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    Chap 8

    Uploaded by

    Kader Amoun

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    of 14
    Jaa ry T T+ SS. e. - J WNT ro Nae) FLEXIBILITY AND LOW BACK A. INTRODUCTION This may seem like a strange combination of topics, but there is logic to this madness. Back problems, especially low back problems, are too common in our world. In fact, 80% of Americans will, at some point in their lives, experience a back problem. Of that huge number of people, only 20% will know why it happened. A recent estimate suggested that 31 million Americans a year will have this problem and that it will cost in excess of $16 billion dollars in Worker’s Compensation claims. And the scariest partis that the crisis may come on with absolutely no warning! And when it happens, itis a crisis! The flexibility part of this chapter can be explained in part because good flexibility can help prevent a back problem. The rest of the explanation is that we needed a good place to put flexibility! Ifyou remem ber flexibility was one of the basic components of health related fitness. We have studied cardiovascular fitness, muscular strength and endurance, and body composition. This is the last of that group. B. BACK ANATOMY AND PHYSIOLOGY Lets look first at the parts of the back. Each of these can be a contributor to a back problem. ‘Bones. The bones of the spine are called the spinal column. Each one is called a vertebra. They are all different and uniquely structured for their position and task. They are divided into groups for easy identification. i Cervical Vertebrae. The top seven, starting at the skull and ending at the top of the rib cage, are called cervical vertebrae. They have less bony mass (they don't normally support as much weight as the others) and have a larger opening (they have more nerve fibers inside). The top two are so unique that they get their own names. They are called the Atlas and the Axis. This is where much of the movement of the head takes place. This group is identified as C1-CS. « Thoracic Vertebrae. So called because they make up the thoracic cavity. These 12 are e: 94 « LIFETIME FITNESS: God has Plans for Youl eee VERTEBRAL COLUMN 2 | cassis they also have a progressively smaller open: ing. Many of the motor neurons exit between these vertebrae, and there are more and more sensory nerves as you go higher up the col umn, They are identified as TI~T12. + Lumbar Vertebrae. Between the bottom of the rib cage and the top of the pelvis, ther are five very sturdy vertebrae, They have a ge bony mass because they are supporting the upper body. They are also the most com: mon sight for an injury: They are L1-LS. Cee + Sacra The triangular bone between the hip bones is actually five vertebrae fused together to form one bone. It does not have movable joints, so the problems here are usually at the junction of the iliac crest (part of the hip RA eessliad 3 § _ bone) and the sacrum, Old-timers would say 3 they had thrown out their “sacroiliac” When © you lie on the floor with your shoulders flat coccyx on the floor and roll your hips over, there may be a loud pop. That’ probably it! + Coccyx. At the tail end of the spinal column are either four or five little bones more commonly Known as your tail bone, You don’t hear much about it until you sit down too hard ice skating. Grow ing up in Colorado, we had someone in our elementary classes sitting on the donut pillow every winter. Nerves, Runnin, 1g down the opening in the vertebrae are A LOT of nerve fibers. They are divided into two basic groups. The ones that bring information in from the outside are called afferent (or sensory) nerve fibers and the ones that take information from the brain back out are called efferent (or motor) nerve fibers. They exit or enter between vertebrae and are identified by that location, The ones exiting VUVVVLY Vy between cervical vertebrae are in groups listed as C1-C8. Why eight, when there are only seven cer- vical vertebrae? The nerves that enter and exit in. the gap between C7 and TL are the eighth cervical nerve bundle, This will be very important to our discussion soon, Discs, Between the vertebrae where there is movement, there are cushions made of a spongy cartilage-like material, They are called discs. They are in place to allow movement, absorb shock, and keep one bony vertebra from rubbing on its neigh bor. When you get bone on bone, you have trouble. ‘Muscles. The final piece to the back puzzle is a large collection of muscles. They have all kinds of fancy names such as erector spinea, but we can get away with a much simpler nomenclature. The back is controlled by BIG muscles and LITTLE muscles. ‘he little ones are from vertebra to rib, or vertebra to vertebra, and they are for posture control, NOT lifting! The big ones are the gluteal muscles, latisimus dorsi, and other big muscles that ARE for lifting: Note the difference in size and function. We will come back to this! C. INJURIES ‘The injuries of the back range from painful nuisances to catastrophic, even life-threatening occurrences: Fortunately, the most severe are less likely to happen. Lets start with those. + Damaging the “cord” is the most severe of the spinal injuries. If it is damaged high enough. it can even affect breathing, The nerve fibers do not have good blood flow and therefore do not heal very well. Bone, skin, or muscle will usually heal because of a constant flow of reconstructive materials. Not so with nerve fibers. The loca- tion of a cord injury can usually be pinpointed by where the body has sensation and movement. and where it does not. If the damage is low in the