Q&A, Soreness/Pain

Q&A: Low Back Pain

lowbackQ:  I was standing and praying all day in Synagogue for Yom Kippur – at least 3-4 hours at a stretch and I had a long walk there from my house, too.  My low back is aching.  Is yours?  Do you have any exercises I should do?  I hear that I should strengthen my abs but my stomach is strong already.  Please don’t use my name in your blog post. I don’t want people to think I am unhealthy.  It just came up because I was standing so long on Yom Kippur and not something that happens to me all the time.

(Achy Back, Some Synagogue in America–Name withheld upon request)

A:  Dear Achy Back,

Don’t worry. Nobody will figure out who you are!  80% (some experts even say 90%) of Americans suffer from low back pain at some point. The majority of folks suffering are between the ages of 25 and 60.

Most cases are due to poor body mechanics – posture/muscle imbalances and not from things like cancer, arthritis, or fractures, bone loss or kidney stones etc.  Though those things can also cause back pain.   Before simply pointing you in the direction of some good core strengthening exercises (as opposed to ab exercises like situps/crunches), the better more complete approach would be to do a postural assessment to see if any muscle imbalances might be causing your discomfort.

A few postural deviations which can lead to low back pain include lordosis (sway back/overly arched lumbar spine and an anterior pelvic tilt), kyposis (hunch back, rounded shoulders and perhaps a forward jutting head) or hip and shoulder height discrepancies which might indicate a spinal curviture/scoliosis.

For those who tend toward lordosis and have an anterior pelvic tilt, I would strengthen the abdominals and stretch the iliospoas and erector spinae muscles.  For those with kyposis, I would strengthen the mid-trapezius and rhomboids and stretch the chest – the pectoralis major and the anterior deltoids.

Performing traditional ab exercises without proper lumbo-pelvic-hip stabilization has been shown to increase pressure on the discs and compressive forces in the lumbar spine actually.   So I think it would be more prudent to work on core stability before building you some abs.

  1. The drawing-in maneuver:   Get on your hands and knees on the floor like a dog.  Make sure your hands are under the shoulders and your ears are in line with your shoulders and there’s a straight line – ears, shoulders and hips.  Knees are directly under the hips.  Maintaining this neutral spinal position, now pull the region just below your belly button toward your spine.
  2. You can also lie on your back with your knees bent, feet on the floor, toes pointing straight ahead, arms and palms down at your sides and lift one leg at a time marching.
  3. Floor bridge.  Staying on your back with knees bent, feet shoulder width apart, arms by your sides, palms down, push though your heels and raise your hips off the floor as you draw your navel in and activate your butt muscles.  Raise your hips until your knees, hips and shoulders are in a straight line.  Slowly lower to the floor.
  4. Floor prone cobra:  Lie on your tummy on the floor, arms at your sides, palms facing the ground.  Draw your navel in, activate your butt muscles, pinch your shoulder blades together as you raise your head and chest off the floor.  (Keep legs and hips on the floor.) Hold for 1-2 seconds and slowly return to the floor keeping your chin tucked.
  5. Plank.  Lie with your belly facing the floor, feet together, elbows under shoulders and forearms on the ground.  Draw your abs in and activate your butt muscles.  Lift your whole body off the ground.  The only parts touching the floor are the balls of your feet and toes, and your elbow and forearm and fist/hand.  (If this is too difficult, you could do it in a modified push-up position – knees and hands on the floor)

Once your core is stable, we could build you some abs and strengthen your low back more to further improve your kinetic chain and prevent the low back pain.  Remember not to hold your breath during these exercises!!

Here are a few other tips to prevent low back pain: maintain a healthy weight, stay active, lift with your thighs by bending at the knee instead of the waist when lifting heavy objects and avoid twisting while lifting. Wear low-heeled shoes.

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Diet, Exercise, General Health

Are You Skinny Fat?

fatIt has been a colorful 2 weeks since I last posted.

I have been substitute teaching PE at an all-girls private High School.  When I took the 9th graders, split them into groups to do resistance exercises circuit-style, one group assigned to do sit-ups couldn’t execute a single sit-up with proper form.  One pretty young thing just lifted her head up and down while laying on her back. It was so sad.

I explained to them the many health benefits of exercise.  I don’t think they were incredibly impressed.

I explained how 65%+ of Americans are overweight – which puts them at all kinds of health risks from diabetes to heart attacks and cancer.  They could even quote back the statistics to me…and nobody seemed to think these numbers had anything to do with them.  If you look around, its usually like a carnival house of mirrors with all kinds of distorted bodies peering back at you – distended bellies and all, but this group was actually relatively thin looking.  From all outward appearances, you would assume they are a healthy bunch.  So I think the girls figured they don’t really need to exercise.

That’s simply not true!  There’s something called Skinny Fat – medically, the term is metabolically obese, normal weight (‘MONW’).  Not enough lean muscle.  Or your ratio of muscle to fat is off-kilter.  For instance, a body-fat of 24-39% is high by medical and health standards, but with good genes and bone structure you might appear thin.  Yes, its also true that if you fit into a size 2, but you still jiggle while you wiggle and your skin feels spongy…there’s a good chance you fit the definition of skinny fat.

Actually, a Skinny Fat person can have the same health risks as someone overweight/obese—or worse.  The shocking news published in the Journal of the American Medical Association is that nearly 1 in 4 skinny people have pre-diabetes and are metabolically obese.   Skinny people diagnosed with diabetes have twice the risk of death than heavy people with it.  Could be that having some extra muscle from lugging around that extra weight is protective?

In other words, a heavy fat person with a good amount of muscle might be healthier than you, Miss String-Bean!  Yeah, fit people come in all shapes and sizes is what I am saying.

Why am I so passionate about this subject?  Because I have been Skinny Fat myself.

Thanks to genetics and bone structure, I appear taller and slimmer than I actually am.  Many years ago, after the birth of my second child, I went for my annual physical.  The doctor looked at the results of my blood tests and asked what I did for exercise.  I told him “I chase toddlers. ” He went on to tell me that although I was active and exhausted from all the chasing of my kids all day long, I was actually 33% body-fat.  I was obese.  I gasped – but I’m not that heavy according to the scale!  He said if I were older, he would have put me on a statin drug because of my cholesterol numbers and that I should start an exercise program (I had not done regular exercise since High School) and eat oatmeal for breakfast.  I joined a gym and attended classes religiously, ate my oatmeal for breakfast, backed off on the fancy coffee dessert-drinks, and within 3-6 months I had lowered my cholesterol 13 points.  This was the start to my journey of becoming a fitness professional.

There are a number of tests your Doc can run to see if you are Skinny Fat, including a fasting glucose tolerance test, HDL, triglycerides, blood pressure, NMR lipid particle test.

So how to fix it when you are Skinny Fat?  Pair a lean protein with a healthy low GI carb at every meal in order to keep blood glucose levels steady.  For instance, an apple with some almonds, a hard boiled egg and oatmeal, celery and peanut butter, rice and beans, chicken breast and bell pepper.  Don’t drink your calories.  Get enough sleep.  Do resistance training with cardiovascular intervals…just like I have been doing with all of the classes I have been teaching at school this week.

Don’t worry – if you lift more than 2 lbs you aren’t necessarily gonna bulk up and look like a female version of the Hulk!  If you would like more help finding a fitness program to help you avoid being Skinny Fat, drop me a line or take one of my classes this week!