Lower-Back Blues

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Q: I’ve been suffering from lower back pain for the last three years. My disk slips when I do even the most simple movements and I can never predict when it will happen. Every time I get a job, I end up having to leave because my back goes out. My back seems vulnerable whether I sit or stand. I’m starting to get very depressed. What exercises can strengthen my back?

A: If you have chronic, debilitating back pain that is seriously affecting your quality of life, then you should be under the care of an orthopedic back specialist. You may very well be already, but if not, ask your general practitioner to refer you to a spine expert right away.

Strengthening the muscles that support your spine is a good idea, and a back specialist should be able to prescribe physical therapy services so that you can get personalized assessment of your weaknesses and supervised instruction to help build up the area. The spine is so complex that no one exercise program will suit everyone.

You’re obviously willing to do what it takes to alleviate your discomfort but proceed carefully. Some methods that allege to be beneficial to the back may in fact cause further pain or damage.

Yoga, for example, is believed by many to be therapeutic. And for some people, some of the asanas, or yoga poses, can be. But some of the moves, especially those that involve extreme back-bending maneuvers may be highly stressful to your back. What’s confusing is that you may not necessarily feel pain or discomfort when you do it, yet you could still be overloading your spine.

Certain ab exercises done in the gym (like sit-ups or crunches) or in the Pilates studio (such as the V-sit or The Hundred) are also touted as good for strengthening your “core” and therefore helping your back. But this may not always be the case, and some of these moves may put too much strain on your discs.

To help weed through the wide array of options, you might start off by reading two books written by Stuart McGill, a professor of spine biomechanics at the University of Waterloo in Canada. In particular, check out Low Back Disorders available at www.backfitpro.com. One of McGill’s recommendations is to avoid doing any back-bending exercises or motions upon the first hour of waking, since the spine appears to be most vulnerable to stress at that time.

What is probably true is that developing strength and endurance in the muscles that stabilize your spine will help alleviate some of the stress it is exposed to. Maintaining good spinal alignment at all times and training your muscles to help hold you in this posture is the way to do this. Certain isometric exercises that maintain your lower back’s natural curve and do not bend it or put too much load on it may be especially beneficial.

Sitting requires spinal flexion (bending of the spine) and so, for many people, long periods of sitting are extremely painful. Even when you try to sit up straight, your lower back is a little bit flexed. Sitting on the edge of your seat and holding your body high, along with getting a lumbar back-support pillow to help your spine maintain its natural curve may help. But you also may need to take frequent breaks from sitting. McGill recommends standing and stretching your arms up toward the ceiling at regular intervals if you are going to be chair-bound.

Standing and walking with good posture may help alleviate stress when you’re upright. Generally this means maintaining the spine’s natural S-shaped curve and avoiding slumping into your lower back or holding yourself lopsided. You may also need to minimize how much you carry and what sorts of bags you use (a shoulder strap? a hand clutch only?). For some people a backpack is useful; for others it increases uncomfortable weight distribution on certain parts of the back. Keeping bags and purses light is always best.

Since your problem is chronic, you should consult with a back doctor and physical therapist first instead of attempting to treat the problem by yourself.

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Martica is a Manhattan-based exercise physiologist and nutritionist and an award-winning fitness instructor. She has written for a variety of publications including Self , Health , Prevention , The New York Times and others. Martica is the author of seven books, including her latest, - Cross-Training for Dummies . (Read her full bio.)

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Saturday, April 04, 2009 4:11:21 PM

Hi Martica, I realize it is politically and legally correct to recommend that back pain sufferers first see a licensed orthopedic doctor or physical therapist. But people should be warned there is NO guarantee that those licensed professionals will have the necessary knowledge and skill, nor take the necessarily correct approach, anymore than a yoga teacher will necessarily suggest the correct yoga poses for a particular individual's back pain, which can vary dramatically as to what is necessary. There are so many possible causes or sources of pain that most orthodox trained professionals never even consider that it is astounding.

For example, the exercise physiologists and physical therapists who have been my clients and/or students told me that what I showed them worked FAR better than what their orthodox schools' trainings taught, and they were now actually mystified as to why their certified trainings were often exactly opposite of what was really necessary and best to help their patients. The doctors I've treated were amazed at how easily they got better with approaches that would never have dawned on them based on what they were taught in medical or chiropractic school.

For example, in both orthodox medicine and yoga, there is a tendency to treat where the pain is. If the back hurts, they treat or stretch the back. (Just like if the wrist hurts, they treat the wrist.) Or, they use the Near-Mythology that a so-called strong core will support their spine and relieve their back pain. ... Sometimes true. ... But very often it is Relaxing & Lengthening the abdominal muscles (rather than the traditional strengthening exercises) that helps relieve back pain the most. Or, many people discover that over-shortened hamstrings and/or gluteal muscles are adversely affecting their back. So getting the hamstrings or gluteals -- or even the adductors -- to relax and lengthen might instantly relieve their back pain, which surprises them a LOT.

And most massage and bodywork therapists never spend enough time on a particular muscle to get it to relax & lengthen enough to make the structural changes necessary to change the tension and stress patterns that cause the pain. That is just one reason so many studies of massage therapy show so little results in reliable treatment of pain.

After 28 years of doing this, and NOT ONCE ever strengthening anyone out of a posture, pain or dysfunction problem, and more often than not working quite some distance away from where the pain is (and I seldom know ahead of time where), it is clear that too many practitioners, be they orthodox or alternative, have NO IDEA how, nor will they take the time, to track down the true source of a client/patients pain or dysfunction, and are usually in a guessing game at best. For many massage therapists or bodyworkers, they are engaged in what we call Poke & Hope: Press on a bunch of muscles and Hope they get better. ... Sometimes works, very often not.

So while in very many cases the orthopedic doctor is ready to do surgery or administer a cortisone shot -- sometimes claiming it is the ONLY thing that can possibly help the patient, a simple muscle release technique to the appropriate muscles eliminates the problem, quite often for good, and sometimes very quickly. In fact, MY clients are convinced they are LESS likely to find proper release from the orthodox trained professionals than from someone like myself who has life-long experience treating such things.

Yet because of the very counter-productive legal restrictions, it is difficult for most yoga or massage/bodywork professionals to gain the experience or training they need to get this level of insight and skill. The physical therapists I've worked with WANT to apply what I have taught them, but the economics of their work situation -- especially in clinics or hospitals -- do not allow for the level of individual, one-on-one, sustained attention necessary to give their patients the time and treatment they really need. As is happening pretty much across the board in medicine, the economics is determining the treatme

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