Exercise expert Paul Chek explains the key causes of low back pain-and how to prevent it with seven simple moves
Our ancestors maintained their strength, endurance, flexibility and vitality through various physical activities and mental stimuli provided by the mostly natural environment they lived in, but in the 21st century in the developed world, the seated workplace is the number-one environment and sedentary lifestyles are the norm.
Since the beginning of the modern medical record, there has been a progressive increase in the incidence of low back pain. Today, eight and a half out of every 10 people will experience a bout of low back pain at some point in their lives. Of those who experience this kind of back pain, 40-60 per cent will have a recurrence within one year. The great majority-90 per cent-will get over their first experience of low back pain in three months no matter how, or even if, it is treated, while the remaining 10 per cent will begin an often lengthy and expensive journey for ongoing help.
Considerable controversy persists over the causes of low back pain, but strong evidence suggests the primary culprit is insufficient exercise of the type that maintains adequate levels of strength, endurance and coordination so that back pain and injury are prevented. We know that exercise is extremely beneficial for healing and maintaining ligaments, muscles, tendons, cartilage and bones. But to determine how much exercise needs to be done for maintenance of these structures requires some consideration of the demands placed on them by our activities of daily living. As you can well imagine, the daily activities of a carpenter or cement finisher will be significantly greater than those of a secretary, store clerk or truck driver. But one commonly overlooked fact is that just because you get a lot of exercise working as a carpenter, brick mason or busy waitress doesn't mean you're getting enough exercise to help you prevent injury, particularly if you also go out and play touch rugby for fun after work.
When we're young, we start out with a built-in protective mechanism in the lower back. This mechanism is reflexively activated whenever we are challenged with a load (whether expected or unexpected) or during a moment of loss of balance.
For example, most of us have unexpectedly stepped off a curb or stair only to catch our balance and move on. But in many people with low back pain, the lumbar protective mechanisms are dysfunctional-as the result of a long history of improper exercise technique, long-term participation in jobs or sports that involve repetitive and often faulty movement patterns, as well as poor posture and simple disuse. It is for this reason that many back patients describe a jolt of acute back pain after an event such as picking up a heavy object, missing a kick during a football game or missing a step while climbing the stairs.
To prevent low back injury (or any musculoskeletal injury), strategic doses of exercise must be inserted into your lifestyle. Exercise is perceived as stress by the body, which then compensates by developing greater functional capacity, so allowing you to perform your activities with fewer chances of injury. A good programme consists of balanced doses of both general and specific exercises. There must be adequate conditioning of the muscles of the torso and limbs, and the nervous system should also be challenged to prompt an appropriate response to any situation without unnecessarily jeopardizing the joints and smaller muscles of the spine.
If you spend a lot of time sitting, your exercise programme should be carefully designed to help you withstand the stress placed on your body from sitting for long periods. The human body does not take kindly to the seated position, which can cause changes in the lower back, chest and neck curvatures of the spine, compression and desiccation (drying) of the spinal discs (those rubbery cushions between each vertebral joint in the spine) leading to a higher risk of disc injury, muscle imbalances throughout the body, and disruption of the body's natural pump mechanisms essential for the circulation of blood, lymph and other bodily fluids around the body.
If you find yourself sitting for long periods of time, make sure you take regular breaks-this can be as simple as getting up and walking around for a few minutes, or longer if possible. This will increase the availability of oxygen and nutrients to the working muscles and tissues (including bone). Specific stretches (see WDDTY November 2013) are also a good way to relieve the stress of extended periods of sitting. The hip flexors, hamstrings and pectoralis minor muscles in the upper chest all tend to get short and tight with chronic long-term sitting.
Your active back exercises
A good exercise to help prevent low back pain is the squat. Learning how to squat with good technique will help you when you have to pick up or move something heavy. From the science of motor learning we know that the body operates in patterns of movement, so if you train in the gym with good squat technique, there will be carryover to your daily life. Squatting also helps to strengthen the muscles of the thigh, which have also been shown to correlate with a lower incidence of low back pain.
In the gym, the squat exercise can be done until the muscles are fatigued (see right) every other day or three times a week, adding a second and third set (again to fatigue levels) if there is minimal post-exercise soreness between sessions. Allow two days of rest after the third squat workout of the week.
A variation of the squat, which can be done at work or at home with no equipment necessary, is the breathing squat (see below right). This form of squatting helps pump fluids around the body and will also build endurance in the legs, particularly in those new to exercise.The spinal erector muscles are responsible for holding the torso upright for the long periods of time we spend standing or sitting each day. These work together with many other groups of back and abdominal muscles, and can be effectively conditioned by the Horse Stance (HS) exercises. These exercises are safe and effective for those beginning a back exercise programme and are easily inserted into anyone else's exercise regime as needed.
The easiest of these exercises is the HS Vertical (see opposite page), which can be used as both a beginner's exercise and as a warm-up to the more advanced HS exercises. The HS Horizontal and HS Alphabet are progressively harder versions that you can work up to with your programme. As many people lack the arm strength to maintain good form for the duration of the HS exercises, the 'relief position' may be used. In this case, you perform the exercises exactly as described while resting on your elbows and forearms. In the relief position, your spine will not be parallel to the floor, but the curvatures should still be in a neutral position.
