Back Pain: Prevention and Treatment
Sarah Serres, Amanda Marsh, Jenna Foral & Allen Jackson of Chadron State College explorer the prevention and treatment of back pain.
The human body is the entire physical structure of a human organism. Ones phenotype (physiological properties) is first determined by genetics and secondly by postnatal factors such as diet and exercise. By the time the human reaches adult-hood, the body consists of close to 100 trillion cells. Each is part of an organ system designed to perform essential life functions, and as we progress through the developmental stages of life we are challenged by many conditions that can be prevented - (Dunbar 2008) One of the most common sites of injury, regardless of the sport, is the lower back region - (Dunbar 2008).
Everyone knows someone who experiences back pain or may be suffering from back problems themselves. Many Americans suffer from acute or short term pain which generally lasts a few days, to a few weeks. It can interfere with a person's daily routines, exercise activities and careers. There is a large number of causes for lower back pain; for example, weak or inflexible hamstrings in runners can often create problems with the most common cause, muscular strains. This happens when an unexpected force, twist, or pull is applied to one or several of the lower back muscles. Ligamentous sprains, another cause of discomfort, occurs when the ligaments of the back are unduly stretched - (Inverarity 2007).
Inverarity (2007) stated; four out of five adults experience symptoms of lower back pain. The back is made up of "33 vertebrae, over 30 muscles, numerous ligaments, multiple joints, and inter-vertebral discs". As seen, there are many structures that can cause discomfort if injured or affected.
Back pain causes limited flexibility and mobility as well as limiting ones range of motion, so conditioning of the muscles that maintain posture should form part of everyone's training program, regardless of the discipline or sporting standard. (Dunbar 2008)
Throughout this article we will provide information which will allow for a better understanding of the likely hood of suffering from back pain, and how many of these conditions can be treated or prevented.
Nearly everyone is at risk of having back pain at some point in their lives. Approximately 70-80% of adults suffer from some sort of back pain. Studies conducted in Atlanta, Dallas and Seattle showed that 37% of males experience back pain compared to 63% of females (McPhillips-Tangum 1998). For both genders, back problems often occurs between the ages of 30 to 50 years of age, usually after most competitive activities are far behind us with the blame being placed on the normal aging process. (Ninds 2008).
We strongly dispute the hypotheses that back problems are mainly due to the ageing process. In many situations the occurrence of back pain is a direct result of muscular imbalances. If such imbalances are left unchecked the discomfort may inhibit activity thus contributing to a sedentary, inactive lifestyle. By strengthening and stretching the muscles of the lower back and abdominal regions you can help reduce or prevent many problems leading to back pain - (Inverarity 2007).
Not only do muscles move bones, they hold the skeletal systems together and maintain balance through dynamic tension in the musculoskeletal system. Muscles act much like guy wires by maintaining the integrity of the skeletal system and. skeletal balance is maintained by opposing muscles. When a muscle is weaker than the one opposing it, the opposing muscle becomes tight and the body segment controlled by those muscles will be out of balance - (Cuthbert 2008).
Studies have shown that a high percentage of people with back pain have nothing more than tight back muscles as a result somatic dysfunction, or more easily understood, a muscular imbalance between the lower back and abdominal muscles in correlation with the origin of a the muscle, and mechanical postural dysfunctions (Duvall et al. 2008). Physical dysfunctions develop over time and are the direct result of imbalances between various muscle groups, what we call "muscle imbalances".
Back pain is real and in all probability the most common job related injury or disability occurring in the United States and is a leading contributor to missed work (Ninds 2008). Four out of every five women experience back pain sever enough to keep them from work. An estimated 72% of Caucasians living in the U.S. suffer from back pain while Black Americans rated second highest with 18%. Pacific Islanders were next with 7.4% and Hispanic Americans came in last with 1.9% (McPhillips-Tangum 1998).
We have already discussed some causes of back pain with muscle strain being a leading factor. Strains often result from participation in sports, housework, lifting of children or simple overuse. We feel that through a well designed training program designed to address the strength and endurance of the anterior and posterior core and hip area muscle strain can be greatly minimized.
Injury is another cause; this includes a direct injury to the back or spinal column, or a sudden jolt sustained in a car accident. Other causes include stress, pregnancy, inappropriate posture and poor sleeping positions. Again, proper conditioning that would include addressing both the lower back and abdominal areas would minimize the occurrence of back problems relating to the factors just mentioned.
Weight gain and obesity also contribute to back pain (Ninds 2008) but, the main reasoning, regardless of overuse, injury, stress or pregnancy, is that muscles acting in unison (agonists vs. antagonists) are typically out of balance in regard to strength and endurance. These Imbalances occur when certain muscles are overdeveloped in one area of the body while the opposing muscles (antagonists) are weak and stretched out of their normal position. Muscular imbalances happen anywhere on the body and often develop due to improper training of the muscle groups, thus affecting our daily routine. There are many treatments available for all kinds of back pain; surgery, anti-inflammatory drugs, over the counter pain relievers, hot and cold compressions, or even deep tissue massage. While some of these treatments may cure back pain, the best way to reduce or stop back pain is through exercise programs that address a balancing of the muscular system.
