Treating and preventing spinal dysfunction (Part 2)

Step 1: Get Proper Treatment

 If you have back pain, a proper evaluation is critical to find the dysfunctional tissue(s) that are causing your back pain.   Many factors contribute to back pain, but the most likely contributors are how you load your spine throughout the day in your job and at home.

If you work in one of the following jobs you are more than likley overloading the following tissues:

1.   Office/sitting job:   Tissues overloaded are neck/mid-back from forward shoulders and low back/hip from shortened hamstrings/psoas which in turn loads the back (specificially the disc).

2.   Factory workers (standing on concrete all day):  Tissues overloaded are the feet (especially with poor footwear), low back due to twisting, neck due to looking down or up throughout the day.

The above two are the most common examples I see in my office every day.   It's easy to find out how you become injured when you look at what you're doing for 8 hours per day.   The constant loading of a tissue over time will fatigue the tissue and eventually that tissue (disc, muscles, ligaments, joints) will breakdown over time and lead to injury.

Treatment involves finding which tissue are involved and then applying proper treatment order to improve the health of that tissue so that it can get back to it's normal work capacity.   

Steps to proper treatment are:

1.  Treat the underlying dysfunction 

2.  Strengthen/address local muscle imbalances or weakness:   strengthening a key rotator cuff muscle for example or a specific weak lumbar muscle before proceeding to the next step.

3.  Address global weakness:  Strengthen/groove an overall movement pattern that applies to the patient's job or athletic endeavor (like a golf swing)

4.  Address proprioceptive/kinesthetic awareness:   this is only necessary if the nervous system has adapted to the injury and has changed how the patient moves.   This step is done in many clinics at step one (putting patients on an exercise ball to improve balance) when in many cases it is not necessary and wastes time.

Step 2: Get moving

As mentioned above, movement is good, and inactivity can cause/exacerbate back pain.

• Resistance training helps build strength and endurance in the supporting musculature, and help activate weaker or inhibited areas.
• Mobility training helps improve active flexibility in tight areas.
• The intervertebral discs lack blood vessels. The only way they can absorb nutrients is through spinal movement. If you want to deprive your discs of nourishment, lie down and sit around a lot.

But before you randomly start lifting, running, twisting and jumping, think WWDMD (What Would Dr. McGill Do)? Spine biomechanicist Dr. Stuart McGill encourages the following approach when it comes to exercise design:

1. Do necessary corrective exercises
2. Groove appropriate movement patterns
3. Build full body joint mobility/stability
4. Increase core endurance (rather than maximal strength)
5. Build full body strength
6. Develop speed, power, and agility

How many people do you know that start at #1?

Spines & squatting

Squatting with poor mechanics will result in injury.

Squatting with added weight puts compressive forces on the spine. Why don’t we see more spinal blowouts at the gym? Luckily, our spine can adapt to compressive tolerance. But our spines need time to adapt. Take your time and allow this adaptation. To assist the process, build up your paraspinal muscles with exercises involving spinal extension and stabilization.

Double check squat form:

• Take a wider stance (at least shoulder width – if not wider)
• Use natural foot positioning (similar to other athletic movements)
• Keep heels in contact with the floor
• Gaze forward or slightly up
• Maintain lordotic curve in lower back — don’t round
• If back squats don’t work, try wall squats with a swiss ball.
• Focus on hip extension — drive from the glutes and hips.

Intra-abdominal pressure (IAP) can help to stabilize the spine during squats. Momentarily stopping the breath and stiffening the abs to make the spine go rigid (think of what you do when you sneeze, or when you know someone is about to punch you in the gut — if you make a little “ungh” sound, you’re probably doing it right) will generate IAP.

Stabilizing the cervical spine

Neck muscles work isometrically to stabilize the cervical spine. A stable cervical spine is critical for contact sports. Thus, folks with greater musculature in the neck and shoulders have a better chance of withstanding cervical impact.

Forcing the cervical spine into excessive flexion or extension with resistance can lead to breakdown of joints and discs.

To build the cervical spine, try incorporating the following exercises. Hold for 10 seconds each, and do 1-5 sets:

1. Isometric neck flexion (forwards)
2. Isometric neck extension (backwards)
3. Isometric lateral neck flexion (right and left)
4. Isometric neck rotation (right and left)

Mobility warmup

Here are some sample mobility drills that can keep the spine mobile yet stable in all the right places.

Cat/cow spinal warm up

G-max bridge:

Bird Dog:

Side Bridge:

 These are a sample of exercises that can be performed to help improve spinal stability.   You can only proceed with these exercises if your spine is healthy.    If you have a problem, please give us a call to today:  605-882-2304. 

 Dr. Bryan Dingsor is the owner of Watertown Chiropractic P.C. in Watertown, SD. He specializes in the treatment of many musculoskeletal conditions and weight loss. For an appointment, please call 605-882-2304 Today.