Saturday, June 25, 2011

Step 10: Provide the Proper Stimulus

The Desk Warriors Guide to Building a Healthy Back 10/10!

This brings us to talk about 'dosing' our workload for the back. You see, every tissue has a tolerance zone. You go above the zone and you introduce injury. Conversely, you never approach that tissues tolerance zone, and you get atrophy and demineralization of the associated tissue that results over time in less capacity for work. What we need to do is apply the proper stimulus or workload so that our tolerance zone gradually improves.

You see in a “bad back” we have very little margin of safety. Too much work, heavy exertions, and faulty motion patterns will cause further injury or pain in this individual. On the completely opposite end of the spectrum, in our elite athlete we have a very high amount of tolerance to both heavy exertions or a high work load. However, if this capacity is not continually challenged, the athlete will lose the capacity that makes them elite. Conversely, if we do have one faulty lift or heavy collison we may go over the amount of tolerated load and induce injury. To sum it up. It is a very critical to prescribe the proper amount of loading in both the “bad back” and the elite athlete, as well as eliminating faulty movement patterns such as poor sitting or standing posture. A bad back will remain bad if we overload it or continually underload it and an elite back will not remain elite for long if we overload it. Conversely, chronically underloading it will eventually reduce its elite work capacity.

The point of the above picture is to help you realize the importance of maintaining your days workload in the margin of safety. The first way to do this is to eliminate faulty motion patterns. Previous injury may make this a difficult task but working with a qualified personal trainer, chiropractor or sports medicine professional may help. Sitting less will surely help as will sitting better.

Assuming our movement is solid and our posture is strong, we can worry about achieving the proper workload. Let’s think of our spinal capacity as a smart phone battery. When we wake up it’s fully charged (assuming we got enough quality sleep). Our goal is to make it to the end of the day with a fair amount of battery left. Then to retire into bed and recharge our battery. We don't want to never unplug our battery (challenge our back), because over time the battery will still lose life (a non-challenged back losing work capacity). Yet, we don't want to drain our battery to 0% and not be able to use our expensive smart phone. When we approach losing battery power, we are approaching the upper margin of safety/tolerance in our back. Do this consistently and we are asking for injury (battery off).

Instead we want to use our phones just the right amount. We want to preserve the battery and not risk having our expensive smart phone shut down before the day is done. Not playing too many games, making too many calls, or leaving 55 apps running will ensure that we preserve our battery. We also want to get the most of our expensive smart phone with its unlimited everything plan and huge monthly bill. Metaphorically, applying these principles to our backs we aim to keep our spinal capacity high by providing the proper stimulus to maintain capacity while not inducing injury. In many cases consistently achieving this will increase the battery life over time so that we may exert more energy into life without depleting our back battery.

So lets take a look at two scenarios

In scenario one. Forty year old 5'9'' 175 pound Bob wakes up after a crummy night sleep with a 75% charged battery. He then hunches over a bowl of whole grains and slurps down a 20 ounces of french roast while sitting through traffic on the way to work. Bob is already down to 51% of his spinal battery. This is because the intervetebral discs are fully hydrated upon rising from bed. Therefore the annular layer is subject to much higher stresses during bending, flexion, and compressive situations (sitting) in the morning. Performing spine bending maneuvers during the first hour of the day is unwise in the unhealthy back as 90% of the fluids have drained by the first hour of our day. Snook and colleagues (1998) proved that conscious avoidance of forward spine flexion in the morning improved low back symptoms.

The above photo demonstrates how intradiscal pressures increase with various amounts of forward bending. This can be exacerbated early in the morning. The meatty steak looking things are your intervertebrael discs. The rings are the annular layers that hold the nucleus in place. Repeated flexion with high intradiscal pressures gradually degrades the annular layer leading to bulging or herniated discs.

Next Barbara arrives at work where she is fortunate enough to have to walk a few hundred yards before she parks her caboose in her less than ergonomic seat at her cubicle. She looks at this walk as drudgery rather than an opportunity to improve her spinal health by walking with proper posture. This desirable activity decompresses the spine and provides necessary blood-flow and motion. At work Bob is seated for most of the day and repeatedly lurches forward to take phone calls, grab things and sometimes bends down to the lower desk drawers to retrieve items. These repetitive tasks require full spinal flexion under compression (sitting and hunching over) and further drain his battery so that by lunch time, he is at 25% battery life.

