Health Tip of the Week: Back pain, "functional" exercise, and lifting things up and putting them down.

DISCLAIMER: THIS BLOG ENTRY IS LONG. Instead of one simple health tip, this blog contains a few health tips as well as a lot of practical information, all presented in a user-friendly manner (I even make fun of science mumbo-jumbo talk a little bit).  Later in the week I will post a much condensed version of this blog that is more in line with my traditional, shorter Health Tip of the Week posts.

I've gone through a lot of changes in life since my last blog entry. I never did get to post my experiences at the USATF championships, but I'll get around to that eventually. Back to the changes though. Since June, I have finished my thesis, successfully defended it, and gotten it approved for printing and binding. I have obtained 2 part-time jobs, as a sports performance coach at a national sports performance franchise, and as an exercise trainer for spinal cord injury patients. I also moved to my own place, and for the first time in my life, had to pick up and move EVERYTHING I had to my own place to live independently. Two weekends of non-stop picking up boxes, walking up and down stairs, twisting while walking over other boxes with them, and finally putting the boxes back down at a different height or angle from which I picked it up took it's toll on my back. It is this move that has prompted this blog entry.

BACK PAIN
Almost everyone has experienced lower back pain at some point in their lives. What exactly causes it? What is a "bad back"? There is actually no one answer. The spine is made up

of 24 individual bones called vertebrae, not including the vertebrae that are fused together in the sacrum and coccyx (the green and purple bones in the picture.) All of the vertebrae are connected by intervtebral discs, which provide some padding between the bones. The vertebrae house the spinal column, which through nerve endings that run in and out of the spine at various locations, sends signals between the brain and the rest of the body for movement, sensory, and lots of other information. The vertebrae are also held in place and controlled by many different thin, long muscles that run up and down the spinal column. Long story short, the spine has many parts, and is very complex.

It is due to this immense complexity that it is very hard to diagnose the exact cause of back pain, as well as to figure out exactly what to do to alleviate it when you have it. For most of us, it just comes and goes without warning, and we just live with it. The spine is so complex, in fact, that the National Strength and Conditioning Association classifies the spine as just one joint, not the multiple sets of joints it actually is (technically the space in between each individual vertebrae is one joint!)

One idea that is pretty widely accepted is that too much of anything is bad for the back and will cause pain. Think of the manual laborer that spends 5-6 days a week lifting things and walking around with them. Think if the waitress or bartender who spends hours at a time standing and or walking around quickly, twisting around obstacles to serve people their food. Think of the office worker who does nothing but sit, 8+ hours a day, 5 days a week. Many people in any of these populations often have back problems or complain of back pain, and the one thing they have in common is they do the same thing all day, every day, without ever changing their routine to loosen their back up or let it do something different.

For example, a study was done on power plant safety inspectors. The majority of their job is literally sitting in front of a big set of dials and monitors all day, making sure that everything in the plant is normal. As this is the case, many of them have some level of back pain. One group of inspectors continued to sit at their stations all day. The other group alternated sitting for 10 minutes with pedaling on an exercise bike for 10 minutes throughout the day. They could pedal at whatever pace they wanted, so it didn't have to be vigorous exercise, but they were still moving instead of sitting stationary the whole day. After a few weeks, the group who alternated sitting with an exercise bike throughout the day reported much lower levels of/no back pain at all when compared to the group that just sat in a chair all day. Hence the notion, too much of anything is bad for your back.

There are other things that can alleviate or prevent back pain, such as being more flexible or maintaining a healthy weight.  I will go into another way of preventing back pain later in the blog.  For now, on to the next topic...

"FUNCTIONAL" EXERCISE
"Functional" exercise or "functional" training are big buzzwords around the fitness industry lately.  The annoying thing about this is that you can ask 10 personal trainers or strength coaches what "functional" training is, and you're likely to get 10 different answers.  There is no one answer to what exactly "functional" training is, or what it entails.

According to dictionary.com, "Functional" means "capable of operating...;having a utilitarian purpose".  The same web site provides the World English Dictionary's definition as "practical rather than decorative; utilitarian".  So, basically, "functional" exercises should be ones that serve a purpose, and are practical in application to the real world, or in the case of athletes, to their sport.  Lets do a random youtube search for "fuctional training" and "functional exercise"...

When in the real world or in what sport are our feet ever suspended while our hands are on the ground?  How does this improve our ability to walk with a wheelbarrow, lean over a counter to pick something up, or hit a baseball further?

What is the "function" of this workout?  Simply using full body exercises to raise the guy's heart rate?  Why are these exercises better than any others?  And for the record, the "clean and press" he is doing at 0:48 in the video is NOT a clean.  And at 0:57, you can hear the trainer say "those are good, nice flat back posture."  REALLY??? His back is clearly as rounded as it can get.  Does flexing the spine to that degree while trying to pick something up off the ground serve a function?

Name to me a sport where we move in this slow and controlled of a manner.  Name to me a situation in real life when we need to hold something all the way over our head with one hand and lunge across a room that we could just as easily walk through.  Yeah, I can't name that sport, or that situation in real life.

I'm not saying these are not good exercises.  I'm not saying they won't get your heart rate up or give a good workout.  I'm not saying that they aren't a good way to keep workouts interesting and introduce some variety for you or your clients.  These clearly are exercises that can give you a good workout and can be fun and challenging.  But what is practical about them?  To what sports or ADLs (activities of daily living) do they apply?  How are any of these exercises functional?

If a "functional" exercise is one that serves a purpose, and is practical in application to the real world or a sport, let me show you the two most functional exercises anyone can possibly do...  

LIFTING THINGS UP AND PUTTING THEM DOWN

This is a sumo deadlift. Ever picked something up off the ground before?  I thought so.  How about something that was so wide you had to straddle it with your feet then reach down inbetween your knees to pick it up?  Well, guess what this exercise simulates?  In addition, because the feet are against solid ground and the hands are fixed, this is a "closed kinetic chain" exercise, which is fancy science talk for "this exercise will help all the muscles in your body learn to work together, so that moving heavy things is easier. 

I don't know if there's an actual name for this exercise, so we'll just call it the stone carry.  Ever picked up something heavy, then had to walk around with it?  Like, say, when you were moving (remember how I said it was my own move that prompted this blog entry)?  How about just moving furniture or something else heavy around your house?  Remember how I said the sumo deadlift is a closed kinetic chain activity?  Well, so is the stone carry - carry something heavy, and all your muscles need to figure out how to work together in order to get the task done. 

So how does it apply to athletes?  Well, I'll admit, I don't think sumo deadlifting or stone carrying has a direct correlation to how well you can tackle somebody or how often you can make a free throw.  But remember, through some fancy nervous system organization, closed kinetic chain activites teach all muscles in your body to work together.  By teaching all your muscles to work together in one movement, it can be easier to teach your muscles to work together when doing another movement.  If your muscles can learn how to work together to pick up a heavy barbell, they can easily learn how to work together to throw a baseball, throw a football, do a backflip, throw a discus, cradle a lacrosse ball, handle moguls, etc.

Don't let the musclehead appearance of the guys in the videos fool you. Yes, I really do think these exercises have more real world application and can help athletes - dare I say, they are more functional - than hanging off a wall while doing squats on an unstable surface. 

SUMMING IT ALL UP

So, if these are practical exercises that relate to the real world, what do they have to do with back pain?  Well, like pretty much any exercise, if you do them improperly, they can hurt you, but if you do them right, they will make you stronger, and be good for you. So lets go over the important technical points of lifting things up, then putting them down.  Watch the videos and you will see one or both of the guys do all the below points very well.

    -Start with the object close to your body.  Notice how the deadlifter starts with the bar right up against his shins?  Notice how Mark Wechter braces the stone against his shins, then pulls it into his chest before even lifting?  The closer an object is to your body, the less distance you have to lift it, and therefore, the less work you have to do.  The less work your do, the easier it will be on your muscles and joints.  Which brings me to my next point...

    -Keep the object close to your Center of Mass (CoM). I know, more science talk.  Bear with me - your CoM is where all the mass in your body is balanced and evenly distributed.  For most people, their CoM is right around their belly button.  Watch the first few seconds of Mark Wechter carrying the stone as he's walking towards the camera.  He isn't carrying the stone out away from his body, and he is also not letting his arms hang down long and relaxed either.  His arms are bent so he can carry the object close to his body, and if I had to guess, it looks to be just a few inches above his CoM.  By keeping the object close to the balance point of his own body, he can carry the object around easily with a decent amount of balance and stability, despite its massive weight.

    -Keep your upper body as upright as possible.  By keeping your upper body upright,

you minimize the shear forces on your back, which it cannot stand nearly as well as compressive forces.  Take a look at the picture to the side.  Remember the intervertebral discs I was talking about that connect and cushion each individual vertebrae?  Well, they handle compressive forces (represented by red arrows), which is when one vertebrae is pushed down on another, quite well.  Shear forces (represented by green arrows), however, occur when one vertebrae is pushed or pulled horizontally in the opposite direction of another vertebrae.  Many back injuries result from shear forces, much more so than compressive forces.  The closer to horizontal your upper body is, the more subject it is to shear forces.  Twisting of the spine can subject it to shear forces too.  So, to minimize shear forces on your back, thus minimizing your risk of injury, keep your upper body as upright as possible when picking something up, just as our powerlifter friend does in the sumo deadlift video.  And if you successfully keep your upper body vertical, this allows you to do execute my final point successfully.

    -Lift with your hips and legs!  Notice how the power lifter's and Mark Wechter's feet are flat with the heels planted on the ground before they begin their respective lifts.  Notice how their hips push forward (toward the object they are lifting) and their knees extend as the weight goes up.  Notice how Wechter uses his legs to hold the object with a vertical upper body to get a better grip on the stone, before he pushes up with his legs again.  And finally, notice how Wechter keeps his upper body stable and square while turning around the corners with his entire body, rather than twisting his legs or upper body first.  The largest muscle groups in your body, your quadriceps, hamstrings, and gluteals, are all in your legs and hips.  Involve all of those muscles, and you won't have to use as many of those small muscles in your back.

So the moral of the story is, despite what some national chain gyms would have you believe, the best "functional" exercise for everyday people is in fact to lift things up and put them down, and to lift things up, walk with them, and put them down.  For athletes, the most "functional" way to train is to lift heavy things up, walk around with them, put them down, and practice your sport.