For 40 years I have been teaching patients in my chiropractic practice that they have to look at the back as a mechanical structure.
The complex movement patterns of the spinal and pelvic joints (bending and twisting) as well as their support function of maintaining the upright posture are controlled by very specific coordinated muscle contraction and relaxation.
When this movement pattern is altered for any number of reasons, the spinal and pelvic joints start to become stressed. The rubbing and grinding produced by this stress causes the joints to become inflamed causing pain. Furthermore this inflammation triggers muscle spasms which further negatively affect the normal movement and alignment of the joints causing more pain
In my book “The Wiggle In Your Walk Must Go…It May Be Hurting Your Back”, I describe in detail how muscle imbalances affect your spine and pelvis and offer a testing procedure for evaluating your specific muscle imbalances and what exercises you should be doing to rebalance those muscles.
Here are 7 Myths about back pain that I commonly deal with in my office.
Myth 1: Lying in bed is good for back pain
One of the more common responses I get when I ask patients to describe their back pain, is that they are stiff and sore when they get up in the morning but it gets better as the day goes on.
Some people are told or believe that lying down is always the best thing to do with back pain.
Here is my take on this subject.
First off let me say that if you have a normal functioning spine with no amount of disc degeneration or arthritis you should not experience this problem.
Those who do have these problems are susceptible to many things and one of these is that lying in bed for excessive periods actually causes back pain. Let’s examine this more closely. A little known fact is that we are all actually taller first thing in the morning than we are before we go to bed at night. This comes down to our spinal disks. The disks in between each of our vertebrae are packed with very concentrated protein chains that love water. When we lie horizontally, the discs fill with fluid and gently push the vertebrae away from one another, lengthening the spine. The reason, our backs are often stiff in the morning is that weak or damaged discs are so full of fluid, like water balloons ready to burst. When we get up in the morning, and our spines are once again vertical, the excess of fluid in each disc begins to seep out and an hour or two after rising from bed we have returned to our normal heights.
This natural ebb and flow of water in and out of the discs is what allows the discs to obtain nutrition. Problems arise, however, when the spine remains in a horizontal position for too long. While about eight hours in bed is healthy, much longer than that is not as it allows the spine to continue to swell and cause disc pain. Limiting your time in bed can help with this.
Myth 2: My daily workouts at the gym will prevent back pain
Truth: An unfortunate reality is that one of the more common reasons that people come to my office is for back pain that occurred as a result of exercising at the gym or at home
I see patients often perplexed by the fact that they take care of their bodies when an “unfit Joe” they know seems to get by with no back trouble at all.
The truth is that someone hitting the gym every day without using proper technique or doing the correct spine sparing exercises during their workout, will develop cumulative trauma in their discs. Repeatedly bending your back at the gym, followed by long periods of sitting at work, chased down with poorly executed daily tasks such as getting dressed, gardening, vacuuming etc., conspire together to cause the slow degeneration of the spinal joints and discs and eventual back pain.
Unfit Joe,” who sits all day, doesn’t experience the same strain on his back that a gym superstar does by aggravating their disc injuries every time they sit. In terms of pain, their spines are better off! The key is not to stop working out! The secret is in changing your default movement patterns and doing the proper exercises so that you can enjoy the benefits of fitness without compromising your back.
Myth 3: Yoga and Pilates are great ways to alleviate back pain
Truth: Many doctors and therapists recommend these programs to their patients. This practice is not without controversy. For example, some individuals including Professor Stuart McGill a well respected expert on spinal biomechanics, feel that certain basic principles of pilates such as the “imprint” where you flatten the spine to the floor when lying down. He contends that such activity disrupts the normal curve of the back and can increase pain sensitivity in those already in pain. He sees the “rollup”, another basic exercise of pilates, as putting too much stress on spinal discs and can cause them further damage.
While I understand the concerns, I feel that these type of programs can be very beneficial BUT they should only be started once you are pain free.
