The Top Three Things You Do In The Gym To Screw Up Your Lower Back
Therapeutic exercise has consistently been proven to be the best way to manage lower back pain. It has a better long-term outcome than injections, medications, and surgery. Unfortunately, many people end up injuring their lower backs in a well intentioned, but misguided effort to get fit. Below are the top three lumbar spine mistakes I see people making in the gym.
You Exercise Sitting Down
The muscles and joints of the lumbar spine, pelvic girdle, hips, and knees are an interconnected team. To get the team playing more efficiently, your body needs to be challenged by gravity and trained in an upright position. A basketball team would never get better if they practiced while sitting at a desk. You should run away from anyone who straps you into a machine in an effort to help you with a back pain problem. By the way, you already sit way too much. You drive, computer, television, and sometimes sleep in a seated position. Prolonged sitting creates much of the tissue shortening and muscle weakness that makes you more prone to lower back pain.
No Consideration For Compression
This is an issue that is particularly important for individuals with prior episodes of lower back pain. Most people are unaware of the many gym activities that create compressive forces on the lumbar spine. Treadmill running (more if you hold on the handles), leg press, crunches, and leg lifts create a compressive loading of the lumbar joints and discs. Be aware of the cumulative loading on the lumbar spine, and alter your training schedule so that you perform certain exercise activities on different days. Do not perform squats on the same day you run on the treadmill. If you are going to perform 50 incline sit ups, do not do it on the same day you deadlift. If you are uncertain of what activities place a compressive load on the lumbar spine, you need to work with a physical therapist or certified trainer.
You Are A Flexibility Freak And A Stability Geek
Creating spinal flexibility without the strength to keep your spine stable sets you up for injury. Many lumbar pain patients I evaluate are able to flex the spine forward and palm the floor. They can bend their spine like an overcooked noodle, but they are unable to summon the muscle control to hold the lumbar joints in a stable position. These patients often report a long history of dedicated stretching, yoga, and Pilates training. They fail the lumbar stability tests, and are often unable to perform the overhead squat or in line lunge functional mobility tests secondary to a lack of core stability strength. These same patients are often surprised at their poor performance in the core stability tests because they “strengthen their abdominal muscles” with crunches and leg lifts. Training to improve spinal stability and exercising your abdominal muscles are completely different things. Every gym goer needs to learn the difference.
Michael S. O’Hara, P.T., OCS, CSCS
KICK THE KICKBACK TO THE CURB
In our physical therapy clinics, we get to treat elbow pain every day. The pain is usually brought on by some kind of repetitive activity. Tennis players get pain on the outside of the elbow. Throwers and golfers get pain on the inside of the elbow. Fitness clients commonly end up in physical therapy with complaints of elbow pain. The cause of the pain is usually some sort of triceps isolation training, and the biggest offender is the “triceps kickback” exercise. The kickback is a Shape magazine standard that appears to be a favorite with female gym goers. The triceps kickback is more likely to give you elbow pain, than to produce thinner and more shapely arms.
Three things make this exercise problematic for the elbows. The kickback exercise creates a bad force curve. The resistance is the strongest when the triceps muscle is at its least advantageous position, and this places the majority of the load on the elbow joint in a fully extended position. When I see this exercise performed in the gym, it is usually executed with a swinging of the dumbbell. The momentum of the weight forces the elbow into excessive end range extension. Kickbacks are often performed for high repetitions. It is not uncommon to witness someone perform three or four sets of twenty repetitions. That is sixty to eighty high speed, end range repetitions under a stressful force curve on each elbow.
From the elbow pain patient I hear, “But I don’t feel any pain when I perform the kickback exercise.” Most golfers, tennis players, and throwers don’t feel pain during their participation in sports. The elbow pain usually sets in later that day or the next morning. Another common concern is that they will not be able to reduce fat on the back of the arm without direct triceps work. This is the “spot reduction myth” that just won’t die and keeps many a physical therapists employed. Avoid the trainer that tells you a specific exercise will take subcutaneous fat off an area of your anatomy.
Elbow irritation that creates scar tissue and inflammation is often difficult to eliminate. The pain in the elbow can get so bad that it limits other training activities. The good news is that elbow pain is often self-inflicted, and with a little education, we can avoid the pain. Watch the video, dump the kickback exercise, and start training your triceps with some push ups and presses. Your elbows will thank you.
