Morning has broken and it’s time to start your day.

You slowly rub the sleep from your eyes, fling the warm, enveloping covers off your body and allow the frigid air of your bedroom to jolt you further from your reverie.

“Why does my back feel so stiff?” is your first fleeting thought as you hunch forward on the edge of your bed, pawing for your fuzzy slippers with your feet. Your sleep-drunk legs have trouble locating their targets so you bend farther forward through your back to add some visual assistance.

You pull yourself to a somewhat upright position, stumble to the bathroom, turn on the tap, bend down to the sink and splash the last vestiges of sleep from your being…

So maybe you don’t dream of saving the world, and perhaps you don’t have fuzzy slippers. Heck, you might not even wash your face.

But if you’re like most people, you likely go through some of the same movement patterns I’ve just described.

What’s the big deal?

The big deal is that your intervertebral discs (yup, the same ones that are involved in “slipped discs“), according to Dr. Stuart McGill’s research, are actually in a more hydrated state after a night of slumber, which puts them at higher risk for injury (disc herniations, disc bulges etc) with certain types of movements, most notably flexion.

Why do the discs “inflate”?

After having spent six to ten hours in a horizontal position while sleeping, the effects of gravity are minimized through your spine. So instead of being compressed (as they are when you’re upright), your discs are unloaded to a certain degree and actually suck up fluid like a sponge. This is why you’re actually taller after waking.

What can you do about it?

This is the simple part. Avoid flexion (bending forward) through your spine until the discs have had a chance to lose some of that fluid.

See, I told you, simple.

McGill’s research suggests that it will take about an hour after waking for this to occur. After that golden hour, it’s safer to bend that way.

Now the hard part: avoiding flexion means you’ll have to modify how you get out of bed, how you sit on the edge of your bed, how you wash your face, brush your teeth and even sit on the toilet.

And depending on how fast you are at getting pretty in the morning, it would also mean you’ll have to avoid slouching at the breakfast table (you do eat breakfast right?).

These are all automatic habits you’ve been reinforcing for years. It’s not going to be easy to change them, but as a former low back pain sufferer, I can honestly say that I prefer dribbling toothpaste down my chin than having bolts of lightning shoot down my leg.

Yours in movement.

Dev Chengkalath

They’re short. Concise. And should be to the point.

And if created correctly, they’re pretty easy for most people to remember.

So here goes…

This is my list of the five worst things you’ve done to you low back today:

1. You’ve flexed through your lumbar spine on fully hydrated intervertebral discs (yup, these are the same discs involved in those famous disc herniations or “slipped discs”). In fact, this was probably the first thing you did this morning upon awakening from your more than likely short and insufficient sleep.

• Sitting bent forward on the edge of your bed in that sleep induced haze right after you wake up.
• Sitting in that same bent forward and flexed position on the toilet.
• Brushing your teeth, washing your face, and maybe even standing slouched in the shower.
• Hunched over the breakfast table (you SHOULD be eating breakfast!).

2. You’ve spent more than 30 minutes (this being a fairly conservative guess) in a static and continuous slouched posture.

• Collapsed on yourself with your ribs resting on your pelvis during your commute to work (this includes planes, trains and various forms of automobiles).
• In your standard computer posture in front of that technological wonder that was designed to make your life easier and more manageable. This position likely has you with your head protruding and your shoulders rounded forward for extended periods of time.
• On the couch watching your favourite television programming (typically for a few hours) after a long, grueling and tiring day at the office.

Slouched Sitting Postures: Over time can lead to injury.

3. You sit. And sit. And sit. Enough said. Follow the link if you need more info on the dangers of sitting.

4. You wear high heels. This one is mostly for the women out there, although, who am I to judge? This piece of fashion will confer the wearer with an instant and noticeable alteration of lower limb appearance. But at what cost?

• Centre of gravity shifts with resultant changes in weight bearing
• Increase in lumbar spine curvature (increased lordosis, possibly excessive)
• Altered muscle recruitment patterns, biomechanics and gait patterns

5. You decided that you were too tired to exercise today. This follows along with number 2. And number 3. I think everyone is aware that exercise is good for you so there’s no need to belabor that point. It’s just a matter of prioritizing it to get it done.

Yours in movement.

Dev Chengkalath

It has the ability to spread knowledge across the globe in real time. You have a problem, google it, and more than likely you’ll find a solution.

So what’s wrong with that?

As a physiotherapist in Toronto, these are the questions I ask myself: How good is the information you’re getting? Is it valid? Reliable? Can it be trusted? Will it help you? Or will it hurt you?

This holds even more weight when dealing with physical issues such as injuries or illness. Plug in your signs and symptoms and within seconds, hundreds, if not thousands of webpages will be returned for your perusal.

It’s no different with relieving low back pain. Plug in those search terms and instantly you’ll have at your disposal more information than you could possibly even use.

When looking at low back pain, a good portion of the information that’s returned discusses strengthening your abs to fix your back problems. At times, this is similar to the information many people are given by their medical and fitness professionals: “Build a strong core to protect your back”.

Unfortunately, abdominal training is typically considered the foundation of core training. In reality, abdominal training is only a small part of the bigger picture. And in some cases, poorly designed or applied abdominal training can actually be what’s keeping you in pain.

As I’ve already talked about six pack abs and low back pain, I’ll just stick to giving you some ideas on how to keep your back strong, safe and healthy. Without further ado, here’s my list of the 3 worst core exercises for people with low back pain:

The abdominal crunch or sit-up: These staples of most back rehab programs should be eliminated because of the tremendous compressive loading forces that they create through the discs of the spine. There are better ways to train the core!

