By Paul Chek, HHP, NMT
Founder, C.H.E.K Institute
As hunter-gatherers, humans maintained their strength, endurance, flexibility and vitality through various physical and mental stimuli, as provided by our environment. Today, the seated work place has become our world. Sedentary lifestyles are the norm and eight and a half out of every 10 people will experience a bout of low back pain (LBP) in their lives.
Of those who experience low back pain, 40-60 percent will have reoccurrence within one year. The great majority (90 percent) will get over their first incidence of LBP in three months, no matter how it's treated.
The remaining 10 percent will begin an often long journey for ongoing help, the expense of which will be 80 percent of all the dollars spent treating LBP in this country.
Although there is often great controversy over both accurate diagnosis and etiology in cases of LBP, there is a growing consensus that exercise is a common denominator in its prevention. Exercise stimulus is known to be extremely beneficial in the healing and maintenance of ligament, muscle, tendon, cartilage and bone.
To determine how much exercise must be done for maintenance of these structures, however, one must consider the demands placed on them by their activities of daily living (ADL). As you can imagine, the ADL of the carpenter or cement finisher will be significantly greater than that of a secretary, store clerk or professional driver. Though the activity levels might differ, a lot of exercise at work doesn't mean your exercise stimulus is adequate.
On the contrary, most people are over-trained and have no functional reserve capacity. The first sign of this is that you are exhausted when you leave work every day and often still feel spent when you wake up the next morning.
To prevent low back injury (or musculoskeletal injury) strategic doses of exercise stress must be implemented into your lifestyle. A good program will consist of balanced doses of both general or aerobic exercise and specific exercises (i.e. strength and coordination exercises).
The purpose of an exercise program is to stress your body beyond the exercise stimulus provided by your working environment. This results in super compensation and development of a larger functional capacity.
After only four to eight weeks of conditioning, your work environment will provide only minimal exercise stress, leaving you not only with more energy, but also protection from injury.
What Protects Our Backs Can Hurt us Too
All of us begin as children with a built in lumbar (low back) protective mechanism. This mechanism is reflexively activated any time we are challenged with a load or during a moment of lost balance.
For example, most of us have unexpectedly stepped off a curb or stair, only to catch our balance and move on. In many low back pain patients, the lumbar's protective mechanisms are dysfunctional due to long histories of improper exercise technique, long-term participation in the jobs or sports that encompass repetitive and often faulty movement patterns, as well as poor posture and plain disuse.
It is for these reason many back patients describe a jolt of acute back pain, for example, after picking up an object that was much heavier than they thought, missing a kick during a soccer game or missing a step.
As a prerequisite to a functional lumbar protective mechanism, the body's nervous systems must not only be challenged occasionally but there must be adequate conditioning in the torso and extremity musculature to respond without jeopardizing the joints and smaller muscles of the spine. The musculature that must be strengthened to ensure stability of the low back are muscles in the front and back of the thigh, the erector spinae (back muscles) and the ever so important abdominal muscles.
The best way to train the thigh musculature is to strengthen them in the pattern movement for which they are most commonly used when lifting an object.
This is the squat (see Figures 1A, 1B). The squat exercise can be done to fatigue after work every other day or three times per week adding a second and third set to fatigue when there is minimal post exercise soreness between sessions. This exercise can be done three times per week, allowing two days, rest after the third squat workout of the week.
For the back muscles, the Horse Stance exercises are safe and effective for those beginning a back exercise program. The easiest Horse Stance (HS) exercise is the HS vertical (Figures 2, 3). This exercise can be used as both a beginner exercise or as a warm up for the more advanced HS exercises. The HS Horizontal (Figure 4) is a progressively harder version, serving as a progression in your program.
What About Strengthening Your Abdominals?
The most poorly understood muscles are the abdominals. These muscles provide crucial support for the back in all planes of motion. When it comes to the abdominals, fitness practitioners often overlook the fact that the lower abdominal musculature should be strengthened first, followed by the oblique, and finishing with the upper abdominals.
This is because the upper abdominals are generally strong and require the least coordination to strengthen. The oblique and lower abdominals are both, respectively, weaker and require more coordinated movement patterns to strengthen.
For this reason, the proper order to strengthen the abdominal musculature is always the lower abdominals, followed by the obliques and finally the upper abdominals.
Now that we know a bit about the abdominals, how do we strengthen them?
Posturaly, the lower abdominal muscles play a vital role in the stability of the low back. Lower abdominal exercises can be progressively added to your routine as your strength and coordination develop (Figure 5).
The internal and external obliques provide the torso with most of its rotational strength and stability. These muscles deserve adequate attention and can be effectively strengthened with the Russian Twist exercise (Figures 6A, 6B).
Most frequently, the upper abdominal muscles are over-exercised by fitness enthusiasts due to their esthetic qualities. Ironically, the upper abdominals usually possess adequate strength to do their job, unless you are de-conditioned. If you can work up to the point of doing 20 Swiss Ball crunches (Figures 7A, 7B), there is not likely to be much more to be offered in terms of support for the low back, unless you are an athlete or perform heavy lifts on the job.
Many people with histories of low back pain find they have a reoccurrence of back pain when trying to do abdominal exercises. This is often because the body will flatten the back in a compensatory effort to make more room for crowded nerve roots.
When an exerciser who is unaware they are compensating with a flat back attempts abdominal exercise, they are likely to feel pain because most abdominal exercises require that the spine be further flexed (forward bent), which aggravates the lumbar discs.
To determine if you should be using a lumbar support to maintain your back's natural curvature during abdominal exercises, refer to Figure 8.
A lumbar support can be made by rolling a towel to the width of the thickest part of your hand. The lumbar support is then placed under your low back at belt-line level, or in such a position that it gives the lumbar curvature support.
If it is placed correctly, it will feel good. The lumbar support is effective when used with lower abdominal exercises as well as the oblique and upper abdominal crunch exercises. Take care not to lift your behind off the ground during these exercises or the lumbar support will be of no benefit.
I hope you enjoy these exercises. Just remember, prior to attempting any of the exercises demonstrated here, those with the history of low back pain should consult a physician and a rehabilitation specialist for guidance.
Once you start these exercises, you won't want to stop. Not only are they an excellent way to keep fit, they will provide tremendous protection against low back pain!
To learn more about how to prevent low back pain, I recommend the following CHEK Products:
Paul Chek, Holistic Health Practitioner and certified Neuromuscular Therapist, is the founder of the C.H.E.K Institute in Vista, Calif. He is also a sought-after consultant to sports organizations, and his services have benefited numerous professional sports teams, athletes and individuals seeking optimal health worldwide. Paul has produced more than 60 videos, 17 correspondence courses and is the author of several books, audio programs and articles.
For more information on Paul's popular "You Are What You Eat" audio/workbook program, or for any of his other health/exercise courses, videos and books, call 800/552-8789, 800/552-8789 (New Zealand or Australia), 44 (0)1273-856-860 (Great Britain) or visit the CHEK Institute Web site.
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