Back pain is an indication of some sort of mechanical problem that is causing the irritation. This mechanical problem must be corrected first or any exercise program has the potential to further harm the problem.
If you really feel strongly that exercise is the answer to your problem then at the very least join a program with a very experienced and knowledgeable instructor who understand your problem and can suggest or eliminate certain exercises that might aggravate your condition.
Better yet have a professional test your muscles to determine the imbalances between strength and tightness so that an individualized exercise program can be developed specifically for you.
Myth 4: Stronger muscles will cure my back pain
Truth: This was a philosophy that was promoted by some rehabilitation specialists some years ago. Remember those “back extension” machines that were so popular.
The myth says that if I train your core and back muscles for more strength then I will be able to lift heavier and have less of a risk for back injury, when in reality it’s actually the opposite.
It’s not that strength is not important…it is. However the type of strength is what is important. Let me explain.
The key to preventing injuries is the ability to maintain your core strength, stiffness, through the duration of all your daily activities. Any breakdown in this core strength during activities causes a loss of energy and can cause injury. The ability to maintain strength for longer periods is called endurance. More strength will not increase endurance. Endurance is a product of repetition under low or no loads
The key is not to be strong in the core just for lifting or during your time at the gym but to be strong in the core for life. For walking up the stairs, carrying boxes, lifting your child etc
Myth 5: Stretching is good for reducing back pain
Truth: Although stretching is considered universally beneficial for back pain sufferers, this is an old-fashioned notion that needs clarification.
Let me begin by saying that I rarely prescribe or recommend exercises for patients who are suffering back pain. If you are in pain, there is something mechanically or structurally wrong with your back. This problem needs to be diagnosed and dealt with before any exercise program should be initiated.
Physiologically, pulling your knees to your chest, or other similar stretches, trigger the “stretch reflex.” This is a neurological phenomenon that reduces pain sensitivity. This provides about 15-20 minutes of pain relief for some, making it a short-term fix.The problem is that you may be aggravating your discs and after you’ve experienced temporary relief, the pain will return, often worse than before. Thus begins a vicious cycle with a misinformed back patient who thinks their only solution to pain is to “stretch it out,” not realizing that this is in fact contributing to their pain. The key is to stop the cycle!
There is no such thing as a stretch that is good for all patients, just as there is no such thing as a single source of pain. Each back pain case is different, and as such each stretch must be chosen very, very carefully and tailored to the individual.
Myth 6: Having a powerful back is protective
Truth: Power is the product of velocity and force. So high power is generated when quickly bending the spine together with a forceful exertion. Generating power in the spine is highly problematic, as it increases the risk of injury. Let’s break it down. If spine movement or bending occur at a high velocity, the forces (or load) on it must be low in order to avoid injury. For example, the golf swing has high velocity but low force.
Alternatively, if the force being placed on the spine is high, then the velocity must be kept at a low level in order to maintain a low risk of injury–think the deadlift (heavy load, low velocity). Essentially, the risk of back injury can be controlled by keeping spine power low.
Myth 7: Back pain is linked to having tight hamstrings
Truth: I often have patients tell me that they think that their tight hamstrings are the root of their back problems.
In most cases, tight hamstrings are the product of mechanical problems in the hip, pelvic or spinal joints and not the cause. An abnormal walking pattern or gait (ie. the wiggle in your walk) causes other muscle groups to change their normal function in order to compensate for the abnormal gait.
Correcting the mechanical problem and rebalancing the muscles will allow the hamstrings to return to their normal state.
Much of this material comes from:
Stuart McGill has been a Professor of Spine Biomechanics for the past 30 years at the University of Waterloo, Canada, where he has a laboratory and clinic that explore low back mechanics, injury mechanisms, rehabilitation protocols and performance enhancement. He has authored over 240 scientific journal papers and four textbooks, and has mentored over 40 graduate students during this scientific journey. As a consultant, he has provided expertise on low back injury to various government agencies, many corporations and legal firms and professional/international athletes and teams worldwide. He is regularly referred special patient cases from the international medical community for opinion.