by Dr. Brian S. Seaman, DC, FCCSS(C), FICC

As another year goes by, there is the inevitable increased focus on fitness as our thoughts turn to "getting back into shape"!

There are many components to any fitness program – strength, flexibility and cardiovascular ("cardio"). The benefits of fitness and being "in shape" are well known and also include an increased level of energy and stress reduction.

One area which is often overlooked is fitness of your back. We don’t see our backs yet it is well known that 80% of us will suffer a significant episode of lower back pain at some time during our lives. Patients usually only ask their health care professionals about their backs, after they have had an episode of back pain. It is quite simple really – being that we don’t see it (our backs) – we often forget about it – until it causes pain!

Caring for your back, is somewhat like caring for your teeth. In between your dental check-ups, you brush, floss and rinse, to decrease the possibility of cavities and gum disease. The same analogy can apply to your back. Exercising your back using a variety of stretching and strengthening exercises, as well as ensuring that a proper balance of the muscles is maintained, reduces the possibility of back pain.

Unfortunately, most people’s interest in their back exercise program is directly proportional to the amount of pain which you are experiencing. Research has shown that only 20% of patients continue with their exercise program after six months.

However, it is important that you give this careful consideration and I can assure you that the effort that you put into developing and maintaining a good back exercise program, will pay you benefits. It is important to ensure that the various components of your exercise program are in place. As I mentioned earlier, this would include stretching, strengthening movements, and ensuring there is a proper balance between the various muscle groups.

Stretching exercises enhance the flexibility of our muscle groups. By doing so, it improves your range of movement, and can reduce the possibility of having muscle "strains". As an aside, this differs from a "sprain" which is a stretching type injury to a ligament or joint capsule. Currently there is debate within the health field, as to the benefit of stretching. However, from a personal perspective, the benefits of ensuring that there is a stretching component to your back exercise program, is very important. There can also be some very practical considerations to this as we do tend to lose a certain degree of flexibility as we get older.

Strengthening is also very important for the health of our backs. There are a number of ways of doing this including basic floor exercises which can be done at home, incorporation of stability ball exercises to increase core muscle strength, and a variety of resistance training which can include hand weights, tubing, or specific machines.

An important component of back fitness, is the concept of balance. Most people think of balance as our coordination, or ability to maintain our balance such as when standing on one foot. However, ensuring that there is a proper balance of strength, and flexibility, between various muscle groups is important. For instance, back problems can also develop as a result of a combination of weak abdominal muscles (your stomach), tight back muscles (the paraspinals or large muscles which run down either side of the spine) and dominant hip flexors (for instance your psoas which brings your knee up to your chest). This combination causes the lower back to adopt a more lordotic posture. A hyperlordosis or "sway back" can increase the strain and compression on the posterior joints or facets, of the spine. These small joints can become restricted or hypomobile as a result of this. This in turn can lead to what is referred to as mechanical type back pain. Mechanical type back pain accounts for upwards of 90% or more of back pain cases. Most people think of "slipped discs" (they don’t actually slip) and "pinched nerves" as the primary causes of lower back pain. Actually this is not the case. Mechanical type back pain is often very successfully treated with a variety of conservative approaches (such as manipulation and exercise) which you should discuss with your health care professional.

Exercises can also obviously benefit your cardiovascular health by strengthening your heart and improving your lung function.

As we get older, exercise becomes very important for the health of our "back bones", specifically the bone density of our vertebrae.
It is well known that weight bearing exercises such as walking, running and resistance training, enhances the density of our bones. In other words it helps to battle what is often referred to by patients these days as "osteo".

Years ago, "osteo" was only used by individuals referring to "osteoarthritis". However osteoporosis has become much more well known, and is a very important factor with our health, especially with women, as you grow older. Osteoporosis can create a lot of problems in menopausal women. Be sure to talk about your health care professional about this. A bone density study may be indicated to establish your level of bone density, and determine if additional approaches are needed such as:Increased focus or modification of your exercise program or activities.Pharmacotherapy or medication prescribed by your family physician (ie. Fosamax, Didrical, Actonel).Calcium supplementation with Vitamin D.

Exercise can be a valuable means of preventing, treating and managing back pain. Don’t ignore because you can’t see it
(the back that is)! Conservative treatment is often the best approach to back pain – surgery is seldom needed. If you experience back pain, stop the activity, ice the injured area and consult with your health care professional.

Ice is often the best choice – it helps to reduce the irritation and inflammation of the tissues (muscles, ligaments and joint
capsules) as well as the small spinal joints (facets). Think of a back injury like an ankle sprain – would you put a heating pad on an ankle sprain? Obviously not! As a general rule, icing 3-4x/daily, for 15-20 minutes is beneficial. Be sure not to leave the ice on too long as the body will shunt blood back to the injured area if it is left on for too long. However if your back pain is not responding, or getting worse, be sure to consult with your back care professional. If you develop leg pain, tingling or numbness, this could indicate a disc injury.

Be aware of how activity affects your back.
Remember to exercise the muscles that support your back.
Stretch, strengthen and balance your back muscles.
Use ice – not heat.
Don’t ignore back pain.

Your back is very important to your health. Don’t ignore it if it sends you a message – pay attention and look after it!
Remember – a healthy back is part of your overall health and well being. Take care of it!

Originally published in
Active Woman Canada, January 2003

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