Even Good Doctors Get Bad Backs: Here’s The Solution

Discussion in 'Physical and Sports Medicine' started by Mahmoud Abudeif, Aug 22, 2019.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    Lower back pain affects about 4 in 5 Americans at some point in their lives—and doctors are no exception. While more than one-quarter of Americans report having low back pain within the past 3 months, about one-third to as many as three-quarters of doctors, nurses, and other healthcare workers report back pain each year.

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    Physicians have physically demanding duties, and working for hours while standing or in a stooped position are biomechanical risk factors for back pain. Because the traditional assumption is that acute or sub-acute back pain tends to resolve on its own, doctors may not provide much advice for patients (themselves included) to relieve it or prevent it from happening again.

    In addition, opioids are now considered a last option for back pain, to be used only when nonpharmacologic treatments fail and only when the benefits outweigh the risks. Nonpharmacologic treatment for back pain includes heat, massage, and acupuncture—but not much emphasis has been put on exercise. That’s a shame because healthcare workers who performed a 6-month neuromuscular exercise program exercising 1-2 times per week (combined with back care counseling) were able to effectively reduce their intensity of low back pain, decrease their absences from work, and diminish their fear of pain.

    To that end, here are three “core exercises” to both strengthen your core and relieve stress on your lower back. These exercises are intended to increase spinal stability by using a high level of muscular activity while minimizing the load on the lower spine.

    Modified McGill curl-up

    Traditional sit-ups or crunches can compress and flex the spine, but the McGill curl-up targets the abs and leaves the spine in neutral. In the modified McGill curl-up, you leave your elbows on the floor to provide greater stability.

    Lie on your back with one leg lying straight out and the other leg bent so that your foot is on the floor by your straight leg’s knee. Place your hands, palms down, under your lower back. This ensures your spine remains in a neutral, slightly arched position during the exercise—it should be performed with no movement of the lumbar spine.

    First, tighten your abs a bit, then lift your head and shoulders (as one unit) off the ground just an inch or a few inches (don’t tuck in your chin!). Imagine your head and shoulders are resting on a bathroom scale; you only need to raise your head enough for the counter on the scale to read “0.” If you raise your head and shoulders too high (as with a sit-up or crunch), you’ll round your lower back, transferring forces to that area of the spine. The movement should involve only the thoracic spine, not the lumbar or cervical region. Hold that position for about 8 seconds, but don’t hold your breath—continue breathing.

    After holding the position, relax your head and shoulders back down to the starting position. Halfway through the set, switch legs—bend the extended leg and extend the bent leg—and continue.

    Bird dog

    This exercise builds the core while the lower back remains stable and the limbs perform the movement.

    Get down on your hands and knees with your shoulders directly above your hands and your hips directly above your shoulders. Your back should be in slightly arched, neutral alignment. Tighten/brace your abs. Then, without any movement in the lower back, extend one leg backward (as though pushing back your heel) while raising the arm on the opposite side (eg, left leg and right arm) until both limbs are out straight. Your heel should be level with your hips and your arm level with your shoulder. Don’t allow your back to sag.

    Keep your eyes on the ground and your head aligned with your spine. Hold the pose for about 8 seconds while breathing, and then return to the hands-and-knees position. Repeat the same movement, or alternate with the opposite leg and arm.

    If this position is too difficult, the modified bird dog uses only the legs.

    Side bridge

    Also known as a side plank, the side bridge targets the abdominal oblique and quadratus lumborum muscles while placing minimal load on the spine.

    Lie down on one side with your knees bent and your upper body supported by your elbow. Place your free hand on your opposite shoulder. Tighten your abs (but not too tight) and lift your hips so that only your knee and elbow/forearm support your weight—your body should be in a straight line from your head to your knees. Your spine should be in a neutral lumbar posture. Hold the position for about 10 seconds while breathing, then lower your body to the starting position.

    When you’ve mastered this modified version, perform the side bridge with your weight supported between your feet and elbow, and/or with your free hand on your hip.

    Some pointers

    With specific exercises like these, the devil is in the details. Be sure to follow these pointers:
    • Listen to your pain—it’s trying to tell you something. For back exercises, don’t follow the “no pain, no gain” motto. If you feel pain, ease up on the exercise.
    • Don’t hold your breath when you hold a pose or exhale when you relax. Keep breathing throughout, smoothly and deeply.
    • De-escalate reps. It may sound counterintuitive, but you’ll do better for your back by doing fewer reps per set in one workout. Start the first set with 6 reps, for example, then 4 reps for the next set, then 2 for the last.
    • Don’t do back exercises first thing in the morning. Intervertebral discs are more hydrated in the morning after you get out of bed, so they’re at their most vulnerable to load. This diminishes over the course of the day.
    • Not every exercise is right for every patient. back pain comes in many different forms and is different for every patient. Likewise, not every patient will progress at the same rate. If any pose causes you severe, sharp pain, stop immediately.
    A Men’s Health video demonstrates all three of these exercises.

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