cord, the lower two limbs may not function, which is called paraplegia. If the injury is higher and all four limbs are affected, the condition is quadriplegia. ‘The possibility exists that the injury is bruising and swelling and some, or all, function will return in the first few days. If the cord is actually severed, the injury will be permanent. Much research is being done in this area, including nerve graft studies in animals and humans. Another area of research is (96 « LIFETIME FITNESS: God has Plans for You! ‘with exoskeletons. Think Ironman! The ae is fitted with a computerized shell that fits over the: Jegs and trunk and allows them to walk! Google it! ma {ng the column, or bones, is less damaging but still very dangerous. Damaged bone ¢ant « peep ar a: damage the cord. That is one of the reasons they are so careful with some- tne een suspected of aving aback or necknjury ts important not to do any harm afer the ini tal event Ths includes the use of backboard, leaving football helmet on, and carefully rling an injured person over, in an attempt to minimize damage after the fact. By the way, the term “bro tsually refers to bone. Saying that someone suffered z broken neck and was paralyzed is potentially inaccurate, Damaging the cord results in paralysis, « Disc damage, while less serious and less permanent, is tremendously painful and disabling, The discs, like the cord, do not have great blood supply, and have limited ability to heal, The first treatment option will be bed rest, but that is often followed by something else. A common surgical remedy is to remove the damaged disc and fuse the two vertebrae into one bone. This eliminates the movement at that join, but the tradeoff is worth it. «+ Muscles get involved in back problems in several ways. You can actually damage muscle, which we labeled a “strain” earlier in the book. You can also cause them to spasm, which sets offa vicious cycle. ‘The muscle spasm pulls you off to the side and that causes you to pinch the nerves exiting on that side, Pinching the nerve causes additional spasms, pinching additional nerves, causes additional spasms, and so on. You get the idea, You are down in a heap, there is no comfortable position, and you are trying to find out which truck ran over you. This process can also be set off by a ruptured disc that is pinching nerve fibers. + Finally, many back problems never have a clear-cut cause, The nerves dor't appear to be damaged, the bones are intact, and there is no obvious muscle injury. This is what they refer to as Low Back Pain Syndrome (LBPS). LBPS is doubly painful because your back hurts and they cantt locate the specific cause. Unfortunately, this is often the case and it results in pain killers and muscle relaxants. Don't get me wrong. You are happy to get them at the time, but you would rather know how to keep it from happening again, EVER! D. CAUSES/CURES Depending on your outlook on lif, this section can be positive (cures) or negative (causes). They are really the same, There are certain behaviors that make a ack injury more likely and some specific things you can do to make them less likely. They fall into four basic categories. Sit up straight and keep reading * Poor lifting techniques are atthe heart of many back injuries, The authors two serious episodes with a bad back were both a result of using the LITTLE muscles instead of the BIG muscles, One time I leaned over sideways to pick my wie up like firemen do, Its her opinion that God struck me down. fiuustadmit I was going to spin around and set her down dizzy. On further inspection, firemen use their legs and hips to lif. 1 ever get the nerve to try it again, will remember that, Here arc aoe recommendations that may help you avoid four days on the floor 1, Dont lift with straigh Qu are usi uscleg, waishtlegs. Ifyou do, you are using thelttle back muscles instead of the big lifting 2. Keep the weight close to you. Many objects are not that h " y x at heavy, but they are awkward. Their center of rey i way over there and yous sway backhoe This casess org on go force on your back. Think of a baby in the middle ofa playpen. They mat only weigh 20 pounds, Chapter 8 Flexibility ane but you have to reach over the side and out away from yourself and that multiplies you put the side of the playpen down and slide the plastic mattress over t0 you, 1t18) ‘The Macho Syndrome—This is all too common in men. We are offended ifsomeone asks) D need help with that?” That awkward item in Suggestion 2 would be less than hialfas hard 10 Pie up if two people did it. They pick up the half closest to them and you get the hal closest &@ Yous You might be able to pick up that big stuffed chair, but then again, you might end up on the squirming and groaning. Now, that’s embarrassing! ‘My favorite suggestion came from a loss-control specialist for an insurance company. It was 100) simple. Keep your chin level with the floor, The only way to do that is to use the big leg and hip. muscles to lift. As soon as you drop your chin, you start using the little back muscles. Try it: Tt works. + Here is the connection with flexibility. A lack of flexibility increases the risk of injury to any muscle, and this is no different in the back. Tight, short mascles are more prone to injury and the back is. constantly bending and twisting, There are several exercises that are good for stretching your back. 1, Lying on the floor on your back, you can pull one knee up to your chest or both knees. This is excellent for stretching the low back 5 3 : 3 s 6 eddtoro/Shutterstock.com (98 « LIFETIME FITNESS: God has Plans for You! 2, Sitting with both legs outstretched and your knees flat, you can teach for your toes: Hence the ypame, ‘sitand reach!” My legs continue to grow making this more and more difficult... i ‘yda Productions/Shutterstock 3, Remember your “sacroiliac?” Lying on your back with your shoulders flat on the floor, you roll ‘your hips first to one side and then to the other. 