Save Your Spine: Top 10 Tips For Avoiding The Misery
Back pain can make bending over, getting out of bed, even breathing seem unbearable. Many of these individuals have back pain because they don't exercise. Yet many avid exercisers also experience crippling back pain. In their later years, bodybuilders often wince like their spine is lined with metal spikes when they lean over to tie their shoelaces. So it seems like you're damned if you don't train, and, eventually, damned if you do.
Particularly among those who lift weights, back injuries tend to occur in the lumbar region, the lower spine. The discomfort can range from mild, occasional twinges to chronic, long lasting, persistently intense pain. A pulled muscle, a damaged disk, a degenerative disorder, or the wear and tear imposed by Father Time can be to blame. Poor posture, incorrect lifting technique, and carrying around a gut for years in turn often cause those sources of pain.
To learn how to avoid eventual spinal damage and associated chronic back pain, I interviewed Jason Highsmith M.D., author of The Complete Idiot's Guide to Back Pain. He is a board-certified, fellowship-trained and highly sought-after neurosurgeon, a world-renowned expert on the treatment and prevention of degenerative and traumatically-sustained back injuries.
Neurosurgeons like me perform more back surgery than any other specialty as a whole. We treat everything from pinched nerves and sciatica to degenerative disc disease and stenosis. My specialty is minimally invasive surgery. Obviously most patients do not need surgery, but every day we treat dozens of patients with spine issues and help them find relief with the best options.
My approach to patient care is multi-specialty. Exercise, weight loss, lifestyle change, physical therapy, chiropractic care, injections and pain management are all steps along the way.
Weakness, numbness or both is a serious cause for concern. Loss of bowel or bladder function is a medical emergency.
Persistent back pain in children is also a cause for concern. Most back pain in children comes from backpacks and poor posture, but it can be a warning sign of scoliosis, or even tumors.
Ligament pain is usually more apparent with active and passive motion; muscle pain is typically worse with active motion. But the difference is subtle.
Most back pain comes from a muscle strain or ligament strain. Having a strong core of musculature can stabilize and brace the spine to reduce injury. Those with a preexisting injury can benefit from core strengthening as well.
Everyone knows that working antagonistic muscle groups is always important in exercise. This is especially true for those with back problems since you want to balance forces on the spine as you build your core. Doing tons of sit-ups for great abs on their own is not a good idea. It is important to equalize the forces on the spine by working opposite muscles.
Some exercises are contraindicated in patients with degenerative disc disease. Weightlifting that increases axial load (weight in line with the spine) can make pain worse. These exercises include leg presses (when done seated with hand grips), deadlifts, military presses and lunges with the load on the shoulders.
The good news is that most bodybuilders are aware of their physique and form and by definition are in great shape to avoid back injuries. However, poor lifting techniques, especially with higher weights, can really tweak things. If you start having back pain, lower the weights and increase the reps.
An overloaded car causes the tires to bulge and wears out the shocks. Likewise, extra weight on the spine has been shown to cause the discs to bulge more. Some weight bearing (walking) is vital to disc health because discs have no blood supply; they receive nutrients from the adjacent bone and cartilage "pumping" nutrients into and waste out of the disc.
Losing weight can reduce wear and tear on the disc as well as bulging. Sometimes damage is already done, but weight loss is almost always beneficial to the spine when done in moderation and when combined with low-impact exercise.
A large abdomen distributes weight too far in front of the spine and affects alignment. It causes you to learn forward too much, and to compensate, most people "hyperlordose" their spine, which forms swayback. Extra weight overloads the discs and the facets.
The obliques, transversus, rectus and psoas muscles in the abdomen, as well as and quadratus lumborum and paraspinals for the back.
Most back pain goes away with conservative care that includes rest, ice and heat and over-the-counter medications. If pain persists for more than a few days or involves weakness or numbness, see your primary care physician.
Many non-spine causes of back pain can go undetected. The primary physician can help coordinate care among all of the specialties mentioned above. When I see patients, typically everything else has failed.
10 Rules For A Healthy Back
Keep your body well conditioned, maintain a healthy weight, exercise regularly and avoid sedentary living to help prevent back injuries and associated pain. The more you move and stay active, the healthier you will be.
The nicotine contained in cigarettes alters the chemical structure of our intervertebral disks, rendering them prone to rapid dehydration. This makes them brittle and leaves them more vulnerable to tearing. This is yet another reason to quit this foolish habit.
Through much of our daily life, we are required to sit, often for extensively long periods. Dr. Highsmith recommends that our computer screens be set at eye level and that our seat is positioned to where our legs are at a 90-degree angle with our feet tilted slightly upward.
Regular small breaks are better than one large break, says Dr. Highsmith. A couple of minutes' walking every half an hour or so will help to relieve the pressure that has accrued through our spinal column while sitting.
