An interesting article the went up on ABC’s website yesterday:
I’ll take a quick look at the main points raised…
“If you’ve ever suffered from back pain, you’ll know how debilitating it can be.
It’s estimated one-in-six Australians suffer some form of back pain.
To make matters worse, it seems many of us are still being treated for back pain using outdated methods.
Bed rest, pain medication and surgery have been proven to be less effective and more risky than taking an active approach to recovery using gentle movement and gradual activity.
Now, the Australian Commission on Safety and Quality in Health Care has released a clinical care standard, which it hopes will become a road map for healthcare professionals in treating patients with back pain.”
So hinting that improving movement quality and building movement capacity is not a ground-braking observation, in fact those familiar with Dr. Andrew Lock will be aware of the relationship between back pain, a rest based approach and atrophy of the multifidus muscle leading to a more fragile back long-term.
“Joe Laurence’s experience of back pain is common to many Australians.
He works in emergency services and injured his back at work with a seemingly innocuous movement.
“I was pulling a hose over a fence and I just sort of felt a shooting pain go from my lower back,” he said.
“It went all the way down to my foot.”
Those familiar with the work of Prof. Stuart McGill will also be aware of his study conducted with the Pensacola Fire Department in Canada:
The main take away here is the importance of strength-endurance in the torso, rather than strength, or the ability to maintain posture during prolonged periods of duress.
It is very common for back injuries to occur while doing something seemingly innocuous, like pulling a hose in Joe’s case, that sets off a back pain episode.
What we must investigate here is the context of what happened…had Joe been on a job for for a few hours already when the injury occurred? If so, this would marry with McGill’s findings on the importance of strength-endurance and resilience to postural fatigue being more important that out-and-out strength.
“For the next three years, he was treated by doctors, physiotherapists and chiropractors.
They all promoted traditional forms of treatment, including bed rest, pain medication, modifying his lifting technique and wearing a back brace.”
“I really took that to a high level — I got super strong through my core because I thought that would help.
“I always braced before lifting anything, I always had a really good posture and yet things only got worse from there.”
Something VERY important to note here is him mentioning “bracing” before lifting. With ANY exercise technique, we MUST first assess the client thoroughly to see if that particular technique will actually help them or hinder them.
As a GENERAL rule learning to brace (remember we want to use it like a dial…not an “on/off” switch) is useful for most clients I see…BUT I do have clients where it either does not help, or even makes them feel worse (roughly 1 in 3 clients).
Sometimes this can be due to faulty technique, or due to end-plate damage in the spine itself…or maybe even because someone has a strong, active psoas muscle and weak glutes…so adding more compression the spine will make the problem worse, not better.
So do I force them to brace when moving? Absolutely not!
The point of a thorough initial assessment is to clearly identify the client’s pain triggers and aggravators…to set the rules of the game for them. If something makes them feel worse, we don’t use it. Simple.
We must focus on avoiding what makes them feel worse and then build an exercise plan on what makes them feel better and gets them back towards THEIR goals.
Some people need more flexion, most need less…some need way more extension…but some can feel way worse.
So how should we approach each and every back pained client?
“It depends” as McGill would say.
…AND remember exercises are just TOOLS, so pick the best ones to suit your goals and don’t make it weird.