Dr. Stuart McGill, one of the foremost spine researchers in the world, has measured compressive forces of approximately 3300N (730 lbs) in the spine with these types of exercises.

This is equal to the amount of force noted by some government health agencies as the amount of force needed to cause injury!

Abdominal machines (crunch and twist machines): So if crunches or sit-ups can cause as much damage to your spine, imagine what happens when you take the same exercise, restrict movement at certain joints, isolate movement at others (in this case the lumbar spine) and then add a load.

Doesn’t sound very good, does it?

Now take that same flexion movement add a loaded rotation component on the twisting abdominal machines and you’re well on your way to getting yourself sent off to the disabled list.

In fact, we’ve  dubbed these types of exercises “disc herniators” and inform our clients on continuing to do these only if they wish to help us finance our latest exotic car purchase.

www.madwhips.com

Take home message: save your spine and stop flexing and/or twisting through your low back!

Back Extension Machines: As described by Dr. McGill, the repeated spine flexion/extension movements used by these devices create the same conditions that were necessary in his lab to produce disc herniations.

Enough said.

Why would you want to do the same to your back at home?

So there you have it…The 3 worst core exercises for people with low back pain. If you love your back, stop doing them.

Let me know your thoughts. Do you agree? Disagree? Or just not care?

Yours in movement.

Dev Chengkalath

In the last blog post, I discussed some of the bony and cartilaginous structures that make up the back so today I’ll spend some time discussing the neurological tissues. These include the brain, the spinal cord and the nerves that branch off from them.

Neurology and related disciplines are in constant states of evolution and the study of the human nervous system can be extremely complicated. For the purposes of relieving your low back pain, I’ll keep the information as basic as possible.

You don’t need to know how a car is built to be able to drive one right?

The brain: This is the control centre of your body. It’s the primary component of the central nervous system (CNS) and is responsible for receiving, processing, analyzing, learning, sending, and organizing information from many sources. When it comes to relieving low back pain, this is your most important tool!

The Human Brain: Control Centre

By using your learning capacity, you can start changing the actions, movements or positions (the “causes”) that keep you in pain. And as you know if you’ve been reading any of my previous posts, the easiest way to remove the pain is to remove the cause.

Spinal Cord: The spinal cord is the second component of the CNS. The spinal cord is a tube-like bundle of neurological tissues, supporting cells and associated structures that extends down from the brain through the spinal canal formed by the stacked vertebrae.

Its main functions are to send, receive, and transmit various signals and nerve impulses to and from the brain and other tissues of the body. It’s also able to independently create certain reflex actions or patterns (e.g. the Knee Jerk Reflex: leg kicking out when your knee is tapped by your doctor’s rubber hammer).

Nerves: The nerves of the body originate from the spinal cord and travel throughout the body into the extremities (Bonus Knowledge Bomb: the exceptions are the cranial nerves which originate directly from the brain). Nerves serve a similar function to the spinal cord and their main function is to transmit messages between the various body tissues and systems and the CNS.

Often, but not always, the part of the nerve that originates off of the spinal cord (the nerve root) will be implicated as the source of the pain in various types of  low back injuries such as disc herniations or bulges.

The Lumbar Nerves

So there you have it, a quick and brief overview of the neurological tissues that are involved in low back pain.

In the next post, I’ll go over the soft tissues and their involvement.

Yours in movement.

Dev Chengkalath

This ubiquitous moniker is a fairly common one.

It’s flashed in eye-catching headlines in low back pain articles. It can be heard reverberating through the halls in hospitals and overheard being discussed in great detail in locker rooms. It’s unfortunately (mis)used all the time  by medical health professionals (physical therapists included) as either an umbrella category for a host of back pain issues or as a misnomer for the actual injury at hand.

In reality, there is no such thing as a slipped disc.

That’s right.

Slipped discs don’t actually exist.

So if the disc hasn’t slipped, what’s the problem?

In most cases, what’s happened is that the intervertebral disc has herniated to some degree and the ensuing tissue pathology has started to cause irritation on the local spinal nerve root.

So if you’re still with me after that last sentence, you get a gold star because that was the technical, mumbo-jumbo way of saying a part of your spine has bulged and is putting pressure on, or causing inflammation around, a nearby nerve. This then becomes the source of your pain, discomfort and dysfunction.

Over the next few blog posts, I’ll delve a little deeper into the “mysterious” world of disc bulges. In order to make this journey easier on you, here’s the agenda for the next few posts. As you’ll see, everything still follows the 3 key issues related to low back pain (which also happens to be the same 3 key issues related to most musculoskeletal issues!).

Part 1: Knowledge

In part one of this series we’ll spend some time on the function and anatomy of the spine. Having this knowledge is paramount in conquering this, or any other form, of low back pain. Knowing and understanding the structures that are involved will give you a better idea on how to protect them or help them do what they do best, heal.

Part 2: Motor Control

In part two of this series we’ll check out some of the motor control issues that lead to, or worsen disc bulges and their painful effects. This includes postures, positions, habits, muscle imbalances, mobility issues or movement patterns that all play a role in disc bulges, whether good or bad.

Part 3: De-conditioning

In the final part, we’ll talk de-conditioning and how you can reverse this process. And, as always, we’ll do all this while keeping your back happy and healthy, using the right kind of exercises, in the right way. Safely and efficiently.

So in the next post, we’ll get the knowledge base laid and then build up on it.

After everything is said and done, you should be better able to understand the true causes and potential cures for your disc herniation (formerly known as “slipped discs“).

Yours in movement.

Dev Chengkalath