"The laptop is the worst thing for proper ergonomics" says Dr. Highsmith. Cell phone use—when the neck is turned sideways—similarly encourages the kind of bad posture that can cause back stress. However, certain communicative technologies, such as Bluetooth headsets, can alleviate much of this strain and may be suitable replacements.
Your abs must be exercised in conjunction with all other core areas to ensure total core health. This means building strength in the lower back as well. Balance flexion (forward bending) with extension (backward movement).
Dr. Highsmith recommends sleeping on our side on a firm yet comfortable mattress. This fetal position will help to take the most stress off our backs. A pillow tucked between our legs will help take pressure off the hips. The worst sleeping position is thought to be on the stomach. It exaggerates your spinal arch and may cause strain.
When back pain first occurs, you'll probably keep doing what you're doing; you'll try to fight through the discomfort. Dr. Highsmith says to stop what you are doing, rest your back, and take an anti-inflammatory medication. Got leg pain or weakness? See your doctor. Lost control of your bowels or bladder? Get to the ER, stat.
If your back pain allows a degree of mobility, keep the area stimulated with light exercise, such as swimming and walking. This helps healing without risking further injury to the disks.
Although Dr. Highsmith stresses that physical activity is an excellent way to strengthen the back and help the healing process, some moves should be avoided if your back hurts. Military presses (where a barbell is lifted overhead) and weight-assisted lunges are not recommended; they can axially load the spinal column (compress the spine from the head area—as when a person dives into shallow water and lands headfirst). Running can also be risky, he says. Just make sure you get your cardio some other way. Your back needs love, but so does your heart and lungs.
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"should be avoided if your back hurts"
if you're not injured I say go for it
The exercises he mentions are examples, not a complete list. An expanded list definitely would include the barbell back squat, as you suggest.
I find deadlift much more scary because you actually bend your back.
For general low-back pain or a specific injury? How long (timewise) are the hangs? Has it worked?
I originally did it to eliminate lower back pain, but now I do it as a preventative measure. Basically everything you do throughout the day compresses your spine so the only way to prevent injury and pain according to him is to decompress it. So I hang for a minute to a minute and a half twice a day. It has done wonders for me and everyone I have shared it with.
Best advice there is in a short article. I peaked at age 31 (I am now 65 years old). I learned that you can get a great workout with a pair of adjustable 50 pound dumbbells, an adjustable bench and a chin-up bar. I have not done a military press with a barbell or heavy weight,or a barbell squat in 30 years. Keep the weight hanging low and make sure your core, front, side and rear, is the strongest part of your body. Power lifting is for young folks.
Bench presses (back flat; don't arch like a powerlifter), dips and lateral raises done seated against a back support all work the shoulders either primarily or in a way that assists the prime movers. Lunges will work safely unloaded, so the walking version is a useful way to improve muscular endurance and balance while losing some intensity from the load. Trade-offs. Instead of running, try the elliptical and/or stationary bike, although avoid hunching. Stay upright.
Thanks for the circa 1983 bias from an M.D. I get that they like to be viewed as experts in all things medical but how do you not at least ask the opinion of a chiropractor about this before posting an article about it? No soup for you bb.com.
Nothing against chiropractors, but a neurosurgeon knows a thing or two about back pain and injuries. If I may ask, what specifically do you disagree with or question?
I'm not saying he's incompetent by any means, I agree with pretty much everything he suggested. My issue is with the way this article was presented. He shouldn't be the sole expert interviewed on this matter, he's a great source for information but I feel that a chiropractor would have a better understanding of preventative care for back pain. You wouldn't necessarily ask an oncologist how to quit smoking so why ask a neurosurgeon how to prevent back pain? They both can tell you the pathogenic effects of their fields and how things will deteriorate, but they are experts in fixing the problem once it has essentially hit rock bottom, not necessarily preventing it. They more than likely will provide sound advice, but the point is, there are better places to seek out these answers.
people think that everything posted on this site is information gold, when much of it lacks evidence of true medical research. That costs money, and I agree, a neurosurgeon should not be posting about back injuries, unless he is working hand in hand with a physical therapist and chiropractor
A neurosurgeon who's also written a book on back pain has indeed done medical research, probably much more than a journalist who might write the sort of integrative piece you mention (multiple interviews with chiropractors, PTs, surgeons, etc.) If done well, that would be a worthwhile piece--and this one is, as well. I appreciate your comments but stand by the work.
I'm currently waiting to have surgery on my back for the second time in 3 years, server prolapsed disk of L5-S1, Australian football injury and only 19yo, what would be the best exercise in the mean time?
I'll take a neurosurgeon who does back surgeries than a chiropractor ANY DAY.
Chiropractors, a few are honest enough to admit it's pretty much just a form physiotherapy (like one I saw who did provide relief, if only temporary).
Too many make unfounded claims, none with scientific evidence to back them up.
If I was to ask for a second opinion I would see a physiatrist.