Patient Lifting Back Injury Prevention Tips

Facts on Lower Back Disc Pain

Low Back Pain Syndrome, or LBPS as it is known, is considered the most prominent form of injury in active adults. Chances are you know someone who suffers from LBPS, or perhaps you do yourself. In strength training, damage to the lower back comprises 44 to 50% of all injuries sustained, according to Science and Practice of Strength Training by Vladimir M. Zatsiorsky and William J. Kraemer. Therefore, it is essential to have an understanding of why LBPS is so common, how you prevent it from happening, and finally how you rehabilitate from it.

Background

It may come as a surprise to some, but heavy resistance training is a relatively safe activity. In fact, compared to tackle football, alpine skiing, baseball pitching, and even sprint running, strength training is almost free of risk, according to Science and Practice of Strength Training by Vladimir M. Zatsiorsky and William J. Kraemer. However, when people who are exercising with heavy weights neglect certain training rules, they then become susceptible to injury. The focus of the lifter should always initially be on the technique being employed during a lift. If improper technique exists, then the load must be lightened. According to world bench press champion George Halbert, The most important aspect one can learn to [safely] improve strength is to learn proper technique, from The Naked Warrior by Pavel Tsatsouline.

Features

In order to understand why the lower back becomes susceptible to injury, it is first necessary to understand how this happens. The spinal column is comprised of intervertebral discs, which are fibrous rings, much like sacks, with a jellylike nucleus. These discs connect the vertebrae acting as shock absorbers, as in a car. In young persons the nucleus contains up to 85% water; as we age that number gradually decreases, according to Science and Practice of Strength Training by Vladimir M. Zatsiorsky and William J. Kraemer. This in part explains why people over the age of 50 are more susceptible to bulging discs. However, the strength of the discs during a vertical load is sufficient. In fact, a strictly vertical load on the spine is very uncommon, given the natural curvature of the spinal column.

The Facts

Research has shown that both trunk bending and rotation cause the most trauma to the discs. These two positions can increase hydrostatic pressure within the discs by up to 4 to 5 times the average pressure on a vertical load, according to Science and Practice of Strength Training by Vladimir M. Zatsiorsky and William J. Kraemer. Additionally, these horizontal positions need not even require heavy weights.

Causes

Despite such factors as metabolic abnormalities, infections, and genetic predisposition, the two most common reasons the lower back becomes susceptible to injury are: 1) Many people unknowingly perform exercises or movements with poor technique and 2) Inefficiency in motor control when the muscles that stabilize the trunk activate later than necessary.

Prevention/Solution

As a professional trainer, the number one rule my clients follow when performing trunk-bending exercises (i.e. squats and deadlifts) is that if your upper body leans forward, then it follows that your lower body must go backward. Otherwise there could be overwhelming pressure on the discs, as when the back is rounded. The second most important rule of lifting is intra-abdominal pressure (IAP). We know that many athletes involved in lumbar-intensive activities, such as weightlifting and rowing, never experience LBPS. This clearly demonstrates how the pressure applied within the abdominal cavity during lifts acts as an internal weightlifting belt and supports the spinal column. In fact, as a result of IAP, the pressure on intervertebral discs can be reduced by up to 20% on average and up to 40% in extreme cases, according to Science and Practice of Strength Training by Vladimir M. Zatsiorsky and William J. Kraemer. The third rule of lifting is core strengthening, or creating a muscular corset around the lumbar region. The muscles that comprise the core must be balanced to allow the spine to bear large loads and keep upright. According to Stuart McGill, a highly regarded professor of spine biomechanics at the University of Waterloo in Canada and a back-pain clinician, If you concentrate on strengthening only one set of muscles within the core, you can destabilize your spine by pulling it out of alignment, from The New York Times by Gretchen Reynolds. The major core muscles include the rectus abdominis (abdominal wall), oblique abdominis (sides), spine erectors, and epaxial muscles (deep muscles of the back). Think of the muscular corset as guy wires supporting a flagpole. When the wires are tight and balanced, the flag pole is strong and stable. Lastly, flexibility must be present namely stretching the hip flexors. Tight hip flexors illicit an anterior pelvic tilt, which in turn puts pressure on the lumbar region.

Rehabilitation

If you find yourself in need of rehabilitation from intervertebral disc compression due to lifting, the recommended measures are massage and swimming in warm water (~ 30 (C), according to Science and Practice of Strength Training by Vladimir M. Zatsiorsky and William J. Kraemer. An alternative to swimming is a whirlpool bath. As the load falling on the discs is greatly reduced, disc hydration increases.

Resources

http://www.spine-health.com/wellness/exercise/avoid-back-injury-right-lifting-techniqueshttp://www.backfitpro.com/References

Science and Practice of Strength Training; Vladimir M. Zatsiorsky, William J. Kraemer; 2006

The Naked Warrior; Pavel Tsatsouline; 2004

The New York Times; Core Myths; Gretchen Reynolds; June 18, 2009