Thursday, April 21, 2011

Low Back Pain - Numerous Causes

Iliotibial Band Tightness

Illiotibial band tightness creates an increased risk of lateral knee injury during knee extension activities. Iliotibial band friction syndrome (ITBFS) is a cause of diffuse tenderness over the lateral knee. While weight bearing during knee flexion, the Tensor Fascia Latae contracts to assist the other hip abductors stabilize the pelvis from lateral movement and the Gluteus Maximus extends the hip for forward locomotion. Both the Tensor Fascia Latae and the Gluteus Maximus can place tension on the Iliotibial tract which produces repetitive friction on the lateral epicondyle. Furthermore, hip abductors weakness can exasperate this pull on the Iliotibial tract by allowing the hip to sag slightly when standing on a single leg, or during locomotion (Fredericson, et. al. 2000).

Ankle Dorsiflexion Inflexibility

Dorsiflexion flexibility is required during the lower phases of the squat and leg press, so Ankle Dorsiflexion inflexibility can make it difficult to perform squat and leg press exercises in full range of motion. If the range of motion of the ankle is limited, hip flexion may be exaggerated and knee flexion is often inhibited. To maintain normal range of motion in both the hip and knee, the heel may have a tendency to leave the floor or platform.

Hip Flexor Inflexibility

Increased risk of lower back injury during hip flexion and extension and overhead standing activities. During extension activities, the lower back can hyperextend more than usual if the hip cannot fully extend. During hip flexion activities, the Iliopsoas can hyperextend spine during hip flexor activities. Risk is compounded when hip flexor inflexibility is combined with abdominal weakness.

Abdominal Weakness

Increased risk of lower back injury can occur during hip flexion, extension, stabilization and back extension activities. Erector Spinae muscles can hyperextend lower back more than usual if abdominal muscles are weak. The abdominal muscles tilt the pelvis forward, improving the mechanical positioning of the Erector Spinae, specifically when the lumbar spine becomes straight. When abdominal strength/endurance is not adequate to counter the pull of the antagonist Erector Spinae under load, these low back muscles are put at a mechanical disadvantage (active insufficiency) further placing additional stresses on these very same lower back muscles. Iliopsoas can pull on the spine during hip flexor activities if the abdominal muscles are weak. Risk is compounded when abdominal weakness is combined with hip flexor inflexibility.

Erector Spinae Weakness

Increased risk of lower back injury occurs during lumbar spine extension or stabilization activities. Back extension exercises involving complete lumbar spine range of motion have demonstrated primarily excellent or good results for those with chronic lower back pain. Excellent or good results by diagnosis: 76% Mechanical / Strain, 72% Degenerative, 78% Disc Syndrome, 75% Spondylo. In contrast, McGill condemns the use of isolated lumbar spine exercise apparatuses and argues erector spinae endurance is more important than strength.

Low Back Debate

McGill condemns the use of isolated lumbar spine machines claiming the compressive forces of these devices can cause disc herniation based on a pig spine model. Nelson recommends the use of these devices and has successfully used these devices to treat chronic low back pain. See Erector Spinae Weakness. McGill suggests certain exercises and movements that flex the spine through the full range of motion be should be eliminated although he admits several thousands of cycles under a load to full range of motion are required to produce disk herniations. It can be argued that potential injury would be prevalent in this situation not due to full range of motion, but rather due to overtraining or lack of progressive adaptation. Nelson explains the avoidance of full range of motion during exercise is a short term solution which promotes deconditioning and consequently deterioration of the joint structures. Eric Serrano, MD, ( medical advisor) suggests these machines can be useful in the early stages of rehabilitation. Dr. Serrano prescribes more functional movements as the patient progresses, introducing transverse / multiple plane exercises in the later stages, particularly with athletes. Also see adaptation criteria and Dr. Nelson's audio interview.

McGill Stuart (2002), Low Back Disorders, pg 55.
Nelson, B.W., O'Reilly, E., Miller, M., Hogan, M. Wegner, J.A., Kelly, C., (1995). The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1-year follow up. Orthopedics, 18(10), 971-981.
Nelson, B.W. (1993). A rational approach to the treatment of low back pain. J Musculoskel Med, 10(5), 67-82.

Walking & Low Back Health

Walking may benefit low back health by imposing a rotational torque on the spine at an estimated 8° of rotation. The vertebral disk undergoes this torque along with a slight degree of compressive force from the upper body weight and contraction of the trunk muscles. The torque is impressed on the annular fibers of the intervertebral disks enhancing their rigidity.
Cailliet M (1996). Low back Pain. Soft Tissue Pain and Disability, FA Davis Company Philadelphia. 3; 153-155.

Super Smoothies!

Peanut Butter and Banana Smoothie
Natural peanut butter lends texture to this hearty breakfast drink.
· 1/2 cup fat-free milk
· 1/2 cup fat-free plain yogurt
· 2 tbsp creamy natural unsalted peanut butter
· 1/4 very ripe banana
· 1 tbsp honey
· 4 ice cubes
Combine the milk, yogurt, peanut butter, banana, honey, and ice cubes in a blender.
Process until smooth. Pour into a tall glass and serve.

Nutritional Facts Per Serving:
Calories 410
Total Fat 16 grams
Saturated Fat 2 grams
Cholesterol 5 milligrams
Sodium 289 milligrams
Total Carbohydrate 50 grams
Dietary Fiber 3 grams
Protein 19 grams

Banana Berry Protein Shake
· 1 cup of berries (any mix)
· 1/2 banana
· 1/2 soy milk (or any kind of milk)
· 1 scoop any kind of protein powder (or if you don't have protein power add 1 egg white)
· 3/4 cup yogurt (your choice what kind)
· 1 cup ice

Add all ingredients to the blender and blend until smooth.

Nutritional Facts Per Serving:
Calories 274
Total Fat 0 grams
Saturated Fat 0 grams
Cholesterol 4 milligrams
Sodium 170 milligrams
Total Carbohydrate 58 grams
Dietary Fiber 7 grams
Sugars 18 grams
Protein 11 grams

Heart Healthy Snack Ideas

Deeply Colored "5-9 A Day" Snacks

It's hard to get in the recommended 5-9 servings of heart healthy fruits and vegetables a day

unless you eat snacks. Here are some ideas...

  • Small box of raisins + low fat string cheese
  • Grapes, dried apricots or dates + toasted almonds
  • Apple or orange + low fat string cheese
  • Pear or banana + whole grain snack bar (look for 3 or more grams fiber)
  • Sugar Snap Peas
  • Applesauce + toasted almonds
  • Red, Orange, Yellow Bell Pepper plain or with light dip
  • Mixed Green Salad with light dressing
  • Cherry Tomatoes
  • Coleslaw with green and red cabbage
  • Mango (fresh or frozen)
  • Pineapple (fresh, canned in juice or frozen)
  • Baby (or big) carrots
  • Celery stuffed with peanut butter or light cream cheese and raisins
  • Figs
  • Cubed watermelon, cantaloupe or other orange melon
  • Sugar free raspberry jello with canned pineapple or pears added
  • Low-sodium V-8 juice


"Success is about having, excellence is about being. Success is about having money and fame, but excellence is being the best you can be."

~Mike Ditka~

"Every game is an opportunity to measure yourself against your own potential."

~Bud Wilkinson~

"There are only two options regarding commitment; you're either in or you're out. There's no such thing as life in-between."

~Pat Riley~

"The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather in a lack of will."

~Vincent T. Lombardi~

"Pain is nothing compared to what it feels like to quit."

~Author Unknown~