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Preventing Pain and Maintaining Back Health
Who is affected by back pain?
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any people from different demographics are affected by back pain. Those affected include: physical laborers, office workers and the elderly. The majority (63% or higher) of people reporting chronic back pain are between 30 and 45 years of age. Data shows that as these individuals enter their 50’s and 60’s, there is a dramatic reduction in physical activity. For many seniors their back issue progress to become a hindrance to independent living.
This event publication was created for Team Building ROI by Silicon Valley Applied Biomechanics, Inc.
There are a number of factors that contribute to having back pain including: age, fitness level, diet, heredity, the presence of other diseases, cigarette smoking, and occupational risk factors.
Executive Producer: Ryan Rosoff Program Director: Jonathan Williams Designer/copyeditor: Elizabeth Nguyen ©2017. Published by Silicon Valley Applied Biomechanics, Inc. For fitness programs, classes and publications, visit us at www.svapplied biomechanics.org
Jonathan Williams is an Exercise and Fitness Specialist, Kinesiologist and Biomechanical Researcher. He is a Certified Personal Trainer and the COO of Silicon Valley Applied Biomechanics, Inc. Williams promotes health and well-being across a variety of demographics through the use of research-based methods. “The modern workplace is an interesting environment, where we see injuries related to a lack of functional movement combined with highly repetitive tasks on a daily basis. Our job is to promote a healthy lifestyle that allows people to handle the requirements of their job, and more importantly, enjoy their life outside of the workplace.” During our session we will discuss maintaining back health in the workplace, inflammation, nerve function, and at-home exercises. In the second half of our time together, we will demonstrate basic exercise techniques that help combat the effects of a sedentary workplace.
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Jobs that require heavy lifting, pushing or pulling, particularly when this involves twisting or bending of the spine can lead to injury if the person’s fitness level is not adequate. An inactive job or a desk job may also lead to or contribute to back pain. Whatever level of physical requirement your job has, it is important to be ready for those activities.
BACK PAIN BY THE NUMBERS
1 in 4 Americans report having back pain at least once a month.
1 in 7 Americans report lasting back pain that affects their quality of life.
63% of Americans between the ages of 30 and 45 years old report having chronic back pain.
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INJURY&INFLAMATION
Who is affected by back pain? Inflammation is the response of living tissue to injury. It involves a wellorganized cascade of fluid and cellular changes within living tissue. Causes of inflammation include viruses, bacteria, autoimmune diseases and physical trauma. Inflammation can be acute, lasting for several days, and can become chronic, lasting weeks or months. It is important to recognize what is causing the inflammation so that it can be treated properly. For most people experiencing back pain, there will be an acute response. This person may have experienced physical trauma (helping a friend move), and will recover relatively quickly in the next few days without needing drugs or medical attention. Lasting back pain, is often associated with chronic inflammation of the involved structures (muscles, connective tissues, and nerves). Repetitive-motion injuries are common in the modern workplace. This includes typing, lifting, sitting, standing, twist-
ing, carrying, and any motion performed in a repetitive manner. These injuries often go unreported because it is not always clear what is the cause of the injury. While many companies encourage people to report work-related injuries, they often look for a singular event that caused the pain, and may dismiss the symptoms if a cause is not identified. It is very important that the diagnosis of the injury be reported by a medical doctor. While acute injuries are more often reported and treated, it is important to address a repetitive injury as it can cause chronic inflammation. Once the inflammation sets in, it can often take an extended amount of time to address and often requires an absence from activities that are causing the injury. Chronic inflammation is associated with cardiovascular disease, diabetic complications, neurological disorders, cancer, metabolic disorder complications, bone muscular and skeletal diseases.
IDENTIFY AND TREAT Four characteristics:
Ways to reduce inflammation:
•Redness (rubor)
• Get regular sleep
•Swelling (tumor)
•Eat greens
•Heat (calor)
•Reduce processed food consumption
•Pain (dolor)
•Quit smoking
•Loss of function (funtio laesa)
•Reduce alcohol intake •Reduce stress levels •Engage in regular exercise TeamBuilding ROI Health
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SCAPULARMOVEMENTS
Upper back exercises and considerations
CLOCKWISE FROM LEFT: Scapular elevation involves bringing the shoulders up toward the ears, an example of scapular rotation, scapular retraction is performed by pinching the shoulders back and an example of shoulder disparity.
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he scapula are specialized bones located on the back of the body (dorsal side). They have a number of muscle attachment sites that allow for 4
a wide range of motions by the arms. They also sit on top of the brachial plexus as it moves from the neck through the trunk, into TeamBuilding ROI Health
the arm. For this reason, it is important to maintain range of motion and strength of the muscles associated with the scapula.