Michael S. O’Hara, P.T., OCS, CSCS
The Sure Cure for Gluteal Amnesia
Your hamstrings and gluteal muscles always work together as a team. Strong, coordinated hamstrings and gluteals are your lower back’s best friend. They anchor the pelvis and hold a stabilized spine in a tight and tall position. They work with the other posterior chain muscles to keep stress off of the sensitive structures of the lumbar spine. Patients with chronic lower back pain often have weak and even atrophied gluteal muscles. Building strength and coordination in the hamstrings and gluteals is often difficult for patients with lumbar spine pain problems. Hip lifts are lower back friendly exercises that can restore the function of hamstrings and gluteal muscles.
There are many different types of hip lifts and all are beneficial. The two basic hip lift drills discussed below work well for most fitness clients and physical therapy patients.
This exercise will strengthen your posterior leg muscles and spares your spine any stress. Lay supine with a physioball under your heels. Place the arms at the sides and push down into the floor with the arms to stabilize the body. Keep the feet together and aimed up at the ceiling. Brace your abdominal muscles and squeeze the legs together. Use the butt muscles (gluteals) and posterior thigh muscles (hamstrings) to lift you up off the floor. Hold the suspended position, in one long line from ankle to shoulder, for three counts. Lower with control and repeat for five to fifteen repetitions.
Bench Hip Lifts
This drill coordinates hip extension and lumbar spine stability. It is very beneficial when progressed to the single leg version. Lay with your shoulders across a bench with the head supported. Place your arms out to the sides. Plant the feet on the ground with the knees bent 90 degrees. Drop the hips to the floor and then push back up with the gluteals and hamstring muscles. Hold at the top for three seconds and repeat. Perform five to ten repetitions. As you get stronger, progress to performing the exercise one leg at a time. From the same starting position, lift the left leg up off the ground. Lower slowly and using just the right leg, lift back to the starting position. Make sure the right foot stays flat on the floor and you push up through the heel. Perform five to ten repetitions on each leg. Switch over to the left and repeat. If you find one side is more difficult, perform an extra set on that side. Eliminating performance asymmetries in this exercise often resolves long standing back pain.
Michael S. O’Hara, P.T., OCS, CSCS
FRACTIONIZED EXERCISE AND HYPERTENSION
Over 60 million Americans have hypertension and another 65 million have prehypertension. Prehypertension is a series of risk factors that place the patient on the path to the development of hypertension. Hypertension is a primary risk factor in stroke and heart disease. Left untreated, it can cause significant disability and early mortality. The good news is that hypertension and prehypertension respond very well to exercise. The bad news is most patients are either are unable or unwilling to exercise for any significant duration of time.
The commonly prescribed dose of exercise to treat hypertension (high blood pressure) is thirty minutes of uninterrupted activity at 65% to 75% of your age adjusted maximal heart rate. To produce results, the exercise must be performed every day. Many hypertensive patients also have physical limitations that limit their activity level. They are overweight, weak, and often have orthopedic problems that make thirty minutes of continuous exercise impossible. Many patients despise exercise activity and would rather die than spend thirty consecutive minutes walking or riding a bike. Researchers at Arizona State University recently tested different exercise prescriptions to see if shorter exercise session performed more frequently would produce positive responses in patients with hypertension.
Study participants wore blood pressure monitoring cuffs that took measurements twenty four hours a day. They walked three times a day for ten minutes on one training day. On the next day, they performed one thirty minute walking session. On the third day, they performed no exercise at all. While both doses of exercise helped control blood pressure, the brief ten minute sessions performed three times a day was significantly more effective than a single half hour session.
The “fractionized” exercise produced lower average blood pressure readings and fewer incidences of blood pressure spikes above 140/90. It turns out that short, cumulative exercise sessions are remarkably beneficial for vascular health. Compliance is king when it comes to exercise success. Compliance with three short bouts of exercise a day is more achievable than one thirty minute session. A ten minute walk at lunchtime. Ten minutes on the stationary bike after work and a ten minute evening walk can fit into most peoples lives.
One of my personal training clients has hypertension and he has been much more successful at controlling his blood pressure with abbreviated training sessions. He was running three times a week and doing yoga on the off days and his blood pressure did not improve. We changed his program so that he strength trains at the gym two days a week and on his off days, he rides a recumbent bike two times a day for only twelve minutes. The more frequent training has been more effective at lowering his blood pressure numbers, and he has been able to discontinue medications.
