By James S. Fell, Special to the Los Angeles Times
February 27, 2012
On a recent ski trip, my best friend handed me a flask of cinnamon schnapps. He called it "courage in 100-proof form," and I needed it. I was perched at the edge of a cliff, looking at a 20-foot drop into thigh-deep powder.
Nearly a decade ago, when I was laid up in an emergency room with two bulging disks in my lower lumbar spine, there's no way I could have imagined myself attempting such foolish feats of middle-aged manliness.
I'm hardly alone in my lower lumbar woes. A 2009 study in Archives of Internal Medicine found that the prevalence of chronic, impairing low-back pain rose from 3.9% of adults in 1992 to 10.2% in 2006. And a 2006 study from the National Institute of Arthritis and Musculoskeletal and Skin Diseases says that lower-back pain is the No. 2 reason why Americans see a doctor, second only to the common cold.
If your employment involves heavy lifting and other physically demanding work, you can injure your back on the job. If you spend a lot of time sitting at a desk, like me, it's probably exercise that's to blame.
"It's the active folks who are getting low-back pain," said Stu McGill, a professor of spine biomechanics at the University of Waterloo in Ontario. "Couch potatoes never create the initial trauma."
That hardly seems fair.
McGill, who has helped Olympians and professional athletes get their backs back into shape, said the majority of low-back pain stems from the cumulative damage caused by bending forward at the waist. That motion causes the vertebrae toward the base of the spine to pinch together; if you're not careful about maintaining proper form, it can lead to problems like herniated disks.
To understand the mechanism, imagine your spinal disks as jelly doughnuts. They are there to provide a cushion between your vertebrae. When you bend forward at the waist, the front of the vertebrae get closer together and the back of the vertebrae to open up. If you use your back properly, the jelly doughnuts remain in place and do their job well. But if you're not careful — repeatedly bending improperly or making sharp twisting motions at the waist — one side of the doughnut gets squeezed and the jelly squirts out the other side.
Then the hating of life begins.
I have traced my initial trauma to a valiantly stupid attempt to impress my classmates in high school gym class. I tried to dead-lift too much weight, putting too much strain on my lower back, and the stage was set.
For years I continued to commit sins against my lower back. The pain grew worse, but instead of dealing with it I popped ibuprofen like Skittles. I've known many a gym-goer with an ibuprofen addiction.
When battling low-back pain, "most people think they just need to train harder," McGill told me. But that only makes it worse.
Eventually, there will be a final straw that breaks the camel's back, so to speak. In my case, it was having a coughing fit while hoisting a heavy laundry basket. The pressure on my lower back caused my disks to erupt, and I collapsed in a blubbering heap. I hadn't cried like that since they shot Old Yeller.
When you're ready to address the root problem, the first step is to do some detective work, McGill said: "Find out what is in the routine that is causing back pain and stop doing it."
"Pain is just a symptom, and we want to find the source," echoed Craig Liebenson, who spent four years as team chiropractor for the L.A. Clippers and is director of Los Angeles Sports and Spine.
Treatments vary depending on the nature of the back injury. I had the most common type: posterior disk bulges caused by repeated forward bending. Under the guidance of a knowledgeable physical therapist, exercises such as "sloppy push-ups" (in which the hips stay on the floor) helped push the disc goo back where it belonged. (Note that this won't work for everyone and might actually make things worse in some cases.)
I also needed to strengthen my core muscles. The core is like a guy-wire system that supports the spine so it won't buckle under pressure, McGill explained. It braces the vertebrae from the top of the rib cage down to the hip joints.
"Healthy core function helps to reduce back pain by providing a margin of error when lifting, bending or twisting," Liebenson told me. It also protects against being spastic. I recently slipped while running on ice and flailed wildly. In years past, this would have wrenched my back and landed me in bed for days; instead, I felt only minor stiffness that lasted for a few hours.
A strong core also helps enforce better lifting form. It helps you keep your lower back stable and properly aligned so the disks are safe.
Core strengthening is an active treatment. Some of my go-to exercises include careful full-body twisting movements against resistance — there is one I like called the "wood chop" — and a variety of planks, which are basically attempts at keeping the lower torso very stiff.
These active treatments require more effort than passive treatments such as chiropractic manipulation or massage therapy. Sure, manipulation or massage can play a short-term role by relaxing muscle tension, making it easier for you to move. But at the end of the day you've got to do some work, not just lie there and let someone else do it for you.
"The most important thing is showing people what to do for themselves," Liebenson said.
Poor hip flexibility can be another culprit of low back pain. If your hips don't move easily, you'll be inclined to bend at the waist, forcing the lower back to round outward and putting disks in jeopardy. Bad posture that rounds out the lower back can be another cause.
There is no magic-bullet exercise or one-size-fits-all solution here. Each back-pain sufferer must get "a thorough biomechanical examination to determine the chinks in their armor," Liebenson said.
I don't need the sloppy push-ups or painkillers anymore, but a variety of core strengthening exercises remain staples of my regimen. And that skiing cliff jump? I left a trail of skis, poles, gloves and goggles scattered to and fro.
But I was fine. My core took the punishment so my low back didn't have to.
Fell is a certified strength and conditioning specialist in Calgary, Canada.
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