No More Back Pain by Dr. Jolie Bookspan – Part 2

Back Exercises

This is part II of “No More Back Pain.” Part I explained how the majority of back pain comes from bad standing, sitting, lifting, and carrying habits. The relentless pull of bad mechanical use of your body during normal activities will eventually strain, tear, degenerate, and injure you in the same way that parts in your car that are rubbing, tilting, or not seating properly will cause early wear and tear. This is true even for pain from arthritis, curvatures, and bad discs. These conditions are worsened, even created by tight weak muscles and bad body mechanics. This is true no matter how many “back exercises” you do. That is why it’s so important to learn the concepts of good body mechanics, presented in Part I and not just “do exercises.” Doing back exercises a few times a week but not understanding the concepts, and keeping old, bad postures and habits that hurt in your back in the first place is like eating blocks of butter and ice cream morning, noon, and night, then doing your “exercises.” You are not balancing the harm.

Strengthening And Stretching Is Crucial But Not The Whole Answer
Tight, weak muscles are easily strained and fatigued during motions that in-shape muscles easily support. What most back exercise programs miss is that strengthening and stretching is crucial but not the whole answer.

Strengthening muscles through the usual back exercises will not automatically “give” you good posture or make you bend and lift properly. Strong muscles will not automatically “support” your body and joints, and will not magically prevent back pain. Plenty of muscular people have terrible posture and lifting habits, and the back pain that comes with it. Instead, you need to consciously learn to apply good body mechanics. If you used your muscles properly all the time to support your own body weight and the weight of your tanks and gear, you wouldn’t need to “do exercises” at the end of the day for your tired, sore, stiff back. Conventional back exercises follow, then some innovative exercises that are surprisingly effective to retrain you for real muscle use, posture, and back pain relief.

Healthy Exercises
Many people get panicky when they feel their muscles working hard; they aren’t used to it. Or they think something is wrong if they are sore the next day. Just the opposite. Your tight, weak muscles desperately need action. A vicious cycle develops of being so deconditioned, tight, and stiff so that you are uncomfortable with movement. Worse, you are so stiff that you are uncomfortable with proper posture.

Obviously you don’t want to do things that send pain or numbness down your leg. There are many exercises commonly done in gyms and fitness centers that are terrible for your back. Part III next month will cover bad exercises, bad stretches, and common daily things that divers do that harm their backs. That doesn’t mean you shouldn’t work your muscles hard. Without exercise, back muscles weaken and tighten. For health, you want to develop a stronger and more active body and lifestyle with exercise.

How do you specifically strengthen back muscles? You must contract them against a load. That does not mean “tighten” them, an outdated concept. Tight muscles are part of the problem. Most people will stretch their back but never exercise it by actually using (contracting) the muscles. Here are a few (of many) good back exercises:

Upper Back Extension (also good for your neck)
This exercise to contract your back muscles is common in most back strengthening and pain reduction programs. Lie facedown; hands at your sides and off the floor. Gently lift your upper body an inch from the floor. This is called back extension. Don’t force. Don’t tilt your head back, just keep your head in line with your body. If it is easy try a bit higher, without forcing. Then lower to the floor. If it’s too much try it again but lower, remembering not to force. Start with one or two lifts. Feel your back muscles working, but nothing should “pinch” or grind. See how you feel the next day. Gradually lift more and move your arms from your sides to overhead. Increase to at least ten every day.

Lower Back Extension. There are several ways to contract the muscles of your low back to work them:
– Lie face down, chin on hands. Lift one leg gently off the floor, knee straight. Hold and lower. Try a few. Switch legs. To progress, lift both legs together, smoothly, without yanking. This exercise works your back, hip, behind, and the back of your thighs.

– Another easy one is to lie on your back, both knees bent with feet on the floor. Lift your hips gently, hold ten seconds, then lower. Work up to at least ten repetitions. To progress, do this with one ankle crossed over the opposite knee, or hold one foot off the floor. This works your back, abs, and legs.

