How to Prevent Lower Back Pains

Max Wettstein: Okay. How is it going? This is Max Wettstein with Destination Health Plus coming to you from Insanitus, right here next to me is Lisa Ford, she has her Masters in Physical Therapy, and I wanted to speak with her today and have her talk to you about low back pain. Low back pain. What causes it? What you can do to maybe prevent it? How to align your body, and maintain a neutral spine and move correctly so you avoid the back pain or any injury in the first place? So, Lisa we were talking, and I noticed you kept going to neutral spine, and you kept talking about alignment, what do you mean by about alignment, are you talking about muscles, or the spine itself, leg length difference? First you got to get yourself aligned properly, is that correct? Lisa Ford: Yes. Alignment can mean a lot of things. Neutral spine is very specific alignment, meaning when your spines aren't in too much lordosis, or it's not too flat either, which is more a kyphotic. So you want your spine in a position where you just have a slight curve. And for some of us, that's easy to find and for some of us it's not, because our muscles are tight, or our spine is very stiff and so we more naturally have an increased lumbar lordosis, or we are very flat in our low back, and that could be for different reasons. Either something you are born with, or just because of muscular imbalances in the system or tightening, and stiffening of the spine. So, if you don't have any significant spine problems, it's not that hard to find your neutral spine. And that's the position you want to stand in, that's the position you certainly want to lift in, and do your daily activities and sitting. Because that is where your center of gravity is the best and all the weight goes through your spine, instead of evenly through your spine and into some muscles more than others. So, very specifically though, we always talk about neutral spine for lifting. That's probably the time where you can really injure yourself, if you are not using a neutral spine. Max Wettstein: Right you always hear about guys in the gym, maybe putting a little bit too much weight on the squat rack, or the dead lift and next thing you know, if they tweak something, because they let their lower back sort of round out and now all of a sudden their spine is not in that nice neutral position with the lordotic curve, which you keep talking about or that nice C curve and so -- Lisa Ford: A slight curve, yeah. You don't want it to be -- there is a balance there. But you are right, that's where you are probably going to get injured when you are not in that neutral spine. Because that's where you are strongest, and that is where, that's the position where you can kick in your stomach muscles, and your back muscles to protect the spine. If I am too lordotic, then my back muscles aren't working, but my stomach muscles really can't, they are on stretch. And the same thing goes if you have a really flattened low back. You maybe able to kick in some of your stomach muscles, but your back muscles aren't working in conjunction with stomach muscles. So, it's when they can contract together, that you are protecting your spine with your muscles and you are also distributing the weight evenly through your spine. Max Wettstein: So, you want to keep the spine in its ideal position, no matter what type of movement you are doing, but now you are saying, you also want to engage the core, and the core is your lower back muscles, your abdominal muscles, keep those engaged throughout the exercise as well. Somehow, you don't really lift with your spine exactly, you lift with your hips, legs, and your butt muscles, is that correct? Lisa Ford: Right. So, our back muscles, the paraspinals, they are really meant to hold you up for long periods of time, so they do the work of like an endurance athlete, they keep you go and go and go, but they are meant to do any heavy duty work. Whereas, your quads and your butt muscles, your gluteus muscles, they are meant to do the heavy lifting and they are more like a sprinter. So, if you are going to bend over and put your spine out of the neutral position, and then as you come back up, you are using your back muscles, and that's just not what they are meant to do. They are not meant to do that kind of activity with heavy loads and they are not meant to do it repetitively. So, when you are in a neutral spine position, and then obviously, if you are going to be lifting something heavy, you contract your abs and your back muscles. You are going to bend at your hips and your knees, and all the lifting is done by the gluteus and the quads, not through the movement of the spine. And that's how you are going to injure yourself. I mean, it's such a common, common injury, whether it's just because you picked up the pencil off the floor, but you have done it 100,000 times before and finally it caught up with you, or if it's because you lifted something really heavy, improperly. And then adding to that, what makes it even worse is if you bend over, and you twist at the same time. Just like getting your luggage at the airport or something, pulling it off and then twisting to set it down, that's such a common injury. Max Wettstein: That compound movement and when you talk about injuries, it's like a spasm or a strain or stress? Lisa Ford: Yeah. It could be anything from a spasm, to a disc bulge, to a complete tear. Sometimes, maybe one vertebrae or couple of vertebrae get out of alignment and then that can create a muscle spasm as well. So, of course you also have the disc problems and that certainly is a big problem in that, but there can be other things too, just something going out of alignment, or muscle spasms. So that neutral spine is so important, and then everybody will say, okay you need to contract your abs, contract your back muscles and that strong abs helps protect your back. And that's true but not, but not -- Max Wettstein: They are both part of your core, they make up your core. Lisa Ford: Right, I think where some people get a misconception is that they, they are going for the six pack abs, they look good. And the rectus abdominis is probably, as far as, protecting your spine, probably one of the least needed muscles. So, everybody is doing that crunches, and yeah it's going to make you look good, but that is not how you are going to strengthen the muscles that need to support your spine. And so, it's more through actual neutral spine exercises, which you'll see a lot of that in pilates. Max Wettstein: What about Yoga? Lisa Ford: No, I wouldn't say no. I wouldn't say so because we are talking about specific strengthening and I -- sometimes in Yoga, yes, you get some of those movements in Yoga like a plank position, which is also a pilates thing too, and physical therapists are very -- I mean, one of the big things we do is, we get somebody in a neutral spine, and sometimes that's hard for people to get into the neutral spine or to maintain a neutral spine, because they are not used to it. And then you strengthen your stomach muscles in the neutral spine. Rectus Abdominis and then your obliques, those are the ones that really kind of, create a corset and then they work together in conjunction with your back muscles and they create a corset that protects your spine. And those are the ones you want to work and you want to work them in a neutral spine position. Get your spine into a neutral position, and then I contract my tummy muscles and my back muscles are contracted the same time, and if I just hold it here -- Max Wettstein: Pull your belly button to your spine. Lisa Ford: Yeah finding that neutral spine, which -- somewhere between -- this certainly isn't it. Too much from here, you don't want to be totally flat either. This is the slight curve, very slight curve and then you contract the same kind of thing where you are pulling your belly button up and in and at the same time, you should feel your back muscles contract, and you are really feeling for the contraction on the side here not the rectus abdominis. Feeling for this corset and you first just start with holding it, and then you add activity to it. Can I control my muscles, and keep them tight while I move my leg, can I keep that neutral spine, or do I lose that neutral spine? Does my back start to arch, because my muscles aren't picking up?