degeneration, meaning they're progressing in tissues that are involved.

“We need to know where you are in the cascade because exercise that worked a year ago is now hurting. Exercise changes as you grow older.”

He used treatment for arthritis as a good example.

“Early on walking is the best therapy. It may even prevent the cascade from developing. But later in the cascade, it can be very exacerbating.”

He said he uses very precise corrective and therapeutic exercise for a specific diagnosis of back pain.

“However, if the person is out of pain we can give more generic programs; i.e., for mobility of the hips, stability of the spine and endurance of the back muscles. We build on patterns of movement such as push patterns, pull patterns, lift patterns and carrying patterns.”

Dr McGill has written two books about back disorders and how to design better therapeutic exercise – they can be seen at www.backfitpro.com.

Scott Stockdale is a freelance writer based in Toronto. 

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