Currently, I am reading Low Back Disorders written by the Dr. Stuart McGill (who is arguably one of the leading spine biomechanists in the world…aka you should start reading any articles and research from this guy). The most important and influential suggestions I received from the athletic development coaches while being an intern at Endeavor is that in order to be a great strength coach (or even personal trainer for that matter) you need to continuously educate yourself to stay up to date with current research, articles, blogs, etc. That suggestion should apply to anyone who is “on fire” for their career.
These next few ill-advised rehab/training recommendations could be applied to the majority of clients/athletes to avoid inadequate treatment/stability practices. Some of the most common recommendations for back health are…
- Strengthen muscles in the torso to protect the low back- Despite clinical settings emphasizing strengthening the low back, there are several studies that show that muscle strength cannot prevent future lower back troubles (1). Muscular endurance of these muscles is the protective mechanism to prevent injury. Why do many therapeutic programs continue to emphasize strength? Probably because there is a holdover influence from the athletic world to enhance performance as well as the influence of bodybuilding approaches to rehab. However, optimal exercise therapy/training indicates that improved health should be primary goal followed by performance enhancement (both can be mutually exclusive!)
- Bend the knees when performing sit-ups-This is widely recommended, however, off of what evidence? Axler and McGill (1997) show that there are far better ways to challenge the abdominal musculature while imposing lower lumbar spine loads (any spinal flexion exercises significantly increase risk of injury).
- Performing sit-ups will increase back health- Based off of what evidence? Many studies attempting to evaluate the role of increased fitness in back health include exercises that are known to cause back problems. It is clear that sit-ups will cause damage in most people.
- To avoid back injury when lifting, bend the knees, not the back- This is one piece of advice given to many to avoid back injury. But it may not be practical because many work settings cannot be performed this way. There are many factors that can create safer techniques.
- A single exercise or back stability program is adequate for all cases- How many times have we heard of isolating muscles in exercise? Bodybuilding philosophy=not how the body functions. We hear of enhancing spinal stability by focusing on one muscle, but this is not true. All the core musculature is important in stability of the spine, not just focusing on one muscle or area. All muscles continually change with to the demands of the task to prevent injury.
These are some tremendous suggestions. Here are a few exercises that maintain “neutral spine” while stressing the core musculature the way they were intended to be worked. Any comments please let me know what you think!
Half-Kneeling Belly Press (Isoholds)
Stability Ball Front Plank w/ MiniRollouts
1-Arm Dumbbell Waiter Walks
(1) Biering-Sorensen, F. (1984) Physical measurements as risk indicators for low-back trouble over a one-year period. Spine, 15: 106-119.