– Kneel on all fours on a soft mat. Tuck your hips under as if you were starting a crunch, to take the arch out of your back. You will feel your abs working. Do not tighten or “suck in.” Just use your muscles to move your back into good posture, like using any other muscles. Raise one leg until it is straight behind you. Don’t let your back arch, do the work with your hip and legs. As you progress, lift your opposite arm in front of you at the same time you lift one leg. Hold and repeat. This is a very mild exercise and you can soon progress to exercises that better simulate using your muscles in daily life against gravity to keep good posture. Following are a few.

Surprising But Important Back Exercises
The exercises above are mainstays of physical therapy programs for the back. But remember that strengthening will not automatically change your posture, and these exercises don’t teach you how to move in real life. You need exercises that specifically retrain you how to hold good posture without arching or slumping no matter what load you put on them. Moving your muscles in a way that is like your real life is called “functional” exercise:

– Holding a proper push-up position is surprisingly effective for your back and posture. How is this functional? It teaches you how to hold your body straight without arching or hunching, even against a high load. This simulates tanks and gear pulling on you while you carry them and uses a lot of back and abdominal posture muscle stabilization to counter it.

Assume a push-up position. Tuck your hips under you, as if starting a crunch to take the arch out of your back, but without curling forward. When you do this, you will immediately feel your weight come off your back, and a big exercise for your abs. Prevent your back from dipping into an arch or your behind from hiking upward. That is the same bad posture while standing up that presses your weight onto your low back and makes it hurt in the first place. Keep your elbows slightly bent. If your arms are so weak that you lock out the elbows, strengthen them, but don’t use that an excuse to hurt your elbow joints next.

– Another functional exercise strengthens your entire torso and retrain you to keep your posture from slouching to the side during activities: When holding your straight, hip-tucked pushup position above, lift one arm and turn your body so you are standing on one arm and the side of your feet. Hold your posture straight and strong. Don’t let your hips sag. As you improve, try dipping your hip toward the floor and raising again to straight posture. Increase the length and number of repetitions. Do both sides. As you strengthen further and improve your balance through this exercise (also important for preventing injuries) begin to lift your upper leg from the floor too.

– Do Back Exercises Standing Up. You need to exercise your back the way you use it in real life–isometrically and standing up so that you retrain how to stabilize against gravity and loads. Tie the middle of a long rubber tube around a doorknob, post, railing, friend, or other device at around shoulder height. Hold both ends in front of you and stand far enough back to create a good pull. Pull both your arms straight down to your sides without leaning back or arching. Hold. Repeat. If you consciously hold proper posture while doing this, you strengthen and retrain all your torso-stabilizing muscles. Now with both arms still straight, lift both arms up overhead without arching your back or leaning back, to retrain how to carry loads with good posture. Repeat. Keep breathing.

The whole idea is to retrain you to use good postural mechanics during motion. Turn to the side and use the same concepts to customize your own exercises to strengthen your back to hold strong and steady during movements you commonly do.

Abdominal Exercises. A common, but unproductive mind-set is to exercise your abdominal muscle separately from the rest of your body. The exercises above will use your abs effectively in conjunction with your back muscles in just the way you need for real life. The October issue of Alert Diver featured abdominal muscles and how to use them for your real life. Next month Part III will detail ab exercises to avoid.

Fix Your Own Pain
Most back and neck pain comes from daily bad sitting, standing, and bending postures, holding muscles tightly, and not enough of the right exercise. The average person does so many things every day to damage their back and neck, it’s only amazing they don’t hurt more.

Take a look at Part III for the surprising ways you may be sabotaging your back with bad diving and exercise habits, and what to do instead to keep your life pain free.

Chinese politician Sun Yet-Sen said, “To understand is hard. Once one understand, action is easy.” Good muscle support for your joints comes not only from strengthening and stretching but reeducating your body for proper use, not by stopping your activities and “resting it” or “doing exercises.” You’ll burn calories when you move properly and get great exercise without going to a gym. You’ll be straighter and taller. You’ll be a better diver. Have an active life to help your back.



Ernest S. Campbell, M.D., FACS

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