Vacation time

We have two excellent Registered Massage Therapists at the St. John’s Back Pain Clinic. One of our therapists, Crystal North will be on an extended holiday until September 22nd, 2014. Judy Batten will be continuing her usual hours during that time and is happy to see any of Crystal’s existing clients. Feel free to call or use our appointment request feature to book your appointment today.

A simplified balance

Talk to a nutritionist and their most simplified approach to weight loss is that if the calories you use up exceed the calories you take in you’ll lose weight. Flip that equation and you’ll gain weight. Often you can simplify injuries to this level as well. Every activity places a certain level of demand on your body and everyone has a certain physical capacity. If the demands exceed the capacity you’ll eventually hurt yourself. If you flip that equation you may enjoy an injury free existence.

 

Demands greater than Capacity = Injury

Understand demands and capacity

Your body is constantly adapting to the demands consistently placed on it and will be expertly prepared for those demands. If your life consists of getting up, driving to work, sitting all day and then watching tv for the night your body will only remain strong enough to roughly keep your body upright while standing or sitting. If you only expose yourself to small physical demands you’ll only maintain a small capacity. If you always take the elevator you’ll always get tired climbing stairs.

Infrequent activities do not last

You stress your body, maybe you do 10 lunges. Your muscles and connective tissues are stretched and strained. The repair process takes 24 to 48 hours and your body adds some extra muscle and connective tissue fibers in case you need them for the next time you do 10 lunges. After a couple of days if you don’t do any more lunges those fibers may not be maintained and are re-absorbed and their materials used elsewhere. 2 weeks later you do 10 lunges and they’re no easier.

Organized demands

You do 10 lunges. 2 days later you do 10 more lunges. Every 2 days you take the new tissue your body has added and stress them. In turn your body adds more tissue and you stress that tissue. Suddenly you have greater muscle strength and connective tissue that can better resist that stress and strain of 10 lunges 2 weeks later you do 20 lunges and they feel as easy as 10. More importantly when you decide to move a few heavy boxes in the basement you’re less likely to injure yourself thanks to this new capacity.

 

10-15 minutes of smart physical activity done every other day is a great starting point to reduce your risk.

 

The blunt truth

You need to give your body a capacity beyond the demands you may place on it. If you’re facing a physical demand that you know is greater than your capacity; expect injuries. Maybe not the first time but you’re poking a sleeping bear. You don’t need to hit the gym and squat 300lbs. You need to be good at movement, you need to be practiced at lifting, pushing and pulling things that weight as much as things you interact with regularly. This could mean a shovel full of snow, a basket full of laundry a couple 2 by 8 boards or a heavy bag far in the back your car trunk. If you’re not preparing for the demands, prepare to call my office.

Spine stability while running

Imagine yourself on a bosu ball, a balance board, a floating wharf on a pond. Every time the platform tilts forward you adjust your posture. Wobbling side to side makes you constantly lean side to side to stay upright. Your spine is undergoing the exact same balancing act as you run. Every foot strike tilts your pelvis side to side and the muscles around your spine work hard to keep your spine and torso balanced above.
So here is the important question, does your back hurt after you run. If yes is your answer maybe it’s time to think about spine stability while you run.

The sideways hip drop

Since your spine and pelvis operate in 3 dimensions let’s simplify things and just worry about side to side movements. What is unique about running versus walking or even standing is that you’re jumping from one leg to the other. When you walk you have near constant support on both feet, especially during that all important foot strike where forces going through your body are the greatest (*somewhere around 1.5 – 2x your body weight). During running one foot hits the ground while the opposite leg is no longer supporting that side of your pelvis. So what happens? You have one force driving upwards through the support leg and 1/2 of your body weight driving downwards on the unsupported side. That’s somewhere in the realm of 2-2.5x your body weight forcing your pelvis to tilt in the time it takes your foot to fully hit on the ground, milliseconds. In that same time your spine has to quickly react, help absorb that force and keep your torso upright. You’ll repeat this process about 4000 times in a 5K run.
running-hip-arrows

 

Making the correction

Having the strength to absorb that force is paramount. That strength comes from a group of muscles called your hip abduction complex which includes well known muscles like your glutes (maximus, medius and their youngest sibling minimus) and other less common muscles like piriformis, superior and inferior gemellus. These muscles help lift your leg to the side if your not standing on that leg otherwise it helps keep your pelvis level. What are some effective exercises? I have three favorites for lateral hip strength and all you need is a resistance band.

