Set the Core – Prevent Low Back Pain

We all go to the gym essentially for the same reason – to make changes in our physical lives.  We want exercises that will help us lose weight, build muscle or improve our general health and appearance.  However, as we reach our 40s and 50s, there are physical and functional changes that occur within our bodies that interfere with the improvements we want to make.   These changes are part of the aging process we all have to contend with.

As we grow older, we become more vulnerable to certain types of injury. Our intervertebral discs dry out.  They become brittle and fractured.  The soft nucleus of the disc is forced out of its normal position and sometimes impinges upon spinal nerves.  Spinal ligaments become calcified and lose their elasticity.  Osteoarthritis of spinal joints can constrict spinal nerves and cause sciatic pain.  And even with relatively minor injuries, our recovery time is longer.

These changes occur in all of us – in some, they are mild, in others, severe.  The pain caused by these conditions varies considerably from one individual to the next.  A severe osteoarthritic spinal joint might cause niether pain nor discomfort in one individual while a much less severe condition can cause excruciating, debilitating pain in someone else.  A minor muscle strain, for example, can produce a painful spasm that can immobilize the entire body.

One of the most common injuries experienced by the older exerciser is a strain of the muscles that support the lumbosacral joint. Spasm, pain and disability are the usual consequences. Here’s a technique you can use that will protect your lumbar spine against sprains and dislocations (destabilization) during your normal exercise routine.  It’s called The Valsalva Maneuver.

The Valsalva maneuver is the attempt to force air out through a closed airway (glottis).  Power lifters and body builders use this technique to support the lumbar spine.  They call it “setting the core.” The maneuver increases intra-thoracic and intra-abdominal pressure adding rigidity to the lumbar spine and keeping it in alignment throughout the exercise.  You can master this technique with a little practice. 

First, take a deep breath and hold it for 3 or four seconds.  Now try to exhale  – but keep your airway closed.  You’ll feel your abdominals and paraspinal muscles tighten.  Now, open your airway and exhale normally.  Next, repeat this maneuver but this time release about 50% of the air you inhaled.  After 3 or 4 seconds, exhale normally.  Finally, do the same thing, but release another 20% of the air you took in.  You’re now left with about 30% of intra-abdominal pressure – sufficient to protect your lumbar spine during almost any exercise.  Remember – the stronger your core muscles are, the greater the protection you’ll get.  Don’t worry about the adverse effects of holding your breath.  You’ll find that as you gain more control over your “abdominal corset” you’ll be able to breath

normally – inhaling on exertion and exhaling as you complete the exercise.

Almost all of the exercises used in a strength-training program require a balanced, stable lumbar spine for support.  When you do any of these exercises, do them correctly. But before you do them, think kindly about your back ..... set the core.

Total Disc Replacement – A Questionable Alternative

As an alternative to spinal fusion, your surgeon may offer a total disc replacement (TDR) for relief of your back and leg pain.  A TDR procedure involves removing the degenerated disc and replacing it with an artificial disc implant.  After the implant has been inserted between the vertebral bodies, normal disc height is restored and motion in the joint is preserved.  This intervertebral joint motion is thought to create "normal balance and a more natural spinal function."  It is also theorized that the artificial disc slows down degeneration of adjacent spinal segments.  This all sounds great until you examine some of the critical details of how the disc works in practice.

Most complications in TDR surgery occur as the result of inaccurate positioning of the artificial disc.  If the surgeon selects too large an implant and places it too far forward in the disc space, the entire implant tends to migrate farther forward, well beyond the the margin of all the other spinal discs. (Migration is the movement or shift in position of an object within the body.  It's a constant risk with any implant.)  This forward position of the implant can puncture the large blood vessel that lies directly in front of the lumbar spine.  The possibility of this one, life-threatening complication is enough to make you think twice about having an artificial disc implanted.

Low Back Pain – The Price of Poor Posture

Do you remember when your fifth-grade teacher scolded you for slouching?  “Stand up straight, young man – and take your hands out of your pockets.”

Sounds like she was giving you some good, therapeutic advice.  If she were a physical therapist, she might have said, “Flatten out that kyphotic-lordotic curve, adduct those shoulders and, while you’re at it, add some posterior tilt to your pelvis.”  If you had followed that advice, it might have helped you avoid many episodes of painful, low back pain. 

There’s no doubt that faulty posture is a significant cause of low back pain.  Thankfully, it’s a condition that can be corrected with a few special exercises and some new, postural habits.

Ideal Posture

In the ideal posture, viewed from the side (A), the normal spine assumes a gradual, S-shaped curve – convex at the top (kyphosis) and concave at the bottom (lordosis).  The head is centered over the cervical spine and not tilted or rotated in any way.  Remember, the position of your head and neck will be affected by the conformation of your upper back.  If you allow your upper back to slump into a rounded, “hunched” position, your head will be thrust forward and downward into an increasingly uncomfortable position (B). 

The pelvis is in a neutral position – crest of the ilium directly positioned over the hip joint.  The forward part of the ilium is in vertical alignment with the pubic symphysis (A).  

Kyphotic-Lordotic Posture

In B, the S-shaped curve is exaggerated.  The kyphotic curve of the upper back is pronounced and the head and neck are forced forward.  Weakened abdominal and spinal muscles allow the pelvis to tip forward and increase the lordotic curvature. This adds strain to the lower back.

Corrective Exercises

Add the following exercises to your daily routine. If you’re overweight, modify your diet. Excess body weight tends to increase lordotic curvature and add considerable strain to the lumbosacral joint.

Upper Body

• Mild stretching and then strengthening of the muscles behind the neck (extensors) will help you establish a more erect position of the head.
• Strengthen the thoracic spine extensors (upper back) to elevate the chest.
• Add deep breathing exercises to your daily routine.  This will help stretch the intercostals and expand the chest.
• Stretch the adductor muscles of the shoulder and pectoralis minor to help bring the shoulders back to a more normal position.

Lower Body

• Strengthen the muscles of the low back.
• Strengthen abdominal musculature with posterior, pelvic tilt exercises.
• Avoid sit-ups.  They shorten the hip flexors and increase lordosis.
• Temporary use of a corset or brace can relieve the strain on abdominal muscles as you train yourself to stand, walk and sit in a more erect position.

The trainer at your gym should be able to show you the proper exercises to achieve these goals.