Bob finishes his day in a similar manner. Painfully he sits through the rush hour commute home. His fury grows with each tapping of the brakes and each witnessed incompetent driver. Finally he arrives home, stressed, angry, STARVED. He throws a frozen P.F. Changs meal in the microwave and impatiently waits for it to be cooked. Bob scarfs down his processed food garbage in typical hunched over fashion. While leaning forward to do the dishes his battery runs out. He rubs the pain in his lower back, wondering why his back hurts.

Bob had planned on taking the dog for a walk but he is too exhausted and his lower back aches. Rather than being yanked around the block by Fiona, his minature doberman. Bob lets her out back to annoy the neighbors while retiring to his bed where he'll watch some meaningless television programs and ache. Lying down at this point is preferable to Bob because his back battery is out and he can't tolerate any more sitting or intense activities. After watching a few re-runs of Seinfeld Bob falls asleep with the tv on…

Bob awakes to his alarm with a 74% charged battery.

Scenario 2

Ron, 40, 5'9'' 175, wakes up after a revitalizing 8 hours of sleep in a pitch dark room absent of electronic noise. His battery is fully charged, 100%. He puts on his shoes and notices his back is a bit tight (from the disc hydration). Rather than sitting down to breakfast, he throws a bit of coffee on the pot and takes his dog for a walk. Ron has been reading The Desk Warriors Guide to Building a Healthy Back. He realizes the importance of walking and avoiding forward bending postures in the morning. Ron returns from his walk, grabs some healthy paleo leftovers from the fridge and heads to work. He gets in his car and enjoys the leftover chicken satays, while his lower back rests firmly supported by the lumbar support he recently purchased. Ron arrives at work with 96% battery life.

At work Ron is aware of his posture. He uses a lumbar support and moves items on his desk often to avoid repetitive tasks. He recently petitioned his boss to allow him a sit-stand work station and won. He often is able to do his work in a reclined fashion to reduce the compressive load on his back, and when he can’t he’ll rise the desk up and stand. He makes certain to take breaks from sitting and static standing. He'll often pace while on his cell phone, gets up to speak with other colleagues and looks forward to the rare opportunity to walk down the hallway to use the bathroom or deliver some finished work.

Like clockwork Ron does not fail to take breaks from sitting, usually every 30 minutes. His co-workers think he’s weird because he’ll sometimes stretch, foam-roll and do these goofy looking three exercises while he’s in his slacks and dress shirt. But none of them would dare insult Ron as they know they would be demolished in a matter of seconds if it came down to it.

It’s lunch time and Ron’s back battery is at 75%.

Ron finishes out his work day in this manner. He is done at 3pm and hits the gym. Ron doesn’t have much time so he does a quick hip mobility warm-up knowing that hip mobility spares the spine. He then mobilizes the thoracic spine and does some spinal bracing techniques as he prepares for heavy lifts. From working with his personal trainer, Ron confidently executes sets of squats working up to 225 pounds for 10 reps. He doesn’t rest long between sets and finishes with some standing dumbbell presses and pull-ups before promptly exiting the gym drenched in sweat.

His battery is at 45%.

Ron gets home before his wife and starts preparing dinner. His kids are already home from school and his son has a baseball game at 5. Ron quickly enjoys a meal of real foods with his family. At little Joey’s ball game, Ron helps coach and throws the kids fly balls. Ron is bending, twisting and running down bad throws. These activities would have bothered his back in the past, but his spinal capacity seems to have improved since he's practiced what he's read in The Desk Warriors Guide To Building A Healthy Back.

His battery is at 30%

He uses a bit of his back battery lifting the kids and jumping around celebrating their victory! When Ron gets home he finishes up some chores around the house, gets the kids to sleep and uses a bit more of his back battery capacity making his wives toes curl in bed. BIG RON retires with 15% battery life left.

After a solid nights sleep, Ron wakes up the next day with the slightly more capacity than he had in previous days.

I hope the above helps illustrate the proper way to use your back capacity through the day. Preserve it by doing a lot of low-intensity moves like walking and mowing the lawn. Practice proper posture and be aware of reducing repetitive tasks. Sit less and sit better. Give your back some exercise stimulus and preserve your capacity.

When we continually drain our back battery to 0% we end up hurting our backs doing something insignificant like lifting a dropped pencil off the ground or sneezing. Don't be like Bob. Be a Ron.

Snook, S.H., Webster, B.S., McGorry, R.W., Fogleman, M.T., and McCann, K.B., (1998) The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. Spine, 23: 2601-2607.

A special thanks to Dr. Stuart McGill. Buy his books here at

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