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Exercise

A Different Approach to Preventing Back Pain

By Exercise, Pain Relief

A Different Approach to Preventing Back Pain

If you suffer from recurring back pain and your current rehab exercises that work on strengthening your core don’t seem to stop your back pain from recurring then perhaps it is time to take a different approach.

For at least the last 30 years there has been a focus on advising people to strengthen their core stability muscles that in turn will prevent back pain. However, the research to support this is thin at best. Much of the research has been carried out on small non representative samples1 . When the samples are representative then whilst some short term benefits can be found no long term benefits (over 6 months) can be seen2 in back pain prevention. Alternatively, it was found that core stability rehab is no more effective than general exercise3.

What’s the thinking behind Core stability exercises?

In essence the theory is by activating your core stability muscles such Transverse Obliques, Rectus Abdominus, pelvic floor, internal and External Obliques, and diaphragm you can help support the lumbar spine and so help manage its work load.

However, if the research is right and there is a lack of effectiveness then perhaps we need to ask the question ‘Why can’t our backs cope with the work load in the first place?’

An Alternative approach

The area of your spine that is in pain is a result of it trying and ultimately failing to cope with extra work load because other parts of the spine or body are not moving as well as they should.

This can cause, muscle strains, ligament strains , joint inflammation and disc herniations and ultimately osteo-arthritis.

Why does Overwork occur?

Low back pain explainedThe body has this amazing ability to adapt and deal with reduced function in one part of the body to maintain our overall function. The spine is a key part of this.

24 interlinking segments that act liked a coiled spring. If a section of the coil stops moving then the sections above and below move more to ensure our bodies can achieve the movement we require. It’s this extra movement of muscles and joints that over time can lead to muscle fatigue and joint inflammation. These are two main symptoms of lower mechanical back pain.

Address the causes not the symptoms

With our more sedentary lifestyle many patients with lower back pain often have common factors such as reduced mobility in the upper back and shoulders and reduced mobility in the pelvis and hips.

Coincidentally these are the two main areas of our body that we keep static for long periods of time every day of the week whilst we are seated!

 

Our sedentary lifestyles reduce our mobility

Poor postureIt is this lack of movement in these two areas that can cause us lower back pain in the long term.

We sit at our desk, shoulders forward, fingers ready to type on our key boards, heads forward, upper back arched. Our hips flexed. Sometimes for hours at a time.

Our bodies take these inputs as a desired position and start to adapt accordingly. The body is always looking for efficiencies to reduce energy expenditure. So it reduces blood supply to muscles. Joints stop moving so nerves receive less innervation.

Muscles in our upper backs become fibrotic and joints become less mobile.

We do this day in day out for up to 8 hrs a day for months and even years! Then we go home and watch TV or use our laptops at home, or alternatively try and get the stress of our work out the system and go cycling and assume the exact same position. Or we go to the gym and contract the same muscles that were contracted at our desks (our pectorals and biceps and hip flexors)

Implications for our Lower back 

If the middle section of our spine can no longer rotate or bend forward as much as it used to do then the lower back (the lumbar spine) will have to move more to ensure that there is no reduction in functional ability and range of movement.

Likewise if we cannot rotate from the hip or our hips are flexed forwards because our hip flexors are permanently contracted from all the sitting down we do then our lower back muscles become more involved in simple daily activities such as walking and standing.

Our bodies make these adaptations without us being aware of them. Day in day out for months and years.

Then add in the role that the lower back was designed for and you can start to see why an upper back or hip that can’t move optimally can help increase the risk of fatigue, strain and ultimately, injury in the lower spine.

The Long Term solution

Change the inputs in your upper back

From a static 8 hrs. Stop every 30-45 mins and make your upper back and shoulders move. Your body will respond by increasing blood supply. Muscles will change to become more flexible. Joints and innervation inputs will increase.

Here is a simple exercise you can do at work whilst sitting down to start changing the inputs. Do it every 45-60 minutes that you are at your desk. Your colleagues might think you are mad at first but soon they will all start doing it! It really works.

 

Change the inputs to our hips and pelvis

We need to reduce the tightness in our hip flexors that builds up over time as we sit at our desk, cars, TV, dinner table and on our bikes . Here is a really effective exercise to do just that.

Do it daily am and pm 10-15x. Include it into any activity warm ups and warm downs too. Especially after cycling or running.

Next we need to improve the mobility and rotation of the hip as well as activating the gluteals and hamstrings.

This exercise combines hip flexion stretches with hip rotation.  Do it am and pm 10-15x for each exercise.  These exercises should all be pain free so if you experience pain after or during then just stop and consult your professional physical therapist.

To Conclude

If you have been doing your core stability exercises and you have had no recurrence of lower back pain, then please continue but consider if you are really addressing the cause. With our increasingly sedentary lifestyles we are placing increasing work load on our lower backs due to a lack of mobility above and below in our upper backs and hips. So if you are doing core stability exercises then add hip and upper back mobility exercises into the mix. If you are not doing any exercise then start to work on hip and upper back mobility with the above exercises. The exercises should always be pain free.

References

(1)Stuber KJ1Bruno PSajko SHayden JAClin J Sport Med. 2014 Nov;24(6):448-56. doi: 10.1097/JSM.0000000000000081.Core stability exercises for low back pain in athletes: a systematic review of the literature.