1. Side lying leg lifts: Lying flat on your side with your legs stretched straight lift your leg 12-18 inches in the air and slowly bring your feet back together. Really focus on keeping your pelvis anchored by not allowing it to roll backwards or to hike towards your ribs. Wrap a light resistance band around your thighs to add resistance. You should be able to comfortably perform 5-10 repetitions. As you improve you can add 2-3 more sets of 5-10 repetitions with a 30 second break.

2. Side lying clams: It’s the exact same set up as exercise #1 but now you bend your legs about half way. Instead of lifting your whole leg pinch your heels together and just lift your knee. This exercise will really make your pelvis roll backwards so work hard to anchor your pelvis so all of the movement happens down in your hip joint not up in your back. Use the same sets and reps as #1.

3. Sideways band walks: Take a resistance band and tie it in a loop around your feet so there’s a little tension if your feet are shoulder width apart. Making sure to lift your feet with every step. Lift your left foot and step sideways to a wide stance. Then lift your right foot and slowly return to shoulder width stance. You should feel the resistance from the band with each step. If you have space repeat those wide steps 3-5 times to the left and then back 3-5 times to the right. Keep a light bend in your knees and proper back posture.

 

The forward tilt

The next dimension we want to check in on is front to back motion for your spine. The most common in this case in what is called the anterior tilt of your pelvis. It is normal to have a slight (about 10 degrees) anterior pelvic tilt. That angle allows for a normal inward curve in your lumbar spine and sets up the muscles of your pelvis and low back for the best possible strength. It’s a very common issue for runners, especially as they fatigue, to start exaggerating that anterior tilt. Now instead of having a slight inward curve of your spine it’s significant. That wharf on the pond is slanted well forward and you’re leaning back hard to keep from falling in. That alone can be exhausting and painful for your low back.

Sadly, that’s just the start. That change in pelvic and spine angle takes away from the stability provided by your abs (aka core) so you’re forced to rely on your hip flexors and long low back muscles to stabilize that poorly positioned spine. To make matters worse that altered pelvic angle makes it more to effectively use your glutes to properly absorb the force of every foot strike. Instead those forces are transmitted straight to your low back where joints and muscles a fraction the size of your hip joints and muscles are expected to absorb the same forces.side-on-runner

 

Making the correction

This can be as much about comfort and habit as it is about strength. Maybe it feels normal to increase the tilt of your pelvis so it may not be a strength issue as much as a matter of practicing good posture. Watch a couple episodes of Family Matters and carefully watch Steve Urkel, he takes posterior pelvic tilt to a very high level. If watching him helps you can work on sitting, standing and eventually walking with slightly “Urkelled” hips. You never need to take this to the extreme but just a light push in that direction. If watching some classic 90s television doesn’t solve it here is a simple drill to help you feel the pelvic position.

Sit on a fairly hard chair or bench where you can plant your feet firmly on the ground. Focus and feel exactly what part of your bum is hitting the seat. On a hard seat your should feel that pressure land right on your sit bones (ischial tuberosities to be exact). Practice tilting your pelvis forward and backwards trying to feel the pressure on your sit bones move forward and backward. Now try to isolate just moving the pressure backwards without slouching your torso. Feel exactly what you’re contract/pushing to make that movement happen. Once you’re successful there move on to standing with bent knees and try to recreate the same pelvic tilt. Progress this to walking while tilting and finally practice this technique while running.

Do you plank? This is another great way to test your pelvic control. A lot of people with low back pain feel planks working their low back rather than their stomach. This is typically because their ‘strong’ position comes from hyper-extending their low back while stabilizing with their hip flexors and low back muscles (as we talked through above) rather than their abs (aka core). To correct this position drop to your knees while staying in the plank position on your forearms. This should make it simpler to start moving your pelvis towards that Urkel position and removing the pressure from your low back. With practice you’ll be able to hold a kneeling plank with tension in your stomach and minimal pressure through your low back. The next step is key. To make this exercise more challenging dig your toes into the ground while in your kneeling plank and slowly lift your knees 1 inch off the ground. This should really ramp up the tension in your stomach while allowing you to maintain good pelvic position. Work to build your endurance in this position by holding as long as you can (up to 60 seconds) without losing posture or feeling that strain return to your low back. It’s more effective to perform the exercise for a shorter period and rest than to push through back technique or pain.