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October 21st, 2009

October 20, 2009 Category: Back Pain, Core Training, Injury Prevention Tags: .

Robertson Training Systems Newsletter 5.19

My Thoughts on the Lumbar Spine and Low Back, Part II

In Part I, we discussed my general philosphies on treating and preventing lower back pain.  In Part II, we’re going to discuss some specifics when it comes to training and coaching.

Training

Obviously, training is a very broad topic, so I’ll do my best to whittle it down a bit.  In this case, I want to specifically discuss mobility, endurance, strength, and my process for training the core/lower back.

Mobility

Obviously, mobility is a hot topic these days.  As Mike Boyle alluded to in his Joint-by-Joint approach to training, the lumbar spine is primarily built for stability.

Does this mean that there’s no mobility needs for the lumbar spine?  Absolutely not.  However, when you examine clients or patients with low back pain, you’ll see a prevailing them: Many of them have too much motion, or a lack of stability, at their lumbar spine.

One of the prevailing arguments you’ll hear is that if there’s not supposed to be much motion there, why do you have a joint?  After all, aren’t joints there to move?

It’s a great argument, albeit somewhat naive in nature.  Obviously all joints are meant to move, but it’s also obvious that all joints have varying amounts of motion.  Not all joints are built to move or function in the same degree or manner.

Flexion and extension are the basic motions of the lumbar spine.  While you would assume this is normal and healthy, Dr. Stuart McGill has performed research on the spines of pigs (which are eerily similar to human spines) and determined that they only have a certain number of flexes and extends before they wear out.

Strength coach Mike Boyle likens this to a credit card – you can bend a credit card back and forth, and initially, it won’t appear to do any damage.  But if you keep doing it, over time you end up with a white-line in the card.

And eventually, it breaks.

The next big argument revolves around rotation.  As Bogduk states in his text Anatomy of the Lumbar Spine, there’s only approximately 2 degrees of rotation at each lumbar segment.  Rotating 3 degrees or more at any lumbar segment can cause microscopic tearing of the lumbar disc.

In contrast, your thoracic spine has 7-9 degrees of rotation per segment, and over 70 degrees of rotation as a whole.  Couple that with the rotary capacity of your hips, and you have all the rotation your body could ever want or need.

So here’s the thing – as a trainer or coach you can go ahead and have your clients flex, extend, laterally flex and rotate their lumbar spine all you want.

Will it get them injured?  Maybe.  And maybe not.

BUT, we know that it can cause damage, especially over time.  For me, it always comes back to risk versus reward – why would I knowingly want to put my clients or athletes in positions that can get them injured?

It doesn’t make sense to me.

Instead, we need to focus our mobility training around the hips and thoracic spine.  But that’s a whole ‘nother can of worms, and something I’ve addressed numerous times before.  Check out the Magnificent Mobility, Inside-Out, or Assess and Correct DVD’s for more information on this front.

Low Back Pain and Mobility – The Battle of the Sexes

Now here’s an interesting observation I see between women and men; they’re both unstable through their lumbar spines, but for different reasons.

Most guys (and especially strength training males) tend to be too stiff through their hips in comparison to the lumbar spines.  What you see is when they try to squat, deadlift, etc., the stiffness in their lumbar spine exceeds that of their hips.  This excessive stiffness forces them out of lumbar neutral, and gets them into trouble.

Females, on the other hand, are too unstable as a whole.  They aren’t necessarily too stiff in their hips, but many women are concerned with stretching and flexibility much more so than males.  All the Yoga and Pilates many women perform reinforces mobility training around the lumbar spine, and that lack of stability gets them injured.

Obviously, I’m generalizing a bit here, but the bottom line is that both men and women need more stability around their lumbar spine, but the rest of the program may be quite different.

A final note on Magnificent Mobility

When Eric and I released Magnificent Mobility 4 years ago, we had no clue it would become as big as it did.

To this day, I can honestly say I stand behind 95% of the exercises on that DVD.  Are Cat/Camels and Yoga Twists ideal for every client, athlete, or spine?

Absolutely not.  But there are a lot of people that do need these exercises.

However, all things change, and the best way to do this was to build a better, more comprehensive product.  I’m sorry if this comes off as a shameless plug, but if you’d like an updated idea of our assessment and corrective exercises for the lower back, you’ll definitely want to check out Assess and Correct.  It should give you a much more up-to-date idea of our training methodologies.

Strength and Endurance

Contrary to popular belief, it’s not all about back or core strength, at least initially.  Instead, the goal up front is to develop endurance around the core and lumbar spine.

Biering-Sorenson did research back in the 80’s evaluating the physical qualities associated with repeated lower back pain.  In this study, endurance was found to be more important for preventing future back pain than strength.

Now with that being said, we have to be judicious in our exercise prescriptions.  The training needs of a marathon runner, baseball player, and power or Olympic lifter are all different.  This is where a long-term approach needs to be developed to core and low back training.

The Four-Step Process

My goal when evaluating a client or athlete is to determine their specific needs and goals, and then to implement training strategies that will allow them to achieve their goals.

Most importantly, a clear assessment/diagnosis is critical to determine which phase of training they’ll be placed in:

1 – Motor Control/Endurance

2 – Pelvic Alignment

3 – Advanced Stabilizatoin

4 – Sport-Specific Stabilization

Rather than cover these in-depth here, I’ll let my core training video do the work. Once posted, I’ll send the direct link to my newsletter subscribers – it should be up in a week or two.

However, let’s briefly discuss the goals of each phase:

In the motor control/endurance phase, my primary goals are to teach them about neutral spine, and then to develop endurance based on that optimal alignment.

Many clients whom you come in contact with have no clue what neutral spine looks or feels like.  It’s your goal to help them these things.

Phase 2 is all about pelvic alignment.  There’s an intimate relationship between the pelvis and lumbar spine, and if you want ultimate long-term success, you need to address both in your training.

Once you have improved awareness of pelvic and spinal aligment, it’s time to start reinforcing the area.  This is where more advanced stabilization exercises can be employed.

Finally, if we are working with athletes we have to prepare them for the rigors that lie within their training and competition.  Strength is great in an isolated setting, but this is where we can start to include sport-specific aspects of training like speed, power, deceleration/force absorption, etc.

Obviously, there’s overlap between phases, and it’s definitely not cut-and-dry.  But hopefully this gives you a basic understanding of how I train clients to prevent low back pain.

In Part III, we’ll discuss some specific coaching tactics to help you take your observation and cuing skills to the next level.

Until next time, good luck and good training!

Stay strong

MR

PS – Don’t forget about Mike Boyle’s Functional Strength Coach 3.0 which goes on sale today.  It should be great!

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