The Best Advice For Low Back Pain

Three questions and two spine health tips every fitpro needs to know.

An astounding 80% of Canadians will experience back pain during their lives (that’s according to Statistics Canada). To a fitness professional, these are more than stats - they represent real people in your gym, studio, and treatment room.

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80% means that, not only could a huge amount of your clients show up with some kind of back pain one day, but also many of your friends, family, and colleagues too. Are you likely to be their go-to advisor? Do you know the best advice to give?

If not, don’t panic! In this article you will learn the key questions to ask, and two gold medal spine hygiene strategies endorsed by DTS Fitness Education and leading back health expert Dr. Stuart McGill.

Back Pain: The Questions To Ask

Question #1 - “Do you have good days and bad days with your back?”

The aim of this question is finding out the nature of the pain. Is it acute or chronic? Is it better or worse after activity? Start getting to the root of the problem.

If the person says yes (that they do have good and bad days), great! They are NOT a candidate for surgery, and you have an opportunity to help them. Your challenge - should you choose to accept it - is to make every day a good day.

If they answer no, please refer them to someone in your allied healthcare professional network.

Question #2 - “Do you know what triggers your back pain?”

The person might not know exactly what triggers the pain, but what they do need to know is they will play a key role in identifying, modifying and eliminating the root cause of their back pain

According to globally recognized back pain expert Dr. Stu McGill, the drivers of all back pain can be boiled down to specific postures, motions and/or loads. Your second challenge, should you choose to accept it, is to determine what postures, motions and loads are behind your client’s pain.

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A common example of posture driven back pain can be seen in clients who sit all day in a slumped, rounded back, flexed spine position. If you were to ask what causes their pain, this type of client might mention everyday tasks: putting on their shoes, picking up things, brushing their teeth or sitting for a long time.

In those cases, exercises driven by spinal flexion such as sit-ups, medicine ball slams and Jefferson curls should be avoided as they can make their pain worse. Remember, spine flexion is not the enemy. In fact, it is a natural motion of our spine. But, excessive spinal flexion is a potent mechanism for developing a disc bulge or herniation. In these cases the disc is the victim of the posture, motion and/or load which causes it to move posteriorly and irritate a spinal nerve.

Question #3 - “What takes the pain away?”

A common answer is “moving”. As fitness professionals, we know that “motion is lotion” and in many cases back pained individuals have figured out that moving around can be very helpful for reducing the level of pain, tightness and discomfort.

Ironically, some common strategies like stretching and/or self-manipulating or joint “cracking” can actually be the pain drivers. These approaches can provide a temporary analgesic effect, primarily due to activating the “stretch reflex” (a neurological stimulation that can temporarily reduce pain sensitivity). Like picking a scab, it may feel good at the time but the long term impact is negative. Unfortunately, lots of people with back pain get caught in a cycle of stretching and self-manipulating to reduce pain, not understanding that this temporary relief is in fact a long term pain driver.

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What does the literature say?

A systematic literature review by Brinkjiki, 2014 looked at 33 studies with over 3100 asymptomatic individuals. Imaging showed 50% of asymptomatic individuals in their 40’s had disc bulges. This supports Dr. McGill’s opinion (based on 30 years of research) that postures, motions and/or loads are the key drivers of back pain - not the presence of a disc bulge or herniation.

Best-Practice Spine Hygiene Strategies

What Is “Spine Hygiene”?

You brush your teeth every day, right? Have you ever stopped to really ask yourself why? The answers will obviously include personal hygiene, fresh breath, and preventing tooth decay.

The irony in dental hygiene is that a tooth can be repaired or replaced. The same can’t be said for vertebrae or intervertebral discs... replacing them is not an option.

We only get one spine, so daily spine hygiene is arguably more important than brushing your teeth! Here’s how to advise on spine hygiene so clients, friends, and family can enjoy a healthier and pain-free back.

Spine Hygiene Technique #1 - Walking

In his book “The Back Mechanic” Dr. McGill describes walking as “nature’s back balm”. In his clinical practice, he prescribes walking to almost every back pain client. The act of lifting and swinging a leg during a walking stride challenges the lateral parts of the spine, core and hips in a way that spares the spine. The coordinated movements of the arms and legs during walking stimulate the energy storing fascial slings, reduce muscle tension, and unload the spine.

How to coach an effective walking strategy:

Walking for Lower Back Pain - Promo from DTS Fitness Education on Vimeo.

  • Posture - look up, look proud
  • Arm swinging - swing the arms from the shoulders (not the elbows)
  • Pace - walk at a moderate to brisk pace (Avoid slow walking - it encourages poor posture and reduced arm swing which increases spinal loads and may trigger low back pain)

“Walk proud, with a bounce in your step and swing your arms”

Spine Hygiene Technique #2 - Bracing

Lots of people with back pain report a sharp, stabbing type pain when doing certain tasks (like reaching for an object, picking up something or sneezing). These sudden pains are generally an indicator of spinal instability, where the pain is generated from micro-movements at the spine joints. A simple strategy to enhance spinal stability is bracing.

Why brace? Remember that the spine is an inherently unstable structure. Nature designed it that way to give us a variety of movement options. Nature also provided us with a kind of guy-wire system so that we can generate enough spinal stability for a given task. For tasks such as lifting a heavy external load, like a 1RM deadlift, our body creates a high level of stability. Compare this to picking your keys up off the floor - the body knows you need much less stability. Too much muscular tension can crush the spine, and too little will allow the spine to buckle.

How to teach a good brace for back support:

3B and Practical Application from DTS Fitness Education on Vimeo.

  1. Have the client simulate how they would react to someone punching them in the stomach. The tension they create is an abdominal brace.
  2. Ensure they are bracing by pushing out - do this by wrapping a band around their waist (you should see it expand when they brace).
  3. Have them “tune” the brace - with permission, poke them in the lateral part of their abdomen with your fingers and ask them to tune their bracing strategy to meet the strength of your fingers. Ask them for examples of everyday activities and aim to help them develop the relevant level of brace. A gentle poke for picking up a light load such as car keys from the ground and a firmer poke to stimulate picking up a child from a car seat.**

Make Sure You Understand Back Pain

Back pain will impact 80% of the population at some point in their lives. You are in a powerful position to really help many of these people get out of pain and avoid future discomfort. Start with determining if they have good days and bad days. If the answer is yes to good days, then you can help them.

Your goal as a fitpro is to stop clients from “itching” their back pain every day, and instead coaching them through effective long term strategies.

The next step is to figure out their pain drivers. You have to eliminate those or they simply won’t get better. If this information is new to you, don’t panic - help is at hand. DTS Low Back Fundamentals teaches practical assessments for clients that will assist them in identifying pain triggers and relief postures, as well as motions and loads associated with low back pain.

Once you have removed the pain triggers, teach your client how to tune their brace and implement a daily walking strategy. These daily hygiene strategies are effective for most people, as long as the dose and duration match their capacity.

Ready to add back pain assessment and guidance to your skill set?

*References
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
W. Brinjikji, P.H. et al, 2014

Back Mechanic - The secrets to a healthy spine your doctor isn’t telling you.
S. McGill, 2015 *