Sports Injuries, Athletes and Low Back Pain in Gwynedd, Conwy, Anglesey, Denbighshire and Flintshire
At The North Wales Spine Clinic a large number of our patients are athletes from Gwynedd, Conwy, Anglesey, Denbighshire and Flintshire who present with sports injuries such as low back pain. In fact, about 80 per cent of the world’s residents suffer from lower back pain at one time or another, and an athletic lifestyle offers no warranty against the problem. At The North Wales Spine Clinic we find in the Gwynedd, Conwy, Anglesey, Denbighshire and Flintshire regions, lower back pain is a common ailment among runners, cyclists, and other athletes, and until now no one has been exactly sure what sports-minded people should do to alleviate – or prevent – the complaint. Now, working in conjunction with the University of Copenhagen in Denmark, we have discovered a series of evidenced based specific coordination exercises can help get athletes’ backs ‘back on track’ and that actually do work!
The Copenhagen investigations add some clarity to what has been a muddled picture concerning ‘best practice’ for lower back pain treatment. Sports scientists and spinal researchers have been pretty certain that inadequate strength and endurance of the back muscles increase the risk of lower back pain, suggesting that back-strengthening exercises would be an ideal preventative to a sports injury of low back pain. However, it’s been impossible to determine which back-muscle strengthening programme is optimal, and recent research has even called into question the validity of traditional back-strengthening therapy. For one thing, scientists have shown that some popular lower back exercises actually magnify ‘intradiscal pressure’ in the spine, possibly INCREASING the risk of difficulties. (Be wary of those ‘abdominal machines’ still prevalent in local gyms and those dated counterproductive exercises still being used by many sports and health professionals!). In addition, other studies have suggested that back-strengthening exercises are no more effective than short-wave diathermy or ultrasound at ameliorating lower back pain. (None of which have been shown to have any significant long-term affects on low back pain at all! Consider this next time a practitioner uses the muscle-stimulating machine for your low back problem).
Developing smoother back movements
So, the Copenhagen investigators decided to take a new tack. Instead of assuming, as almost all other researchers have done, that muscle-strengthening routines are the answer for lower back pain, we suggested the Danish researchers should reason that healthy functioning in the low back does not depend on muscle strength, endurance, and flexibility alone – but also on the COORDINATION of movements involving the lower back. What we see in practice every day is individuals who move clumsily and therefore put inordinate strains on their lower back muscles, connective tissues, and spinal structures, even if their basic muscle strength is pretty decent, leading to the onset of pain. As a result, the Danes hypothesised that training to improve coordination – but not necessarily muscle strength – would help individuals develop smoother movements of the lower back, which would then decrease the risk of harmful stress on the low back and thereby reduce the risk of pain
Think this through; do you train with a strength and conditioning coach? It seems in the UK strength and conditioning is the ‘be all’ in sport at the moment. Take some time to examine what happens in the US, Australia and New Zealand. Do they have strength and conditioning coaches? Sure. Is that all? No! They also focus on movement, balanced and coordination during training collectively known as ‘proprioception’. You HAVE to be coordinated and balanced in your movements to produce maximal muscular output otherwise reduced performance, compensation and injury are just guaranteed! Remember YOU CANNOT FIRE A CANNONBALL OUT OF A CANOE. Think abut it don’t just accept the norm, athletes need question what’s going on with their training, whether they are playing rugby for the local side or for a national side!
