Monday, November 8, 2010

Low Back Pain (Part 2): Injury Limits to Fat Loss

Low back pain is a common and often a debilitating condition. The good news is that most cases of low back pain are preventable or easily treated. If you remember from Part 1, the lumbar spine is meant to be stable and in a neutral alignment (see anterior pelvic tilt), and the hips and thoracic spine are meant to be mobile. Thus, abdominal exercises that promote movement around the lumbar spine may actually be the cause of low back pain! Likewise, inactivity and prolonged static postures (such as sitting in a classroom all day or having a desk job) tend to decrease the mobility of our hips and thoracic spines causing people to compensate by moving at their lower backs.

Deadlift: Good hip mobility

Deadlift: Poor hip mobility with low back compensation

Anyway, exercises for the core should be designed to promote stability, and a quality mobility warmup should be completed before every training session. The rest of this entry will discuss what may be done to address these two topics.

Again, I would like to point out that nothing in this entry is meant as a substitute for medical advice. It is for educational purposes only. Anything you might apply from this post is of your own free will and at your own discretion. Furthermore, if you decide to complete any of these exercises, it is recommended that you stop if there is any pain. Certain low back disorders require specific therapeutic exercise. The exercises here are general non-therapeutic exercises that may be performed in an effort to prevent low back pain, not treat an existing condition.

Choosing abdominal exercises
What not to do: crunches, sit-ups, bicycles, side bends, etc.
What to do: plank variations, rollout variations

The Plank

The key to a good plank is holding the position while maintaining a neutral spine. Many people will tell you to draw in your abs to activate your transverse abdominus muscle, but I disagree. I don't find that muscle particularly useful for much of anything. If you want to, you certainly may, unless of course you are working with me personally, in which case I would probably convince you not to bother. For many, this exercise will be fairly challenging to hold for a few sets of 30 seconds. Some might find it too difficult. There are two options for those individuals. The first is to hold it for shorter periods of time. If that is still difficult, the other option is to perform a regression from the knees. If it is too easy, the time can be increased, a foot can be lifted from the ground (3-point plank), a pushup position can be held (increased demand for shoulder stability), or the feet can be elevated onto a box or into a TRX Suspension Trainer.
Side Plank

Like the plank, the plank is a fantastic exercise for core stabilization. This works the obliques especially well. Again, a regression for the exercise is to perform it from the knees. Progressions may include increasing time or placing the feet into a TRX.

Ab wheel rollout variations, to me, are the absolute best options for training the core. They are also among the most difficult, and I usually do not start beginner clients with them. If you google image search ab rollouts, you will see many variations of them. The easiest ones are performed with a large stability ball. Progressions from that movement are the ab dolly, "rollouts" in a TRX, and then the ab wheel. Extremely strong and talented people can perform ab wheel rollouts standing, but those people are few and far between.

Ab Exercise Summary: Maintaining a neutral spine is key to preventing low back pain.

Hip and Thoracic Mobility
There are several keys to maintaining mobility of these key areas of the body

1. Avoid "creep"
2. Regular soft tissue work (massage, foam rolling)
3. Static Stretching
4. Dynamic Mobility Drills

Avoiding "creep" is simple. Creep is the tendency of our bodies to adapt to any position that we hold for a long period of time (15+ minutes or so). For example, if you sit like a hunchback all day, your tissues will tend to get locked into that hunchback position unless something is done about it. How do you avoid creep? Fidget, move around, etc. Don't let yourself sit around longer than 15 minutes. Get up and stretch or something.

Soft tissue work is extremely important. If you cannot afford regular massage (and let's face it, most of us cannot), then the foam roller is your best friend. I could go into all the details of foam rolling, but that was the whole purpose of me writing the article on foam rolling a long time ago in the first place! So, if you are new to it, just click that link and you will be taken to that article. The areas you want to focus on if your goal is to prevent low back pain is the thoracic spine and all the muscles on the front, back, and sides of the hip.

Foam rolling is likely going going to be painful for whatever muscle you are rolling (the t-spine rolling will probably not hurt as it is more of a mobility drill than soft tissue treatment), but it hurts less and less as you improve your muscle tissue quality.

Static stretching is important, but it is more important to know which muscles to static stretch. This requires an assessment. For example, if you have anterior pelvic tilt, then hamstring stretching is a bad idea! Usually stretching the adductors (inner thigh) is a great idea. The same goes for the quads in most cases. Any stretch should be performed while maintaining a neutral spine.

The final piece of the puzzle for improving mobility and preventing low back pain are the mobility drills. Unfortunately, mobility drills are very difficult to describe in a single blog entry. In a nutshell, mobility drills are simply dynamic stretching. If you have the time to look it up, search for mobility drills of the hip that focus on extension and abduction or the thoracic spine that focus on extension and rotation. Those will be the most important for most people.

In conclusion, the most basic keys to preventing low back pain are training the stability of the lumbar spine and the mobility of the thoracic spine and hips. If your back hurts, you can't train. If you can't train, it is awfully difficult to burn fat. So, take care of spine. Don't skip out on the warmup and avoid those situps!

By the way, for a bunch of free training templates and a 15% discount code for The Theory of Fat Loss, check out the official Facebook page for the book.

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