STOP THE PAIN!
Cheryl was satisfied with her workout. She benched her personal best, did a great set of bicep curls, then finished up with a hundred burning ab crunches. When Cheryl returned to work she bent over to pick up a pencil from the floor, and could not straighten her back up. The diagnosis: lumbar disk herniation.
It seems remarkable that so many people who work out so hard continue to suffer from disabling low back injuries. The good news is that your workout can protect you from lumbar disk injury. First let’s define our terms. Lumbar disk injury is a condition in which part or all of the soft, gelatinous portion of the intervertebral disk is forced through a weakened part of the disk, resulting in back pain and nerve root irritation. What does lumbar disk herniation look like? Let’s take a look. Figure 1 illustrates the anatomy of the lumbar spine. You may know it as “the small of the back.” It is comprised of five vertebral bodies separated by shock absorbing intervertebral disks (L1-L5). The disks are very much like chewing gum that has a soft liquid pocket in the center. The liquid center is called the nucleus of the disk. Chronic incorrect posture pushes the nucleus away from the center of the disk. As the nucleus moves backward, the outer portion of the disk will bulge to accommodate it. If the bulge becomes large enough to encroach on a nerve root, sharp shooting pain will result. The bulging of the disk is the herniation. Don’t be confused by the term “slipped disk,” there really is no such thing. The disk is sewn into the vertebral body above and below. It will not slip around like a hockey puck caught between two smooth surfaces. If the bulging disk is intact, conservative care, including rest, specific stretches and chiropractic adjustments, will be the treatment of choice. If the disk material is torn, or if the soft nucleus escapes from the disk, then surgery may be required.
So what can you do to prevent this injury? Take a look at your body profile in the mirror. Is the “small of your back” prominent? If so, you would be classified as “hyperlordotic” or “swaybacked.” That presents a set of issues that I will discuss in an upcoming article. If however, what you see in the mirror is a flattened “military spine,” then you are posturally at greater risk of experiencing a disk herniation. The flatter the low back curve (hypolordosis), the more weight-bearing stress is absorbed in the disks of your spine. Every time you bend forward to touch your toes (flexion) you push the nucleus of the disk backward toward the nerve root. This is a key concept of treatment and prevention. Flexion exercises push the disk in the wrong direction. They must be balanced with extension stretches and exercises (arching backwards) in order to prevent disk injury.
Let’s go back to our friend Cheryl. She was able to consistently bench press multiple plates yet was devastated by bending forward to pick up a pencil. Her workout routine did not incorporate extension stretching and strengthening exercises. An evaluation of her workout indicates that she repeatedly flexed her lumbar spine, causing the disk material to bulge backward. By the time she returned to the office, the flexion it took to pick up a pencil was enough to press the disk against a nerve root. Bending forward was the proverbial straw that broke the camel’s back. The injury had been set up by months of workouts that featured repeated flexion exercises. The numerous ab crunches involved repetitive lumbar flexion. Ab crunches are an essential part of any serious workout routine, but they must be balanced with extension exercises in order to keep the lumbar disks properly positioned.
There are many great extension exercises that can be added to your workout routine. Start with the stretches developed by Robyn McKenzie, P.T. Lay face down on a flat surface. Begin to arch the lumbar spine while pushing off of the ground with your arms. Try to lengthen your spine as you come upward. Be certain to keep your pelvis flat to the ground so that the lumbar spine is being stretched into extension. Once fully extended, hold for five seconds, then gently move back down to the starting position. Repeat the exercise ten times for a full set. Be certain to do at least three sets.
In order to strengthen the extensor muscles of the lumbar spine try “Superman Exercises.” There are many variations. While lying flat with your stomach down, raise your left arm and right leg up into the air. Hold that position for a count of five, then switch to the right arm and left leg. You should feel the extensor muscles of your back contracting and strengthening.
One final suggestion: Get your hands on one of those oversized physical therapy balls, they are great strength and flexibility tools. Sit on the ball until you feel comfortably balanced. Carefully use your legs to move forward while leaning further and further backward into an arched position on top of the ball. You should be face up and fully extended. Breathe deeply, allowing the contour of the ball to arch your low back comfortably. Hold for thirty-five seconds then slowly use your legs to return to the original seated position. Congratulations, you’ve just shown your lumbar disks much love. See you in the gym…
Originally posted 2017-01-11 20:35:49.