FROM LEFT: Scapular retraction (pinching the shoulders back) involves the rhomboids, scapular elevation (bringing the shoulders toward the ears) involves the trapezius.
Elevation / Depression These movements can be thought of as “up and down” and are associated with lifting objects. One of the muscle groups of interest is the trapezius.
Suggested corrective exercises
Retraction / Protraction
Mid row
These movements can be thought of as “forward and backward” and are associated with pushing or pulling.The muscle group involved in these movements are the rhomboids.
Chest press
Generally, people have scapula that are slightly elevated and protracted, or raised and slightly forward. This can cause pressure on the brachial plexus and it passes through the neck and into the arm. It is important to keep the associated muscles flexible and strengthened to avoid tension.
Back fly (Ts and Ys) Swimmer pull down
Plank Pose
Suggested corrective stretches Torso hang Ear to shoulder Yes / No Palm reach
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LOWERBACK Lower body and hip movements and considerations
When performing overhead squats, raise arms overhead and make sure the knees do not extend beyond the toes.
The lower back is considered to be the area from lower thoracic vertebrae to the sacrum. The sacral plexus and the sciatic nerve are two key structures when looking at causes of lower back pain. This area of the body is commonly reported to involve differed pain, or pain that may be caused in one area, and felt in another. The most common example of referred pain is inner thigh pain caused by sciatic nerve compression. There are several muscles to be considered when choosing corrective exercises which include the gluteal, hamstrings, hip flexors, and adductors.
Suggested corrective exercises
Suggested corrective stretches
Squats
Toe touch
Lunges
Back bend
Good mornings
Side bend
Windmills
Hamstring Stretch Hip flexor Stretch
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ANATOMICALREFERENCE Brain
Cervicle Plexius Brachial Plexius
Spinal Cord
Sacral Plexius Sciatic Nerve
Trapezius Deltoid Rhomboids (Deep) Tricep Latissimus Dorsi External Oblique Gluteals Adductor Magnus Hamstring Group
Gastrocnemius
Achilles Tendon
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EVENTRECAP
Putting It All Together Informational Background
Lower back
Dynamic stretches
•How many people affected •Common problems
•Review anatomy
•Knee tuck, straight leg kicks, over under, skips
Upper back •Review anatomy
•Lumbar area (lumbo-dorsal fascia, erector spinae, sciatic nerve, gluteal fold)
•Signs of dysfunction (tingly fingers, numbness, burning sensation, postural distress )
•Signs of dysfunction (uneasiness in seated position, numbness or burning in thigh area, overly tight hamstrings and spinal stabilizers)
•DEMO: Recommended corrective exercises / stretches
•DEMO: Recommended corrective exercises / stretches
•Wrist stretch, upper trap stretch, shoulder rotation
•Good mornings, squat, lunge and windmill
•Brachial Plexus / Neuropathy
•Putting it all together in 30 minute “workout”
To perform a mid-row, flatten the back and retract the scapula.
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•Laps in 4 directions •Basic warm up stretches / concepts •Upper back exercises (Ts and Ys, scapular push-ups, birddog) •Lower body exercises (Squats, lunges, good mornings)
CLOCKWISE FROM TOP: Knee hugs provide self-myofascia release, back twists help loosen the mid-back region, reach-throughs stretch the back and sides, cobra pose provides an intense back stretch, seated neck stretches and trapezius stretches help prevent tension in the upper back and neck.
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THIS PAGE:
CLOCKWISE FROM TOP: Child’s pose helps stretch out the upper back and relax the lower back, lumbar twists helps stretch out the psoas muscle group, cat pose is a spinal flexion that stretches out the lower back, cow pose is a spinal extension the relieves pressure from the hip flexors, and toe touches helps maintain back and hamstring flexibility.
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CLOCKWISE FROM TOP LEFT: Good mornings begin in a split stance, it is performed by hinging at the hip to stretch out the illiopsoas muscle group and the hamstrings, front squats helps to stregnthen the lower body, the knee should not extend beyond the toes during a lunge and should return back to neutral standing position.