The most advanced HS exercise is the HS Dynamic, which is best used only when you're proficient at the other HS exercises.
Proper conditioning of the abdominals is also important for avoiding low back pain and maintaining a healthy back, as these muscles provide crucial support for the back in all its planes of motion. Many people with a history of low back pain find they have a recurrence when trying to do abdominal exercises, especially crunches or any type of flexion done on the floor. They are likely to feel pain because the exercise requires that the spine be further flexed, which aggravates the lumbar discs. If this describes you, then switch to any of the functional abdominal exercises using Swiss balls, cable machines and medicine balls, as these are not performed flat on the floor and can condition the abdominals with less likelihood of pain (see WDDTY October 2013 for some effective Swiss ball exercises).
Before attempting the exercises described here, those with a history of low back pain should consult a rehabilitation specialist or a C.H.E.K practitioner for guidance.
Adapted from How to Eat, Move and Be Healthy! By Paul Chek (Vista,CA: C.H.E.K Institute,2004). Other resources: Chek P.The Golf Bio mechanic's Manual, 3r dedn.Vista, CA:C.H.E.K Institute,2009 About the author: Internationally acclaimed speaker, autor and Holistic Health Practitioner Paul Chek draws upon over 25 years of experience in corrective exercise, high-performance conditioning and integrative lifestyle manage
Paul is the founder of the C.H.E.K Institute in California (www. CHEKinstitute.com and www. CHEKconnect.com) and the creator of the P~P~S Success Mastery Program (www.ppssuccess.com). In the UK, please visit www.CHEKeurope.com or call 07963111906.
Begin by placing the feet a shoulder's width apart or slightly more, with the toes turned out up to 30 degrees. If using a dowel rod or bar (as shown here), rest it comfortably across the shoulders (never the base of the neck) with the hands slightly wider than shoulder width apart.
In preparation for the squat, hold the chest high with the shoulder blades pulled slightly together, and tilt the pelvis forward by slightly increasing the curve in the lower back. Hold the back in this position (throughout the squat) to protect the lumbar discs and aid in strengthening the postural muscles of the back. Inhale and gently draw the belly button in towards the spine.
Initiate your descent by a slight bend at the knees; the hips will naturally follow. Always hold your head so that your eyes are looking straight ahead. Your knees must track directly over the second toe throughout the descending and ascending cycle, with the weight equally distributed between both feet and between the balls of your feet and your heels.
The descending cycle is complete when you have gone as low as you can while still keeping perfect form. The speed of descent and ascent should be smooth and steady, with no locking of the knees when standing.
Take a comfortable stance wide enough for you to squat down between your legs. Place your arms at your sides or in front. Inhale through your nose, then lower yourself as you exhale through your nose. If you need to exhale through your mouth, keep a little tension in your lips.
Go as low as is comfortable, pause, then inhale and return to standing. Repeat at the paceyou naturally breathe for up to100 times.
Horse Stance starting position
To begin these exercises, position yourself as follows:
(1) hands should be placed directly under the shoulders; (2) knees should be placed directly below the hips; and (3) the spine should be parallel to the floor and neutral (no exaggeration of curves at all), with the hands and face parallel to and facing the floor and lower legs parallel to each other, feet perpendicular to the floor. Bend the elbows slightly and point them towards the thighs to bring the torso parallel to the ground.
Horse Stance Vertical
Lift one hand and opposite knee off the floor just high enough to slide a magazine underneath. Hold for a count of 10. After 10 seconds, switch to the opposite hand and knee for a 10 count, and repeat this process to fatigue or for 15 reps on each side. The exercise requires the small stabilizer muscles of the spine to work to resist the spinal torsion (twisting) created by the diagonal pattern. When lifting the hand and knee off the floor, be careful not to let your pelvis deviate towards the supporting leg side, as this faulty movement pattern will shift the work from the back muscles to the supporting hip.
Horse Stance Horizontal
This exercise strengthens the postural muscles of the back and posterior thigh muscles. From the start position, move an arm 45 degrees away from the head but parallel to the floor, and follow this by extending the opposite leg straight back and parallel to the floor. Hold this position for a count of 10 before switching sides and repeating the same movement.
This exercise should be done to fatigue, which is when you either lose form or can no longer hold the position for 10 seconds.
Horse Stance Alphabet
From the Horse Stance Horizontal position, imagine there is a pencil growing out of your heel and a pad of paper behind you. With this image in mind, draw the alphabet using your foot, which should be half below the horizontal plane and half above it. There should be no deviation of your pelvis to either left or right, your arms should stay parallel to the floor and at 45 degrees to the long axis of the body at all times, with all spinal curvatures in neutral and the torso parallel to the floor.
Horse Stance Dynamic
From the start position, bring one arm and the opposite leg into a tuck position, aided by contraction of the abdominal muscles. From this tucked position the exerciser uncoils into the HS Horizontal position. After a brief pause, the process is repeated to the point of fatigue, which is when the perfect form starts to deteriorate. Wrist and ankle weights may be added when you can perform 30 reps while still maintaining good form.
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