Over the weekend I had the fortune of attending a 3 day seminar with one of the leading researchers in the industry who studies back pain. Dr. Stuart McGill is a professor and researcher at the University of Waterloo and has been studying the spine and back pain for other 30 years. He combines his experience as a researcher, teacher, and clinically helping hundreds of patients (from a large number of elite athletes at the highest level, to regular folk) to manage and resolve their back pain. You could visit his website http://www.backfitpro.com/ if you would like to do some reading on your own.
Obviously I learned a tremendous amount of information, as well as many of the concepts I already know were reiterated. More importantly I was able to watch a master clinician work with people and pick up on cues and hands on techniques that I think will really support me working with my clients.
How can I summarize what I learned in 3 days to a few key points for you to take away? Here goes:
Here are a few tips that I know will support better long term spine function (remember this is not an end point, these are a few guiding points on your journey to learning how to better support your spine and back health).
#1: Start keeping your spine in a neutral position more often.
Whether you are bending, lifting, standing, twisting, exercising, sleeping, sitting etc. you want to recognize what a neutral spine feels like and try to maintain that. Take a look at the photo below. See how my spine in the photo on the left is directly up and down and my pelvis (waist band is balanced) as opposed to the photos on the far right (top and bottom). I want you to get a feel for maintaining this spine more often. You could find your neutral spine by arching your back as far as you can, then rounding it as far as you can and finding the halfway point. Give it a try right now in a bending, standing, planking, or kneeling position. Most of you are going to find you have to really tilt your pelvis forward (arch your low back) a lot more than you realized in order to maintain a neutral spine. Most of you will notice you sit a lot of the day in a “tail tucked under position”- like the photo on the top right.
When we don’t maintain this neutral spine we compress and shear through our back muscles as we move around. Let’s use an example:
In the photo of the spine below we see two vertebrae from our spine lined up vertically with a disc in between each vertebrae. The spine on the left of the photo (below) is demonstrating what happens to the disc when we sit in flexion, which means rounding our tail under, shown in the photo above on the top right where I am sitting in the rounded posture. When we sit in this flexed position (or move, and bend, or do sit ups) the motion is forcing the disc to travel out towards the back of the spine. On the other hand, If I were to always walk with a major arch in my low back (lordosis) or sit how I am sitting in the photos above in the bottom right photo (big arch and lean in my back) then I am doing the opposite and am pressuring the disc to travel and potentially move and slide out the front. This big arch back position is represented in the spine photo labelled ‘extension’. Either way that disk can cause damage to itself, as well as the surrounding structures of the spine, leading to a variety of spine and back problems (disc extrusion, pinched nerve, bone on bone rubbing, lack of mobility) etc. Choosing this poor spine positions repeatedly over time compromises the position of our spine and most definitely could lead to back issues.
This photo might help you visualize a bit more how a disc may impinge on a nerve. That yellow tube running down the spinal column (you can only see the tip of it) represents the spinal cord. An extrusion of the disc into the cord could happen from assuming the forward bending and compression patterns we see with the pelvis tucking and rounding out of the lower back.
So tip #1- as I said above- start keeping your spine in a neutral position more often throughout the day. I may post more details on this in the future- or in the meantime if you see me in the gym then ask, I’d be happy to help you out with this.
#2: Stabilize your spine.
Once your spine is moving well in a neutral position then it’s time to stabilize it. I have made videos about this in the past, but remember, the #1 function of the core is to stop and resist motion- this is what stability is. For example, if someone was going to push you over you use your core to stabilize yourself and resist motion. In another example, if you are hiking up the grouse grind and step up onto the next rock and didn’t have spine stability you’d be snaking up the grind and would leak power from your core. Does this make sense? Think of this analogy (which I love by the way):
This guy has NO spine stability. His spine waves side to side all day. If he were to climb the grind he would have no integrity from his center unit to allow him to generate force. Instead he would take a step and wobble around through the mid section each time. This is an extreme example, but this is what is happening in most people’s backs who don’t train their spine stability. All day long with no spine stability you are just getting micro movements of your spine and discs that over time can cause injury. We need to train our core to be incredibly stiff and strong and stable so that every movement we take throughout the day (pulling open a door, getting out of a chair, pushing a shopping cart) is done with stability.
So what do we do to train spine stability? Every exercise can become a spine stabilizing exercise. What that means is you engage your entire abdominal region before moving. Abdominal unit doesn’t just mean flex your abs, it means get your entire core (from ribs down to hips engaged). From there perform your exercise. I could list off 50 great stabilizing exercises for you, but the first 3 that Dr. Stuart McGill recommends (based off his research of studying the most effective ways to train spine stability with the lowest amount of force and load presented to the spine) are called The Big 3. Here is a fantastic summary of these exercises: http://runwaterloo.com/the-big-3-exercises-for-your-core/. Dr McGill recommends doing these exercise everyday to set the spine up and get it ready to stabilize (and prevent injury throughout your day). Athletes at all levels also do these exercises regularly, and before a game, to get their spines stable and ready to withstand the forces of their exercise. Most of all when doing these exercises you need to ‘brace’/’engage’/tighten’ your core. This doesn’t mean suck your belly in, this means tighten up that entire abdominal unit (your sides, the abs under your rib cage, and the abs down near your belly button and abdomen). Without fully engaging these units you have not protected and stabilized your spine. This means that when you start to do the exercises you are moving your back and your back muscles. This totally defeats the purpose of the exercise which is to RESIST MOVEMENT :). Try it now- take a sniff of air and see if you can tighten the entirety of your mid section.
If you CANNOT tighten your midsection (or if you want to feel it really engage) try this exercise called the Lewit, which has been shown in McGill’s studies to be the best way to create the abdominal bracing with a neutral spine. This guy does a great job in explaining the exercise: http://www.stack.com/a/lewit-exercise
So there you have it- 2 tips to leading a healthier spine life: learn to move all day with a neutral pelvis, and then begin to stabilize (strengthen the core). You are on a great track to eliminating the chance of back pain, as well as potentially recovering from a current injury. This isn’t the end of the line for strengthening the spine. You also want to look at a variety of other factors including the mobility of your hips and shoulders, your ability to add speed, direction and load to these exercises (and your spine) to mimic everyday life, and also work on strengthening muscles such as your lats and glutes. Start here for now. If you want to send me videos if you are unsure about finding a neutral spine, feel free. Give those big 3 exercises a go (in the exact perfect form listed in the link) and you are on to a good start.
On a final note- I started reading McGill’s book after the weekend and I am very impressed with how easy and simple it is to read. I think it would be a fantastic resource for anyone struggling with back pain currently. Find it on his website; http://www.backfitpro.com/books.php (It’s called The Back Mechanic).