Michael S. O’Hara, P.T., OCS, CSCS
FOR MY LEGS, I JUST RUN
This is the response I get from many physical therapy patients referred for problems with hip, knee, and lower leg pain. The only exercise they undertake for the lower extremities is distance running. They perform resistance activities for their upper body, but do not spend any time on strength training or mobility work for the legs. Attempting to keep your legs healthy and strong for a lifetime by solely distance running is a flawed plan.
Your muscles consist of different types of fibers. Distance running stimulates the slow twitch type fibers, and if performed for a significant period of time, it will convert the fast twitch fibers to slow twitch. Fast twitch fibers produce quicker, more explosive movements. They are the muscles you use to sprint, jump, or catch yourself when you trip or fall. Aging alone reduces the number of fast twitch muscles and distance running artificially enhances this fast to slow twitch muscle fiber conversion. The good news is that some dedicated strength training can reverse this process.
Running is a single direction activity. The best parts of life and athletics happen in multiple directions. Our muscles are laid out in a spiral and diagonal pattern. We are designed to move in a combination of three directions. Distance running is predominantly a sagittal (forward-backward) movement pattern. Comprehensive lower extremity training must include mastery of the frontal (side to side) and transverse (rotational) planes of motion. Most of the running patients I treat have limitations in their ability to move in one or both of these other directions. The deficits they exhibit are usually the drivers of their pain problems.
Imagine you only have one set of tires for the lifetime of your car. Do you take car out and race around the hairpin turns of a country road or are you more conservative in your driving? You would probably make sure the wheel alignment was proper and that the tires were balanced. Your legs are similar to those tires. The replacements for a worn out knee or hip is not nearly as good as the original equipment. The process of getting the replacement is not as simple as a tire change. Distance running is a high level fitness activity that demands that you have all parameters of fitness plugged in to stay injury free. If your goal is a life time of fitness, you may want to consider other activities.
Distance running has never been a good fat loss activity. You see more thin people running because they are more successful at running. It is the same as seeing heavy men participating in sumo wrestling—heavy men are more successful at sumo. Overweight people are generally not very successful at distance running. The benefit to injury ratio is just not in their favor. The best fat loss results occur with dedication to dietary change and a program of strength training.
Michael S. O’Hara, P.T., OCS, CSCS
FITNESS GOAL: FAT LOSS–HOW TO GET IT DONE
1) Get very well acquainted with what you are eating. Read the books written by Dr. Berardi and David Zinczenko. The information on precisionnutrition.com is easy to follow and free of the usual internet diet hype.
2) Become more aware of how much you are eating. Buy a kitchen scale and weigh every morsel of food you ingest over the next month. Keep a daily food log and learn the meaning of a “food portion”. If you will not do #1 and #2 on this list, then recommendations #3 through #10 are not likely to help you reach any fat loss goals.
3) Limit sitting. At work, get up and walk around every ten minutes. When you go to the gym, do not sit or lay down for any reason. Sitting reduces your ability to move, and if you do not move well ,you will never get fit. Sitting is analogous to cigarette smoking for your fitness.
4) Get better at the basics.—squat, hip hinge, vertical pull, vertical press, carries, horizontal pull and push. No single arm dumbbell laterals while you stand on a balance board with one eye closed. Basic movement patterns can be scaled down or ramped up to suit any fitness level.
5) Fractionize your exercise sessions. Two short bouts of exercise (15-20 minutes) performed every day will produce a greater change in your body composition than the 50 minute session you perform at the gym twice a week.
6) You must limit contact with people who knowingly or unknowingly sabotage your plans. For a period of time, you may need to get new friends, avoid some family members, and reduce contact with toxic coworkers. Long lasting body composition changes are derived from forming new healthy habits and altering habits takes time. Once your new fitness and eating habits are ingrained, you are far less susceptible to outside influences.
7) Set realistic goals that you commit to paper. The goals must be written and have a three month, six month, and one year time line. Many people ignore this recommendation—I think is scares them. Time sensitive, written goals are powerful.
8) Drop the “abdominal exercise” and “muscle isolation exercises” and spend that time on multi joint, full body exercises that help you move better and make you stronger.
9) Drop the “long slow cardio” and spend that time on interval training. Push hard for fifteen to thirty seconds and then recover. Perform six to eight of these intervals and get comfortable with being uncomfortable.
10) Get some help. The fitness knowledge base has expanded dramatically over the last ten years. What you learned about exercise fifteen years ago is probably outdated, less than optimal, and possibly detrimental. A trainer can also help temper any beginner enthusiasm that tends to send people to the doctor’s office.
