Tuesday, January 08, 2013

Reconditioning Part II

For my previous injury-related post regarding knees, shoulders, and hips, read this.

When initiating a back rehabilitation routine, it is important to remember a few key spinal qualities.  Firstly, and perhaps most importantly, the spinal extensors are static muscles.  Unlike other skeletal muscles, which stretch and contract in order to facilitate movement, these extensors are only meant to hold a static, stable position with a (relatively speaking) very limited range of motion.  To perform this function, the spine is held in place not by one or two pairs of extensors, but by many overlapping pairs of varying lengths.  This network stabilizes and supports the spine, while myriad other skeletal muscles use this layered foundation to rotate, extend, lift, and lower the shoulders, arms, neck, and legs--there are almost no activities which do not affect the back.  This means that this musculature can both withstand and exert an extreme amount of force, making it highly resilient but also highly susceptible to injury--especially if the spine is not supported properly.  And in spite of this strength and resilience, the back is still fairly delicate, so working around an injury involving the back may contraindicate lots of exercises, even for non-affected areas.  Sharp pain is usually a good indicator that an exercise or stretch should not be performed—this is not to be confused with muscular “discomfort” that needs to be explored and pushed!

Persistent tightness in the lumbar spine is one of the most common back complaints.  Because of the overlapping nature of the spinal extensors, in order to stretch and loosen the lumbar spine, the stretch must be initiated in the upper back first.  The lower back cannot round until the upper back has rounded—this may mean extensive preliminary stretching is necessary before you can even start on your lower back.  Start by bending at the waist and pulling the chin towards the sternum; keep your legs straight and focus on rounding your entire spine.  You may feel a stretch in your upper back or hamstrings as well.  Continue working on this stretch until the lower back rounds completely.

Adopting an upright posture, with a line falling from the ear through the shoulder, hip, and knee, will immediately provide spinal relief as well—think about it every few minutes and adjust as necessary until straight becomes a habit.  “Unloading” behaviors will also help alleviate pressure: When standing, rest one leg at a time on a step or foot stool to unweight the spine.  Kneeling, rather than squatting or bending over, will help you achieve the same effect when closer to ground level.  These actions reduce the “load” on your spine by literally removing the weight of one leg, allowing for elongation, relaxation, and a reduction in pressure on the lower back.  This is why it is equally important to “get up and move around every once in a while” when engaged in seated activities (turns out your grandma was right about that one).  Getting rid of excess bodyfat will also aid decompression efforts.
Front-to-back and top-to-bottom balance is as important with the back as it is with the knees and shoulders.  Overly strong abdominals literally pull the spine out of proper alignment, often causing lower back tightness, over-arching (swayback), limited range of motion, and pain.  Over-emphasis on “core” over the past decade has made this a fairly common issue.  Top-to-bottom imbalances are common as well: Strong trapezium and other upper-inner back muscles overpower the neck--when combined with untrained arms, lower back, and deltoids, this can cause stiffness, limited range of motion in the neck and shoulders, and headaches.  This is common in waitresses and housekeepers, or anyone who performs repetitive arm extending, retracting, or over-head activities.  Adding a combination of pulling and rowing movements, in conjunction with a full-body program, will help solve  these problems.

For rows, concentrate on rotating the shoulder girdle forward and back, only using the arms to hold on to the weight.  For pulldowns, use the same technique, but in an up-and-down plane of movement.  You can also watch my two back videos to see how I'm doing some of the more commonly implemented exercises.

Shoes and Chairs
Small things like the shoes we wear and the chairs we sit in can significantly impact our joint and overall health too.  Even properly or improperly approaching a flight of stairs can impact rehab progress.  The therapists at work like to say that recovery is more affected by “lots of small bits” than any one cure-all exercise or treatment, and shoes and chairs are certainly “bits” that make a difference.

Fashion being what it is, there are a lot of “bad” shoes out there: Vans, Uggs, ballet flats, flip flops, and most other hipster footwear are great examples of what not to wear.  These shoes may look cool, but they have a number of mechanical problems in common: the two most glaring deficiencies are a complete or significant lack of arch support and a complete or significant lack of shock absorption.  Flat soled shoes are very popular, but they do nothing to help stabilize or protect the feet, ankles, knees, hips, or back.  Each time your foot strikes, the force exerted on your foot (equal and opposite, remember?) radiates up your leg into your back, distributing that force through all the joints along the way--lack of proper cushioning in your shoes magnifies this effect substantially.  Lack of arch support affects your joints in a similar manner: Without support under it, the arch “falls,” allowing your foot to collapse inwards towards your body.  This causes collapse in the knee, unevenly distributing stress to the inside of the joint, resulting in improper stresses on the femur, which translate into the hip, which translate up into the back—see where I’m going with this?  Failure to correct this problem can result in long-term problems: bunions and other foot disorders such as plantar fasciitis, uneven cartilage wear in the knee, labrum issues in the hip, and of course pain and mobility limitations.  Investing in high quality daily footwear, or at the very least using insoles, can help offset some of this damage. 

If you spend a lot of time sitting, most likely in front of a computer, then your chair and sitting posture both need attention.  Using foot rests or seat wedges can help unload the spine by lifting the legs up or tipping the pelvis forward, proper lumbar support will help encourage proper posture, and cervical support can help alleviate the upper back irritation caused by sitting.  Arm rests can also help alleviate neck pain as they help “unload” the neck.  Buy a chair that has all these features (and is appropriately load-tested), or modify your current throne as necessary to maximize comfort.  Remember, good sitting posture will help you figure out what your sitting needs are!

Phew!  Finally finished the series, and I've definitely had enough of this subject for now :P  Time to focus on contest prep!

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