Keeping Your Spine Stable

Did you get a users manual for your body? I have often wondered why there are so many misconceptions out there about how to maintain a healthy spine and what exercises need to be performed to protect your back and neck from injury. There is no shortage of advice out there, however, having the proper knowledge of what exercises and practices are good for your spine is crucial. As a PT, low back and neck pain are two of the most common symptoms I treat.

Throughout the month of December, my posts will focus on the spine and how to care for it; from the base of the skull to the pelvic girdle. This week I am focusing on low back pain.

Low back pain affects a large portion of the population and can be quite debilitating; likewise, low back pain is the leading contributor to missed work days. The intensity of low back pain and the level of debilitation it causes varies from minor to requiring immediate surgical intervention*. 80% of adults experience acute low back pain; of those who experience acute onset of low back pain, 20% will go on to develop chronic low back pain, that is pain that persists after 3 months of initial injury. [1] Many acute injuries causing low back pain last a few days to a few weeks and tend to resolve on there own [1]. So how do we prevent injury and manage low back pain?

A review of randomized research trials showed two areas essential to preventing low back pain: exercise and education. [2] A regular exercise routine is important to keeping your spine healthy. Regular exercise would include 150 minutes per week of cardiovascular exercise and 2-3 days week of resistance/strength training. Cardiovascular exercise is anything that gets your heart rate elevated, walking, running, biking, swimming, do something you enjoy but get that heart rate up (please see past posts dated 10/17 and 10/26 for more information on cardiovascular exercise). Resistance or strength training can vary depending on what you prefer, machines, pulleys, functional exercises, yoga or Pilates; the important point here is to incorporate your trunk or abdominal muscles. As a PT, I always stress the importance of stretching. If you are exercising, please stretch! If you are a “weekend warrior”, someone who rarely exercises but will go all out on a hike, run or play a pickup basketball game, you are at a higher risk of getting injured. [1] Maybe your back is hurting right now and you are wondering how do you exercise when your back hurts? Choose exercise that is gentle and low impact- recumbent bike, walking in a pool, water aerobics class, or a seated upper body bike. The point here is try moving, get your heart rate elevated!

Understanding your spine is important to avoid injuring yourself. Your spine consists of 24 individual vertebrae separated into 3 sections: the cervical spine, your neck, the thoracic spine, from the base of your neck to the bottom of your rib cage, and the lumbar spine, your low back. Your sacrum is the bone that your spine sits on and is nestled between your 2 pelvic bones, and comprised of 5 fused vertebrae; the coccyx is the small “tail bone” that extends off your sacrum. Vertebrae in your spine vary by size depending on the region; the cervical vertebrae are small while the lumbar are massive, the thoracic vertebrae vary in size as you transition down the spine, the ribs attach to the thoracic vertebrae. There is an inter-vertebral disc between each vertebrae consisting of collagenous material that provide cushioning and shock absorption. Another fact are the muscles of the spine are roughly 60% Type 1 fibres ; Type 1 fibres are called slow twitch and are “resistant to fatigue”. [3] Your back muscles are actually different fibres; they are meant to support in you sitting and standing; when you are sitting at your desk, your back muscles are still working. Our leg muscles are Type II fibres, fast twitch and designed for force production. This is why you have probably heard “lift with your legs, not your back”. Now that we have a little information about the anatomy of the spine, lets discuss posture. Posture can be the most important change you make to avoid low back pain. Prolonged sitting or standing should be avoided; take breaks when you can but while you are sitting or standing check your posture. Here are some tips on posture:

  • Sit upright in your chair with your head aligned over your shoulders

  • Your feet should be on the ground

  • Your knees should be at the same level of slightly lower than your hips

  • You should be sitting back in your chair

Standing for prolonged periods can be challenging. Make sure you are changing positions and take seated rests as able. Some tips for standing posture:

  • Make certain your shoes are comfortable and support your feet

  • Avoid leaning to one side or slouching forward with your belly

  • Avoid locking your knees

  • Try mini squats, toe raises or standing with wide stance and shifting your weight

Simply stated, maintaining the natural curvature in your spine will help to reduce back pain; any time we accentuate a curvature in our back, we will have pain. If you perform heavy work, a back brace will not protect you, you have to keep body mechanics in mind and be safe. If your job requires heavy lifting, use the proper lifting equipment or get help, if available. If your job requires you to perform repetitive tasks of getting up and down off the floor, make sure you use your legs and practice your squatting. Whether your job requires prolonged standing or sitting, make sure you take breaks and change position frequently.

So you have about 1 week to start evaluating your exercise routine and to start employing some tips on posture and repetitive activities to prevent back injuries. Next week we will discuss exercises for the lumbar spine and hips to take to the gym or perform in the comfort of your own home.

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*Back pain that needs immediate attention causes intractable pain, numbness, loss of motor function in one or both legs or loss of bowel and bladder function. If you experience these symptoms with low back pain, go to the emergency room immediately; these are signs of peripheral nerve damage or possible spinal cord injury.

[1] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

[2]Prevention of Low Back Pain: A Systematic Review and Meta-analysis. https://www.ncbi.nlm.nih.gov/pubmed/26752509

[3]https://www.jospt.org/doi/pdf/10.2519/jospt.1998.27.6.389

Nicole Skinner, PT