In the study forty Copenhagenians aged 18 to 65 with chronic low back pain took part. The subjects had all experienced lower back pain for at least three months in the preceding year, but none of the individuals suffered from serious problems such as osteoporosis, painful osteo-arthritis, inflammatory rheumatoid arthritis, or disc degeneration
The subjects were divided into two groups, each of which trained for one hour two times per week over a three-month period. One group carried out conventional endurance/strength training for the low back, while the other conducted the special coordination training. After a 10-minute warm-up, the endurance/ strength group completed four key exercises:
1) Leg lifts, in which subjects stood by the end of a table, leaned over into a prone position with the hips against the edge of the table and the chest flat on the table, and then lifted both legs behind them to the greatest possible height;
2) Trunk lifts, in which subjects lay prone on a table with their hips at the edge and the upper part of the body extending out over the edge of the table face-down (a strap over the calves kept individuals from toppling off the table). With hands behind their heads, the participants lowered their trunks and then lifted their trunks upward to the greatest possible extent (very much like traditional ‘Roman-Chair’ exercise);
3) Abdominal contractions (sit-ups), in which individuals lay on their backs with their knees flexed, feet on the floor, and arms behind their heads and then slowly ‘sat up’ in a straight- forward direction; and
4) Lat pull-downs, in which participants sat on a seat, grasped a weight lever, and then pulled the lever down behind their necks and shoulders, lifting a weight stack which was attached to the lever
During the strength/endurance workouts, subjects did as many repetitions of each exercise as possible (but no more than 100), with 30-second pauses after each set of 10 repetitions. At the end of the workout, participants completed about 10 total minutes of stretching, using 30-second static stretches of the various muscle groups
Like the strength/endurance people, the coordination-trained subjects started their workouts with 10 minutes of jogging and warm-up activity. They then completed four coordination exercises which we use at The North Wales Spine Clinic, including
1) ‘Knee-elbow touches” in which they started in an upright, standing position and then rotated their trunks to the right, lifted their right knees while standing on their left feet only, and touched their right knees with their left elbows. They then returned to the standing position, rotated their trunks to the left, lifted their left knees, and touched their left knees with their right elbows. This alternating pattern – left elbow touching right knee and right elbow touching left knee – continued for up to 40 repetitions;
2) ‘Balancers,’ in which subjects started out on all fours (hands and knees on the ground) and then extended their left legs straight back and their right arms straight ahead, while remaining in balance on their right knees and left hands. They then went back to the starting position and moved their left arms ahead and right legs back before alternating this pattern for a total of up to 40 reps;
3) Modified sit-ups, like No. 3 from the strength/endurance training except that instead of sitting up straight ahead, subjects moved forward alternately to the left and then to the right as they did their ‘crunches’; and
4) Proprioceptive training, in which the participants stood on a wooden disk with a sphere attached to its undersurface. Subjects tried to keep balanced on the sphere without letting the edges of the disk touch the floor – while twisting their bodies and bending at the knees. Participants stood on both feet at the beginning of the study but progressed to one-footed balancing (alternating feet) after several weeks. Post-workout stretching was the same as for the strength/endurance group
And the results?
After three months of training, both groups had less lower back pain, better mobility of the lower back, and less trouble carrying out their daily activities, and the coordination group improved just as much as the strength/endurance group. Consumption of drugs to control lower back pain was reduced by about two-thirds in both groups as well
Notably, back-muscle strength increased in the strength/endurance group but not in the coordination subjects, yet each group made similar improvements in lower back function, demonstrating that an upgrade in strength is not the only thing which can heal a ‘bad back’. Supporting this idea is the fact that there was not a strong correlation between improved back strength and reduction in lower back pain in the Copenhagen research
What does the Danish research and the approach of the physicians at The North Wales Spine Clinic mean to you? If you suffer from lower back pain or want to minimise the risk of lower back pain in the future, improving your back-muscle strength is a decent idea, but it’s not the complete answer. At The North Wales Spine Clinic we understand the need for such interventions as the coordination drills completed by the Danish athletes to ‘smooth’ and coordinate the functioning of your lower-back muscles and spine, we also specialise in improving the flexibility of your low back by using specific and safe exercises to stretch out your lower back muscles AFTER they are thoroughly warmed up. With improved strength, coordination, and flexibility in their low back, the athletes that come to us at The North Wales Spine Clinic are able to exercise more efficiently and with less fatigue in the lower back area. In addition, the prevention of lower back pain allows our athletes to train more consistently, leading to higher-quality performances.
In summary, research and evidence in low back pain is moving forward with a modern high quality approach. What was the ‘done thing’ yesterday has often been proven to be counterproductive today yet is still widely used and prescribed by health professionals who don’t update their knowledge. A large body of evidence shows that the quality of global human movement cause musculoskeletal injuries in sports or otherwise. Evidence for many hands on therapies and machines is poor for the long-term remedy of sports injuries. Basically, the today’s high quality robust research suggests most athletes with a sports injury need to address the causative movement disorder if they want a long-term solution.