Michael S. O’Hara, P.T., OCS, CSCS
Keeping You Playing and Not Aching
Strength and conditioning coaches are very concerned about the number of competition days their athletes lose to injury. Player competition days lost to injury are tracked by college and professional sports teams and the strength coaches performance is graded based on those days lost. For a professional athlete, staying healthy for an extra year of competition can mean another million dollar paycheck. The amateur athlete that avoids injury is far more likely to land the scholarship or make the leap to the professional level. Making athletes more durable—less likely to get injured, means job security for the strength coach. So what have strength coaches discovered that leads to greater durability?
Over the years, I have asked this question of well over twenty strength coaches working with professional and collegiate athletes. Their answers have consistently been the same regardless of whether we were discussing swimmers or football players. Keeping injury rates low and athletes healthy revolves around coaching for these attributes.
Every coach stated that getting athletes stronger is their biggest concern. The stronger athlete is less likely to get injured. If they do get an injury, the problem is usually less severe and they are quicker to return to the playing field than a weaker athlete. Every coach echoed the refrain that strength training was essential for the female population to stay injury free.
The ability to easily travel in and out of basic patterns of human motion is proper movement. Proper movement is all about neuromuscular control—communication between the brain and the body. Can the athlete squat, lunge, hip hinge, push, pull, and rotate in a fluid and pain free manner? Are these patterns of motion automatic and are they maintained during a state of fatigue? Proper movement and flexibility are not the same. Lots of flexible athletes have horrible movement.
Stable in the Right Places
Some areas of the body are meant to move and some are supposed to stay stationary. Athletes are masters of adaptation. If they cannot get motion from one joint, they will find a way to use another part of their body to get to the job done. Most of the athletic overuse injuries happen when a segment of the body that is supposed to stay stable is forced into a motion it was not designed to perform. The basketball player’s knee that crashes into valgus when she jumps, the runner whose lower back sidebends with every stride, the volleyball player with a floppy forefoot all are examples of stability issues. Stability can be trained just like any other athletic skill.
Bodies change. Poor nutrition, lack of sleep, postural stress, soft tissue trauma and poor training habits can all produce performance limitations. You cannot evaluate the athlete or fitness client once and be done. Consistent ongoing evaluation of basic strength, movement patterns, and joint stability is crucial. The Functional Movement Screen (FMS) is the best place to start for most general fitness folks. See the trainers for an assessment and get your score. The results can get you started on what you really need to do.
Michael S. O’Hara, P.T., OCS, CSCS
DEATH OF A GOOD GOVERNMENT IDEA
Tobacco and Our Judicial System
I am rarely enthusiastic about anything that happens with our Congress, but in 2009, they passed a law that would require the addition of large graphics and text warnings about the harms caused by smoking. Somewhat disturbing pictures and more direct verbiage was supposed to cover the top half of every package of cigarettes beginning in September 2012.
However, in an act of judicial activism, this rare good government idea has been stopped. Federal District Court Judge Richard Leon has recently blocked the implementation of the new labeling plan. He feels the labels are “calculated to provoke the view to quit”—ah duh! He feels that this crosses the line. He feels the new labeling requirement violates the tobacco companies’ free speech rights. The judge has no concern for consumer protection, the cost of health care, or the fact that this product continues to enslave millions of Americans every day.
Tobacco companies have a problem. Their product kills a significant number of their customers every year. They need new addicts to replace the dead ones, so cigarettes are pedaled to the most easily influenced and impressionable of our country’s citizens. Almost everyone gets hooked on cigarettes when they are young and naïve. I have never heard of anyone starting the smoking habit once they get past 25 years of age.
Gran for gram, nicotine is the most addictive chemical on the planet. It provides more withdrawal discomfort for your money than opiates and amphetamines. The severity of the withdrawal symptoms keep people hooked on this poisonous product through a lifetime.
“Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.”—Mark Twain
No other consumer product adds more to the cost of health care than tobacco. Cancer, emphysema, and heart disease are all extremely expensive health care problems in this country. I can think of no greater cost saving tactic than reducing the use of tobacco products. If stronger warnings can produce a once percent reduction in the number of American smokers, they are well worth the alleged infringement on the poor tobacco companies’ freedom of speech.
Our government needs to make tobacco products more expensive and the gruesome consequences of smoking more evident. The federal tax on a pack of cigarettes is only $1.01 and the State of Michigan excise tax is $2.00. Increase both of these taxes by 100% and use that money for smoking cessation programs and the enormous burden smoking places on the US healthcare system. The courts need to overturn this judicial silliness and get those pictures and warnings on every package of cigarettes.