Muscle balance is a vital component to injury prevention. Regardless of your choice of exercise one must focus on muscle balance. Muscle groups work in pairs and there needs to be a balance in training both the agonist as well as the antagonist muscle group for each body segment, resulting in equality in regard to strength and flexibility. As an example, we flex the elbow by using the biceps muscle while the contraction is controlled by the antagonistic muscle, the triceps. The triceps muscle must be willing to stretch for the bicep muscle to contract for flexion to occur at the elbow - (Delzeit 2002).
The focus of muscle balance involves eliminating the strength imbalance between two opposing muscle groups. For the young athlete this may also be a limiting factor in the development of overall speed. As coaches and trainers one must be cognizant of Muscular balance testing to compare the strength of opposing muscle groups. It is extremely important to the prevention of injury and assists in the development of maximum speed and improved performance. If not addressed through a well thought out and disciplined training program muscle imbalances can slow down and possibly result in injury to the young athlete - (Mackenzie 2008).
Minimizing the Risk
Anyone can benefit from stretching the muscles, ligaments, tendons, and soft tissues of the human body. Anyone who suffers from back pain should focus on stretching the neck, back, hips, glutes and hamstrings All of these areas are important in the support of the spinal column. It is important to stretch properly by moving into all stretches slowly and avoid bouncing. You should feel the muscles stretching but it should not cause pain. Hold the stretch for 30-45 seconds allowing the muscles and joints to become loose. It may take a few weeks or even months of stretching to notice the change in spinal mobility, but back pain relief should follow (Ullrich 2007) (Ullrich 2007a).
Flexion exercises stretch the muscles and ligaments in the back and neck, as well as strengthen stomach muscles. These types of exercises are best for people who find relief by sitting down (Ullrich 2007) (Ullrich 2007a).
An example of a flexion stretch is the chin-to-chest stretch. Begin in a standing or sitting position, gently bend the head forward while bringing the chin toward the chest until a stretch is felt in the back of the neck (Ullrich 2007) (Ullrich 2007a). The back flexion exercise is another example; begin lying on one's back and pull both knees to the chest simultaneously, while flexing the head forward until a comfortable stretch is felt in a balled up position (Ullrich 2007) (Ullrich 2007a).
Low impact aerobic exercise is another way to improve function of the back. Performing 30-40 minutes of aerobic exercises can release endorphins, a biochemical of the body that is a natural pain killer. This can help reduce the pain and also help decrease the dependency of prescribed pain medication. Recommended low impact aerobic exercises are; walking, elliptical trainer, swimming, water aerobics and the stationary bike (Ullrich 2007) (Ullrich 2007a). However, when anyone starts an aerobic exercise plan, they should start off with shorter, easier workouts and then increase the time as they proceed and back pain lessens (Erstad 2006).
The importance of doing any strengthening exercises for back pain is to help relieve the pain as well as help make the recovery process quicker and strengthen the back. The first thing to remember when performing any exercise is to use proper form to prevent any further injury. Never perform an exercise where the back is not supported.
Strengthening exercises can include extension and flexion exercises. Extension exercises strengthen back muscles and help to stretch the tissue along the spine. These exercises are best for people who find relief by standing and walking. Some examples are the press- up back extension and alternating arm and leg exercise (Erstad 2006). The press-up back extension can be performed on a machine with weights, or with one's own body weight. The alternating arm and leg exercise can be done by lying flat on one's back and bringing up the right arm and left leg together for a count of one, then repeat the step with the opposite side.
There are many everyday things to take into consideration to help decrease back pain. Simple and effective techniques are discussed that can prevent pain as well as preventing a trip to the doctor's office. First each person should consider the positions of their spine which should be in a neutral position. Practice standing with your back, shoulders and heels against a wall. Second, make sure you a sitting properly with back up tall, and your hips and knees at a 90 degree angle. Women should take into consideration the amount of weight they have in their purse, decide what is really needed and what is not. If women are carrying around more than 5 to 10 pounds in their purse, they have a greater chance of back pain.
Keep in mind that there are many remedies to help reduce and relieve back pain and many steps one can take to reduce the risk of developing chronic back pain. The bones, muscles and ligaments in our backs are needed in order for us to function in our everyday lives; it is important that they are not taken for granted. Take some of these exercises and examples that we have provided for you into consideration, however please consult your doctor before attempting any exercise.
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About the Authors
Sarah Serres, Amanda Marsh, and Jenna Foral are upper level students at Chadron State College and plan on going into exercise related professions.
Allen Jackson is an assistant professor with the department of Health, Physical Education, and Recreation at Chadron. He encourages learners to voice their opinions and share ideas with the educational community.
The following Sports Coach pages provide additional information on this topic: