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Posted by David LaPorte
In Reply to: The McKenzie 7 Step Method posted by Josh Steinberg (MD), Syracuse
I wrote this a few years ago and had a couple of physicians tell me that
it wasn't idiotic. Anyway, it works for me.
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I'm not a medical expert, but I've had my share of low back pain and I've
learned a few things. When in doubt, go see a medical professional.
Low back pain is one of the most common problems afflicting humans. It's
been estimated that about 80% of these problems arise because of poor
posture. These posture problems occur when we stand but are even more
significant when we sit or ride a bike. We tend to round up our low
backs, stressing the ligaments and tendons which lie along the spine. It
is the irritation and inflammation of these ligaments and tendons which
leads to most low back problems.
It is important to remember that back pain results from the sum total of
ALL the stresses your back experiences. Even if you only experience pain
when you're riding, poor riding posture may not be your only problem.
For example, you may be sitting poorly at a desk all day or lifting boxes
poorly.
**Low Back Pain and Posture**
Since posture is the problem, it is also the solution. Those of us who
suffer from low back pain need to be constantly vigilant. We need to
maintain some arch in our backs as much as possible.
Sitting is a particular problem. Most chairs, coaches, car seats, etc
provide little low back support. You can buy low-back support pads at
some drug stores. Try them before you buy them because they are not all
comfortable. Alternatively, you can fold a towel and put it behind your
low back. The key is to maintain some arch without being uncomfortable.
Position on the bike is also important. Get your bike fit checked at a
shop that you trust. You should also work on maintaining a flat back when
riding. One way to achieve this is to push your belly button toward the
top tube. Try to do this by rotating your hips rather than by contracting
your low back muscles.
***Stretching***
Stretching is an important way to achieve flexibility and improve your
posture. A very useful stretch is to place you hands on you butt and push
your hips forward while standing:
o
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you should feel this in the front of your hips. Tight hip flexors prevent
an upright posture. After a few seconds, arch your back and slide your
hands down the back of your thighs:
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/
This movement puts the arch in you low back. You can do this stretch many
times a day. It is particularly useful to do it periodically when you
have to sit or ride for an extended period of time.
A more potent stretch that can be done a couple of times a day starts
with you lying on your front. Using your arms, push your shoulders off
the floor. Don't lift with your back. Keep your low back as relaxed as
possible. Let your hips hang down, staying as close to the floor as
possible.
o
__/|
This is a powerful stretch and should be started gradually. Otherwise, it
can do more harm than good. However, done properly, it can be enormously
helpful. Over a period of weeks, you should gradually increase the height
you achieve and the time you hold the position. It is also less stressful
to do this stretch for short periods with a little rest than for a long
period (for example, 3 X 10 sec with 5 sec rest rather than for 30 sec
straight).
Once your back starts to heal, you will probably need to stretch it
deliberately. This is apparently because of the scar tissue that built up
during healing. Keep it gentle, especially at first. You could easily
reinjure your back. Here's a good one: lie on your back with your legs
straight. Pull your knees up, grasp your thighs by your hamstrings and
gently pull your knees to your chest.
Stretching the ham strings can also help relieve low back pain. Tight ham
strings tend to pull the pelvis out of line. This can stress your low
back. The problem with most ham string stretches is that they also tend
to stretch the low back by forcing it to round up. The most appropriate
stretch I know requires the use of a doorway. Lie in the doorway with
your butt near the wall. Gently slide your foot up the wall until you
feel the stretch.
doorway
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Two ways to make the stretch more gentle are (1) bend the lower leg,
keeping only your foot on the floor or (2) move your butt further away
from the wall. To make the stretch more intense, loop a cord or towel
over your raised foot and gently pull it away from the wall. As with all
stretches, this shouldn't hurt.
***Exercises***
Another key to preventing low back pain is to keep your abdominal muscles
strong. These muscles help support the back. Do abdominal crunchers, not
sit ups. Sit ups emphasize the hip flexors, not the abs, and can be hard
on the back. Crunchers are done by lying on your back with your knees
bent. Press your low back into the floor and curl your head and shoulders
off the floor. Hold for a couple of seconds, then lower back to the
floor. Repeat until you can't get your shoulder blades off the floor. Abs
can be worked every day.
Strengthening the low back muscles can also be helpful. To start, lie on
your front with your arms and legs extended in a straight line with your
body. Raise your right arm and left leg. Put them down and raise your
left arm and right leg. Put them down and continue. As your back strength
improves, try raising both arms and legs at the same time, arching your
back in a "reverse stomach crunch". There are, of course, more powerful
back exercises, but they are also more stressful and shouldn't be
considered until your back is 110%.
***Medication***
Antiinflamitory medication can be helpful. Ibuprofen, naproxin and
aspirin are all available without a prescription. Acetominophen (eg.
Tylanol) is NOT an antiinflamatory. These drugs are most effective if
they are taken early since inflamation is hard to get rid of once it's
become established.
A danger in antiinflamatory drugs is that they are also pain killers.
Pain is your body's way of telling you that your doing damage. If you
block the pain signals, you can easily aggravate your injury without
knowing it.
Muscle relaxants are sometime prescribed for back problems. These should
only be obtained from a physician.
***Ice, Heat and Massage***
Ice is a great way to reduce pain and inflamation. A good way to apply
ice is to freeze water in a paper cup. Peel the cup back to expose the
ice and then use the cup as a handle while gently rubbing the ice over
the effected area. Ice is particularly good for the first couple of days.
Some people find that it's useful to continue ice treatments beyond that.
Others find that the ice treatments make their backs tight if they
continue beyond a couple of days.
Heat, especially moist heat, can be useful. However, it should not be
used for a couple of days after injuring your back or after aggravating a
current injury. Regardless of the timing, if you feel worse during or
shortly after heat treatment, stop doing it.
In the later stages of a back problem, I find that my low back muscles
get tight. Gentle massage seems to help them relax, promoting the healing
process. I suspect that massage could make things worse in some cases,
such as when the injury is fresh.
***Book***
An excellent book on this subject is "Treat Your Own Back" by Robin
McKenzie, Spinal Publications Ltd., P.O. Box 93, Waikanae, New Zealand
ISBN 0-9597746-6-1. They use this book at the Low Back Center of the
University of Minnesota Hospital.
Good luck.
