Following up on our last post, we thought it would be a good idea to talk about how training your core to gain enhanced stability is also critical for those of you out there with lower back pain.
Over the 12 years that I have worked as a personal trainer, my niche tended to gravitate towards clients with injuries. Most of them had been in motor vehicle accidents, so I dealt with a lot of sore necks, shoulders, and of course, lower backs.
While I can fully admit my degree did not focus on working with any types of injuries, I was lucky enough to have a professor that introduced me to information produced by an internationally recognized low back specialist by the name of Professor Stuart McGill.
He authored several best selling books to guide people out of back pain called Low Back Disorders, Ultimate Back Fitness and Performance, and more recently Back Mechanic.
He has spent over 30 years investigating the risk and reward of different exercises to enhance back resilience and performance.
If you ever hear or read that sit-ups, crunches and all their variations are not the best choice for your lower back, it stems from the research completed by Stuart McGill. He’s worth a google, but for now, let’s see if I can give the short version, and help teach you some simple core exercises for lower back pain.
Your Spine is like a Credit Card
I bet I got your attention with that heading! Let me explain what I mean.
One of the theories that Dr. McGill tested was that repeated bending of the spine (flexing/extending) can lead to herniated discs (slipped discs, disc bulges, you have probably heard of one of these). But there are several parts to the story – for example simply bending the spine with no load is usually not an issue. However, if the spine is under load while bending this can cause issues – depending on the pain history of the person. The discs are the squishy cartilage looking things that are between each of your vertebrae.
Notice the circled area, that’s what a herniated disc looks like
His observations on cadaver spines from people and animals, together with studying groups of physical workers, military, police and firefighters, suggested that repeated bending of the spine when under load can eventually lead to an injury to one of these little discs in your lower back.
The combinations of bending repetitions and the amount of load that lead to disc damage are specific to the individual such as size of the disc, age, training style and adaptations, etc. His work involved many studies to sort out these details. But one of the movements tested looked almost identical to a good old-fashioned abdominal crunch machine in a gym….. AHHHHHHH!!!!
So this brings me back to my heading, your spine like a credit card, in that if you keep bending it, it will crack.
To be more specific, Professor McGills work showed the disc is more like an adaptable fabric where the fibres that make up the disc can delaminate (split into thin layers) allowing the gel nucleus in the middle to seep through the annulus and create the bulge.
Note in (A): The lighter pinkish disc nucleus is seeping through the annulus
Another way to look at this is comparing it to a jelly doughnut. If you place enough force on one part of the doughnut, the jelly will seep through.
I use this example with clients to help explain to them that repeatedly putting their spine through cycles of loaded flexing will eventually lead to problems. This could be from abdominal exercises that place undue stress on the lower back, from lifting with a flexed spine, or sitting with rounded posture (also producing a flexed spine).
You may find it interesting to learn that sitting pain usually occurs after the disc has already been sensitized by inappropriate bending mechanics.
So how do we train the core if you have lower back issues?
You could start by reading our last post here, as those exercises could certainly help but we’d like to be a little more specific and focus on core awareness first.
Many people with lower back pain have a lack of awareness of their core muscles, as well as something Dr. McGill coined Gluteal Amnesia. That’s right, your butt stops working, leaving your lower back and hamstrings left to do the job of extending your hips, leading to more lower back troubles. We’ll touch more on this in a future post
Now is this the case for everyone? No, it’s not, but in general these are things Shelley and I have witnessed in our clients that experience lower back pain for various reasons.
So how do we gain awareness of our core?
Enter the Brace
The first thing that we need to work on with clients experiencing lower back pain, is how to appropriately ‘brace’ their core.
What do we mean by bracing? Have you ever stiffened up your tummy because your wife is about to punch you in the stomach for being, oh I don’t know, a man? Guess what my friend, you just braced your abdominals, or as I like to call it, you ‘Braced for Impact’.
Learning to brace is basically a tightening of the abdominal wall, so that you prevent any movement at the lumbar spine while you perform a task, like lifting, a push-up, or the aforementioned dart in the guts from your beautiful wife. Well that would be more to protect your internal organs (Shelley can punch pretty hard), but you get the idea.
