Saturday, June 25, 2011

Wrapping It Up!

The Desk Warriors Guide To Building A Healthy Back

We've learned that we need to sit less, sit better, use a lumbar support, take frequent breaks from sitting, walk more, stabilize our lower backs, mobilize our mid-backs, improve our posture, gain core muscular endurance and provide our backs the proper stimulus. But, what stones have we left unturned on our quest for a healthy spine? What myths, have we left unbusted.

Stones Unturned

1.) We need to improve diet. If we can change our nutritional environment into an anti-inflammatory one via diet we may be able to modulate pain. Pain sensitivity seems to increase in the presence of chronic inflammation. So how can we turn off chronic inflammation?

A.) Nutritionally, we can eat a proper ratio of PUFA (poly-unsaturated fats) which is estimated to be between a 1:1 and 3:1 ratio of Omega 6 to Omega 3 fats. Sadly, some estimate our SAD (Standard American Diets) provide upwards of 20:1 Omega6:3. This creates a pro-inflammatory nightmare as omega 6 fats promote pro-inflammatory processes while omega 3's do the opposite. Eat more omega 3 and less omega 6. Consider supplementing with fish oil. Getting this ratio in check decreases inflammation and should help reduce pain, specifically LBP.

B.) Sleep. We need to focus on getting QUALITY sleep and QUANTITY sleep. Inadequate sleep can be pro-inflammatory. Short sleep times are associated with poor glucose metabolism (hyperglycemia) which is pro-inflammatory. Furthermore, there are many links between short sleep times and hypertension, increased obesity, and other poor health outcomes. On average we slept 9 hours per night in 1910. Now we sleep less than 7.5 on average. Sleep more.
C. Lose weight. You all know that being obese places huge strain on your joints. This is obvious for the knee and the ankle, but obesity also effects the spine. If you have significant body fat, focus on losing it to alleviate compression of the spine.

D.) Lose body fat. Body fat gives off pro-inflammatory cytokines. Losing body fat can decrease inflammation. If you're fat, you're inflamed.

"Old Wives Tales"
What you've heard wrong about back health

We've already dispelled the myths that sitting "rests" the back and that having a "strong" back protects from LBP. We tore down the sit-up as a pro-phylactic exercise for the back. But what other myths are still lurking.

1.) Tight hamstrings cause back pain. A longitudinal study of men in the military did not reveal any significance in regards to LBP and tight hammies (Hellsing, 1988). Future LBP also was not able to be predicted based on tight hammies (Biering-Sorenson 1984). Personally, i've done all the hamstring stretching in the world to relieve my LBP and at best I found it to do nothing. Furthermore, many of the prescribed hamstring stretches place the low back in flexion and as you know from reading this, flexion can often exacerbate LBP.

2.) Leg length discrepancies cause LBP. This is certainly true of large leg length discrepancies. But studies show that even leg length differences up to 5cm rarely develop chronic pain (Grundy and Roberts, 1984). Further, lumbar scoliosis and leg length differences of less than 1cm were not found to be associated (Hoikka, 1989). Don't let your orthopedist/chiropractor install that shoe lift before reading the whole Desk Warriors Guide to Building A healthy Back.

3.) Lifting/moving on the job: bend the knees, not the back. This advice forms the foundation of every job-safety ergonomics guidelines. However, sometimes it is too physiologically costly to always head this advice. Sometimes it's just downright impossible. Also, no conclusion has been made as to its efficacy. I will say this advice needs to be adhered to when lifting set loads in the gym, such as a squat or deadlift. But as for how to perform some light repetitive task on the job bending, the back may not be so bad.

4.) Leg presses are safer than squats. This is false and a huge mistake. Maybe 225 pound leg presses are safer than 225 pound squats for someone who is far too weak to squat the weight. Leg presses force lumbar flexion regardless of load. They are also generally terrible for the knees. They allow larger loads to be moved and thus people feel cool when under the numerous 45 pound plates. Long story short. They are not better for your back. Not even close.

5.) Back Extension machines are safe & effective: McGill and colleagues use commercial gym back extension machines to herniate discs in lab. These are the machines where you sit down & strap in with a seatbelt. A padded bar digs into your back and pushes you forward as you resist it and then extend backwards. Basically it pushes you into full flexion, loads your spine, compresses it greatly and herniates your lumbar discs. Don't use these machines.

Thanks for tuning in. Post questions or comments! Share with your friends or that guy with the bad back!

Biering-Sorenson, F. (1984) Physical measurements as risk indicators for low-back troubles over a one-year period. Spine 9: 106-119

Hellsing, A.L. (1988) Tightness of hamstring and psoas major muscles. Upsala Journal of Medical Science, 93: 267-276.

Hoikka, V., Ylikoski, M., and Tallroth, K. (1989) Leg-length inequality has poor correlation with lumbar scoliosis: A radiological study of 100 patients with chronic low back pain. Archives of Orthopaedic Trauma Surgery, 108: 173-175

Grundy, P.F., and Roberts, C.J. (1984) Does unequal leg length cause bain pain? A case control study. Lancet, August 4: 256-258.

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