Michael S. O’Hara, P.T., OCS, CSCS
YOU, A BOSU, and WHEW!
A New Twist On An Old and Much Hated Exercise
I had a basketball coach who was a Burpee fanatic. You lost–Burpees, turn the ball over—Burpees, late for practice—Burpee Eternity. I hated doing Burpees, but I was never, ever tired in a practice or a game. I believe Burpee conditioning drills gave me the physical stamina and mental toughness to stay strong an entire game.
Fitness engineering has developed a new training tool and now we have the Bosu Burpee. A Bosu is an inflated half dome with a hard, flat bottom. It has handles on either side that you use when performing the Bosu Burpee.
The Bosu Burpee gets you moving from the ground up, at a quick pace with a strong core stabilization demand. Too many gym activities are seated, slow, and neurologically numbing. Neurologically and metabolically, we need to practice moving the entire body at faster speeds to stay fit. The Bosu Burpee is a total body conditioner that brings us up to speed.
Start with your hands on an inverted Bosu—bottom side up, in a push up position. Perform a push up with your chest touching the Bosu. Jump both feet up under the hips. Try to get your feet planted flat on the floor. Rise up from the floor and lift the Bosu overhead. Return the Bosu to the floor and repeat the movement from push up to overhead lift. Learn to do this movement slowly, and then once you have the motion “neurologically grooved”, pick up the pace. Bosu Burpees are a conditioning drill that should be performed at a fast pace. They work best if performed for set periods of time. Try starting with twenty second intervals and build up to 60 seconds.
Bosu Burpee Modifications
If you cannot do a push up or your arms give out way before the rest of the body, try performing the push up from the knees or keep the elbows fully extended and eliminate the push up portion of the exercise. As you practice this exercise, your arm strength will improve. If your middle sags and/or the Bosu wobbles, you need to dedicate more time to core stability training. Add some physioball roll outs, TRX fall outs, and front hovers to your exercise program.
Scoring the Bosu Burpee
Set a timer for sixty seconds and count how many Bosu Burpees you can perform. Remember you must start from the bottom and only full repetitions are counted. The best I have ever done is 18 repetitions. My middle gives out before my arms or legs—I need more core training. I believe this scoring system is a fair representation of Bosu Burpee performance.
Levels Men Women
Beginner 10 4
Intermediate 16 9
Advanced 22 14
Michael O’Hara, P.T., OCS, CSCS
CORE-TEX TRAINING PLATFORM
The New Tool In Our Training And Rehabilitation Toolbox
The latest addition to our rehabilitation and training toolbox is the Core-Tex. This thirty inch round platform floats on three roller bearings that permit it to tilt, translate, and rotate. The tri planar motion of the Core-Tex creates an ideal environment for us to work on retraining our patients’ balance, coordination, and proprioception. It can also be used to create challenging core and shoulder girdle stability activities.
One Stop Shopping For Better Proprioception, Balance, and Coordination
You can improve all three of these critical components of function with one or two Core-Tex activities. Beginners can use the handrail to create a more supportive environment, and as they improve, progress to reducing the assist from the arms. Integrating head movement, arm reaches, and weight shifts into the drills enables the clinician to design activities specific to the patient’s needs.
Keeping The Loads Level
The Core-Tex reveals any deficits in weight distribution. If the patient is unconsciously avoiding loading one side the body, the movement of the Core-Tex platform quickly reveals the flaw. The therapist can then prescribe training to increase tolerance of loading on the affected side and return for re-evaluation on the Core-Tex.
Tuning Up Your Righting Reflexes
Many of the sensors that keep our body in an upright position are located above the neck. I don’t care how strong or flexible you are, if these neural feedback systems do not work properly, you will not move well. Evaluating and improving the function of righting reflexes centers in the inner ear and the neck is a frequently neglected area of rehabilitation and fitness. Incorporating activities that involve moving the head and neck while standing on the unstable Core-Tex platform has proven to be very beneficial in patients with slow reflex response times.
Rotation In The Right Places
Being able to rotate through the thoracic spine and hips is an important aspect of optimal function and pain free existence. Many physical therapy patients have neck and shoulder pain driven by a lack of thoracic spine range of motion in rotation. Deficits in hip rotation produce undue wear and tear and eventually pain in the knees and lower back. The Core-Tex turns 360 degrees and allows us to teach transverse plane motions at the hips and thoracic spine in a fully functional upright, weight bearing position.
Michael S. O’Hara, P.T., OCS, CSCS