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Find more exercises, stretches, modifications and information at www.svapplied biomechanics.org/blog TeamBuilding ROI Health
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GLOSSARYTERMINOLOGY Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to (1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; (2) stretch muscles of the back and hips; and (3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting and raising the trunk, each exercise performed while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine. Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion. Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that re-
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quires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the disks and actually do more harm than good. In addition, avoid highimpact activities if you have disk disease. Acute pain. The most common type of back pain. Acute pain often begins suddenly — after a fall or injury, for example — and lasts no longer than 6 weeks. Analgesics. Medications designed to relieve pain. Analgesics used for back pain include both prescription and over-the-counter products. Some are made to be taken orally, and others are rubbed onto the skin. Ankylosing spondylitis. A form of arthritis that affects the spine, the sacroiliac joints, and sometimes the hips and shoulders. In severe cases, the joints of the spine fuse and the spine becomes rigid. Cauda equina syndrome. A condition in which the nerves that control the bowels and bladder are pinched as they leave the spine. Unless treated promptly, the condition can lead to the loss of bowel or bladder function. Cervical spine. The upper portion of the spine closest to the skull. The cervical spine comprises seven vertebrae. Chronic pain. The least common type of back pain. Chronic pain may come about suddenly or gradually; it generally lasts for 3 months or longer. TeamBuilding ROI Health
Disk. A circular piece of cushioning tissue situated between each vertebrae of the spine. Each disk has a strong outer cover and a soft jelly-like filling. Diskectomy. The surgical removal of a herniated disk. A diskectomy can be performed in a number of different ways, such as through a large incision in the spine or through newer, less invasive procedures using magnifying microscopes, x rays, small tools, and lasers. Facet joints. The joints where the vertebrae of the spine connect to one another. Arthritis of the facet joints is believed to be an uncommon cause of back pain. Fibromyalgia. A condition of widespread muscle pain, fatigue, and tender points on the body. Fibromyalgia is one cause of low back pain. Herniated disk. A potentially painful problem in which the hard outer coating of the disk is damaged, allowing the disk’s jelly-like center to leak and cause irritation to adjacent nerves. Intradiskal electrothermal therapy (IDET). A treatment for herniated disks in which a wire is inserted into the disk through a small incision in the back. An electrical current is then passed through wire to modify and strengthen the collagen fibers that hold the disk together. Kyphoplasty. A procedure for vertebral fractures in which a balloon-like device is inserted into
the vertebra to help restore the height and shape of the spine and a cement-like substance is injected to repair and stabilize it. Laminectomy. The surgical removal of the lamina (the back of the spinal canal) and spurs inside the canal that are pressing on nerves within the canal. The procedure is a major surgery requiring a large incision and a hospital stay. Lumbar spine. The lower portion of the spine. The lumbar spine comprises five vertebrae. Osteoarthritis. A disease in which the cartilage that cushions the ends of the bones at the joints wears away, leading to pain, stiffness, and bony overgrowths, called spurs. It is the most common form of arthritis and becomes more likely with age. Osteoporosis. A condition in which the bones become porous and brittle and break easily. Rheumatoid arthritis. A disease
that occurs when the body’s immune system attacks the tissue that lines the joints, leading to joint pain, inflammation, instability, and misshapen joints. Sacroiliac joints. The joints where the spine and pelvis attach. The sacroiliac joints are often affected by types of arthritis referred to as spondyloarthropathies. Sciatica. Pain felt down the back and outer side of the thigh. The usual cause is a herniated disk, which is pressing on a nerve root. Scoliosis. A condition in which the spine curves to one side as a result of congenital malformations, neuromuscular disorders, injury, infection, or tumors. Spinal fusion. The surgical joining of two or more vertebrae together, usually with bone grafts and hardware. The resulting fused vertebrae are stable but immobile. Spinal fusion is used as a treatment for spondylolisthesis, scoliosis, herniated disks, and
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spinal stenosis. Spinal stenosis. The narrowing of the spinal canal (through which the spinal cord runs), often by the overgrowth of bone caused by osteoarthritis of the spine. Spondyloarthropathy. A form of arthritis that primarily affects the spine and sacroiliac joints. Spondylolisthesis. A condition in which a vertebra of the lumbar (lower) spine slips out of place. Tissue rejection. Tissue rejection occurs when a person’s immune system attacks donor tissue, such as donor bone tissue used for spinal fusion surgery. Vertebrae. The individual bones that make up the spinal column. Vertebroplasty. A minimally invasive surgical procedure that involves injecting a cement-like mixture into a fractured vertebra to relieve pain and stabilize the spine.
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ADDITIONALREFERENCES BOOKS:
WEBSITES:
Strength Training Anatomy, 3rd Edition Paperback — March 9, 2010 by Frederic Delavier
National Institute for Occupational Safety and Health
Yoga Anatomy,2nd Edition — Oct 28, 2011 by Leslie Kaminoff and Amy Matthews
www.cdc.gov/niosh
www.rheumatology.org
National Center for Complementary and Integrative Health National Institutes of Health
Arthritis Foundation
The Anti Inflammatory Diet Cookbook: No Hassle 30Minute Recipes to Reduce Inflammation, Jan 24, 2017 by Madeline Given NC and Jennifer Lang MD
nccih.nih.gov National Institute of Neurological Disorders and Stroke National Institutes of Health www.ninds.nih.gov
North American Spine Society www.spine.org American College of Rheumatology
www.arthritis.org American Chiropractic Association www.amerchiro.org American Osteopathic Association www.osteopathic.org
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