I want to be clear that we are not talking about ‘sucking in your belly’ or what we call ‘drawing in’ in the fitness world. Drawing in activates just 1 core muscle known as your transverse abdominis.
This has it’s place at times, but a good solid brace engages the entire abdominal wall. It’s called an abdominal wall for a reason, walls are meant to withstand forces, not move around!
What’s very important to mention is that the brace is tuned to the task – not too much or too little – just the right amount to eliminate any pain and increase the ability of the spine to bear load. Some people can actually over brace which can create other issues. But more on this in the next section.
So how can you learn to brace properly? Try this simple technique:
- Stand up tall, or sit-up tall in your chair if you are sitting while you read this
- Take a deep breath in, preferably through your nose (hope you don’t have a cold)
- Begin to exhale through your mouth, but stop the flow of air as if you were trying to hold your breath (this is also called the Valsava Maneuver, more on this later)
- You should feel your abdominal wall tighten up. Way to go! You just braced!
- Now see if you can breathe yet maintain this stiffness in your core. This is the part that takes practice for some people, especially those that have experienced lower back issues
Notice the difference in the video between “drawing in” vs. “bracing” my abdominals. We want to brace.
By learning to brace appropriately, you now have a valuable tool to help you protect your lower back on a daily basis.
Levels of Bracing
You can gauge how much you should brace your core based on the activity you are doing. In the past, for clients, I have put levels of bracing on a scale of 1-10. This will take some practice, but overtime you will get the hang of it. Here is how it can work:
- Level 1-2: A very light tightening of the abdominal wall to help you sit up straight when working, or while you are walking around
- Level 3-4: Still a light brace, but a little more to help protect your spine when doing activities around the house like sweeping, mopping, cleaning, carrying a full laundry basket, and lifting your toddler.
- Level 5-6: A medium brace, requiring more awareness, for moderately heavy activities. This would be things like lifting boxes, lifting furniture to find missing action figures, shoveling snow (OHH CANADA!) and carrying a toddler on your hip (think about your suitcase holds!)
- Level 7-8: A heavy brace, used for the very core exercises I showed you in the previous post. You can breathe through it still, but it’s a little challenging. This type of bracing may also be used when you need to help your buddy carry in his new washer and dryer.
- Level 9-10: A maximal abdominal brace. This would really only be used in maximal effort lifts like squats, deadlifts, and bench presses. You would actually hold your breath to achieve this level of bracing.
The Valsava Maneuver
When I first heard this, I thought it was a new technique to help someone from choking, but I was wrong. The Valsava maneuver is what I just talked about above in a level 9-10 brace. It’s when your attempt to force air out of your lungs, but stop the flow of air when exhaling.
By doing this, you essentially force a reflexive brace of your abdominal wall. This can actually be an effective technique of protecting the spine when having to lift very heavy objects, like Shelley’s blush Kitchenaid Mixer, that thing is heavy!
I’m just kidding around, but this maneuver is used by strength athletes, and can be a great little tool to help you protect your back, when having to lift something heavy.
First of all I’m sorry. When I started this post I had full intention of getting into the actual core exercises we use with our clients that have lower back issues. I knew it was important to touch on bracing, but it turned into it’s own post. That should show you how important and helpful this little technique can be.
Try it out, and let us know what you think. In our next post, we will delve into the actual exercises we used to coach our clients with lower back pain. Stay tuned!
As always, we welcome comments and questions. Happy Bracing!
Rodney and Shelley
*It should be noted that the Bolded text within this post were contributions by Professor Stuart McGill himself*
McGill, S. (2017). Back mechanic: The Secrets to a Healthy Spine Your Doctor Isn’t Telling You. Gravenhurst, Ontario: Backfitpro.
McGill, S. (2017). Ultimate Back Fitness and Performance. Gravenhurst, Ontario: Backfitpro.
McGill, S. (2016). Low Back Disorders Evidence-Based Prevention and Rehabilitation. Champaign: Human Kinetics.