(2) Xue-Qiang Wang,1 Jie-Jiao Zheng,2,* Zhuo-Wei Yu,2 et al. Public Library of Science. 2012; 7(12): e52082.Published online 2012 Dec 17. doi:  1371/journal.pone.0052082A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic Low Back Pain

(3)George SZ1, Childs JDTeyhen DSWu SSWright ACDugan JLRobinson MEBMC Med.2011 Nov 29;9:128. doi: 10.1186/1741-7015-9-128.Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial.

 

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Reduce Running Injuries By Changing Your Running Posture

By Exercise, Pain Relief, Sports

Improve your running technique

These two pictures put side by side show how from childhood we have good hip extension. The knee of the back leg is almost a straight line with hips and abdomen and chest.  Haile Gebrselassie hasn’t lost that full hip extension either!

However for most of us that have desk based jobs our hip flexors – the ones that help us bend at the waist- become tighter and can keep us in a slightly flexed position. In turn this means that when we run we do not get full extension at the hip.

Why does this matter?

1) Increased risk of running injuries

If our hips remain slightly flexed through the gait cycle then the femur (thigh bone) is always slightly rotated inwards. This in turn can put extra strain on the IT band, the knee and the hip bursa which can leading to strain injuries in these areas.

We can also try to over compensate with a short back swing and with a longer stride. This takes up more energy too and can lead to greater strain on the knee and foot leading to Achilles tendonitis and patella femoral pain syndrome (pain behind the knee cap)

Alternatively, runners gain extra hip ‘extension’ by arching their lumbar spines and this in turn can lead to lumber spine pain.

 2) Reduced running efficiency

It also does not allow for most efficient running. When your hip reaches full extension you have stored maximum potential energy in the hip flexor muscles (psoas, iliacus and rectus femoris) which turns into Kinetic energy on the swing phase of the run as you bring your leg forward for the next step.

And so we can expend more energy in running with less hip extension.

What can you do ?

Running injuries tend to be multi-factoral but a lack of Hip flexion is often involved.

To help increase hip extension you need to work on lengthening your hip flexors (psoas, iliopsoas and Rectus Femoris) as well as activating and strengthening your Gluteal muscles.

And then consider how to incorporate this into your running posture. Look up as you run and run with a more upright stance. This will help with a greater degree of extension at the hip.

Here are two key exercises designed to help you do just that

Do them daily am and pm 10-15x each and work them into your warm ups and warm downs

Hip flexor stretch- a guaranteed antidote to sitting at your desk and shortened hip flexors

Hip extensor activation- Gluteal (buttock) strengthening


Hugo Firth BOst, BSc, MA
Osteopath and
Sports Rehab Specialist

Sports Osteopath Hugo Firth

Member of the General Osteopathic Council
Member of the Institute of Osteopaths
“My approach to healthcare is a balance between osteopathy and patient empowerment through effective therapeutic exercises. I recognise it’s not always possible to come in for a treatment, and many conditions can be helped with the right exercise if used early enough. After all prevention is much less painful than cure“.
I offer free advice via email, phone 0208962331 or by filling in this online form here
New Patients: 60 minute appointment  – book here please

Office Chair Exercises

By Exercise, Pain Relief, Sports

Office Chair Exercises

by Hugo Firth, Osteopath

Back and Neck Exercise

90 Second Desk Exercise Workout

Want to know the best way to relieve stress at your desk? Our resident Sports and Exercise osteopath Hugo Firth has devised this special 90 second workout.  Hugo Firth brings together his life long skills of in sports together with his career as a successful Sports Osteopath. Quickly relieve tension and relax tired tissues. 

Do these exercises up to 6 times a day. Why not book bookmark this page and refer to it daily?

As with all exercises these must not be rushed and if symptoms persist you may wish to seek professional help. Why not contact Hugo for some friendly advice – click link below to use our online form:

Use our online form to ask us any quetion about your health or the health of a friend.

Top Tips

In the mean time here are some tip for general well being.

  1. Take a short break out of your chair every 60 mins or so. You may even wish to drink more water to prompt you to get up more often.
  2. Choose a variety of exercises throughout the week to help you keep fit. Try and avoid repetitive exercises, such as constant exposure to running, cycling or the same gym exercises. Postural variety is what keeps you going. 
  3. Avoid any prolonged activity, such as long periods of sitting, driving, or standing. Its hard to break this up if it is what you do for a living, but during your most stressful times, try and find a way around it. 
  4. Early nights help boost healing. So why not try a week of early night (just once, as a one-off) and we are sure you will be so impressed you will want to do that again. 
  5. Try and avoid soft deep chairs and settees. Contrary to popular belief soft squidgy chairs, beds and settees can be a source of hidden danger to the spine. If you are going through a bad time, try lying on your side or back to watch TV (or read), either on the settee or on the floor.

Hugo Firth BOst, BSc, MA
Osteopath and
Sports Rehab Specialist

Sports Osteopath Hugo Firth

Member of the General Osteopathic Council
Member of the Institute of Osteopaths
My approach to healthcare is a balance between osteopathy and patient empowerment through effective therapeutic exercises. I recognise it’s not always possible to come in for a treatment, and many conditions can be helped with the right exercise if used early enough. After all prevention is much less painful than cure“.
I offer free advice via email, phone 0208962331 or by filling in this online form here
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