In Part 1 I discussed the importance of posture for spinal health and how posture affected muscle tightness. Read Part 1 here. Just recently, I had my intern Melissa Parks perform the breathing exercise in that piece. After 5 breaths her back pain was gone and she had improved shoulder mobility.
Part 2: Mobility and Stability
When
I meet with potential clients I always assess their movement capabilities.
Using the criteria from Functional Movement Systems movement can fall into four
categories:
Functional
Non-Painful
Dysfunctional
Non-Painful
Functional
Painful
Dysfunctional
Painful
The
painful movements are handled by a health care provider, although I regularly
work with clients experiencing chronic pain. I eliminate all the painful
movements from the program and attack all the dysfunctional non-painful
movements. You can still get in a full workout with low back or knee pain.
Often
attacking dysfunctional movement elsewhere can eliminate your pain. A 2007
review paper by Wainner and Colleagues called this regional interdependence –
each segment of the body impacts other segments. They identified a number of
studies that supported this. In particular, the hip was often involved with low
back pain.
I
look at full body movement as well as breaking the body down into segments. A
simple yet effective way of training each segment of your body is Mike Boyle’s
and Gray Cook’s Joint-by-Joint Approach to Training (Cook and Colleagues, 2010). While all joints require a
basic level of mobility and stability, some areas require more of one than the
other. For the purpose of this article I’ll define mobility as the ability to
move a joint through its full range of motion and stability as the ability to
control that motion.
Requirements
According to the Joint-by-Joint Approach
Ankle:
Mobility
Knee:
Stability
Hip:
Mobility
Lumbar
Spine: Stability
Thoracic
Spine: Mobility
Scapulothoracic
Joint: Stability
Glenohumeral
Joint: Mobility
Notice
how the lumbar spine requires a lot of stability rather than mobility. Many
people have more than enough mobility here. Hence, I don’t recommend stretching
your low back unless otherwise recommended by your chiropractor. While I have
many of my clients perform five gentle repetitions of cat/camel from yoga as
recommended by Stuart McGill (McGill, 2007), I don’t have them performing any sort of
sustained low back stretches. Stretching the low back often feels good temporarily, but
may be preventing you from eliminating your back problems for good (McGill, 2007). In
pain-free individuals some spinal movement is encouraged as it enhances
nutrient uptake into the spinal discs (Contreras and Schoenfeld, 2011).
Note: Eliminate any exercise that causes pain.
Stuart McGill found that 5-6 repetitions of the cat/camel greatly reduced low back stiffness, but there was little gain from performing more than this (McGill, 2007).
In
addition to the Joint-by-Joint Approach we can learn from Vladimir Janda.
Decades ago he saw that most people had the same dysfunctions. He called these
common dysfunctions upper and lower crossed syndrome. From Janda we learn that
it’s beneficial to strengthen the gluteals, anterior core muscles (particularly
the external obliques), and lower traps, while stretching the hip flexors,
pectorals, and lats (Page and Colleagues, 2010).
I’m
going to focus on lumbar stability and hip mobility in this piece, because they
seem to be most often related to low back pain.
Hip
Mobility
Foam roll: Focus on the quad/hip flexors, hip adductors (inner thighs), and hip external rotators (butt)
Static and dynamic stretches: work on the same muscle groups as with the foam roller. You can either hold the stretches for 30-60 sec or move in and out of the stretched position.
Core
Stability: The low back muscles are often strong enough, because they're overworked due to lack of support from the gluteals and abdominal muscles. Instead of performing hundreds of crunches it's better for your back to perform anti-extension and anti-rotation exercises. In addition, strengthen your glutes.
A resistance band can also be used.
Many people - especially those with low back pain - require improved mobility in the hips and improved stability in the lumbar spine. The low back also requires support from the gluteals and abdominal muscles.
Stay fit,
Jonathan Pratt
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