4, For similar results while siting, pull one foot up by the seat of your pants and hook the op} elbow behind it. Rotate your trunk. i ve /artemida-psy/Shutterstockcom UN Chapters Flexibility and Low Back = 99 We hear regularly about our “core” muscles. A major component of these is the abdominal muscles: If these are weak, your stomach can protrude, which moves your center of gravity forwatd: 10 Om pensate, you have to push your hips and shoulders back or you will fall on your nose. Compare the Tow back curve in the following three pictures. A pregnant lady is a more attractive example OF ‘what wwe do when we let out abs go! wes 5 < z ‘To make sure that we exercise the correct muscles, we need to talk about hip flex: hip as you walk. One of these specifically (iliopsoas) is attached to the leg and the inside of the ot When you work it, it pulls on the low back and exaggerates the curve of the lumbar spine. This ae regular sit-ups and leg-lifts can make your back hurt. This muscle does NOT need. in bal ror m aa Daw de Welsch bose ms hat cloned tobe vorkd? Hew art see a CGrunches work because you start with the hips lexed, eliminating the hip fl bending the knees at a 90-degree angle before ting the hip exons, ou your upper back up from the floor do this by Yousstart. Then, you can actualy sit up or just eu EES SSASSSISI SIDI SIU US UUIUUGG GEG OY ae 100 + LIFETIME FITNESS: God has Plans for You! ‘odidesign021/Shutterstock.com, ©GaudiLab/Shutterstock.com Notice that the hands are not clasped behind the head. When You start to fatigue, you have a tendency to pull with your arms and that puts pressure on the discs in the neck. Crossing your arms on your chest or reaching with your finger tips helps to iso- late the abdominal muscles and protect the spine. A close relative of the crunch is the re' erse crunch, where your back stays on the floor, but your legs come up. This works the abs alittle differently and can be used ranches, Notice that the legs start in a bent in conjunction with the regular ert the hip flexors. 3. If you feel compelled to do leg lifts, you should start with one foot planted. and that k helps rotate the pelvis back and stretch the hip flexors scribed earlier as the “litle” back muscles. When «The other half of the core muscles are the ones we d sme good back exercises. these are stronger, they are less likely to spasm or tear. Here are so 1. Keeping your legs onthe ground, you lift the chin snd chest up of the ground. a ‘Maridav/Shutterstock.com 2. From your hands and knees, you rai the o i and fa fr se the opposite leg and arm. Ihave fallen over doing this 3, Lying on your stomach, you raise your arms and legs at the same time, This one is sometimes referred to as the butterfly. Shutterstock.com 2 Photography/ 4, This one is similar to #2 but Iam less likely to fall over. From the hands and knees, you extend one leg back. -Soloviova Liudmyla/Shutterstock com With all of these, you start with a few repetitions and gradually increase the number you can do, ‘You may have a litle soreness in the beginning, but too much soreness means you did too much too soon. Be patient! + This last contributor/deterrent to back health does not have the scientific backing the others do. ‘They have found, statistically, that people with better aerobic fitness have fewer back problems. You remember aerobic fitness from early in the book. That is your ability to walk, swim, bike, run, and produce large amounts of ATP through the oxygen-rich metabolism. nection, but the truth is that they don't have strong research to prove why along with better back health. It just does, and since better aerobic fitness h ‘will just count this asa bonus. : E, FLEXIBILITY PRINCIPLES It just my opinion, but stretching is boring. So why do I do it? As you age, You measured in degrees and expressed as range of motion (ROM). Its limited by bone: and soft tissue such as muscle. Some people will just be more flexible genetically becau canit change like bone structure. We can all stretch the muscles and maximize oe G ‘makes reaching and lifting more possible, whether that is for sports, working on up babies (grandchildren)! , “There are several specific principles that we discussed earlier that apply to flexibility: The first 5 specificity, Just because you have double jointed thumbs does not mean your low back is flexible; This ‘means that, like with weight lifting, you are going to have to work (stretch) all the major muscle groups; You especially have to stretch the ones that get the most work, because they are getting stronger and shorter. Therefore, runners have to give extra attention to the running muscles, swimmers the swimming muscles, and so on. Related to specificity is the question of what type of stretching to do. If you are a competitive athlete, the newer “dynamic” stretching is now encouraged. Ifyou are just trying to maintain ROM, the traditional “static” stretching is still preferred. This is considered to be safer because muscles have a built-in reflex that contracts the muscle if t is stzetched suddenly. Slowly stretching a muscle and holding the stretch allows it to relax and lengthen, Repeating this will, over time, increase ROM for that specific joint. ‘We talked earlier about the FITT principle. The “F” stands for frequency. With stretching, you can stretch every day. In fact, you can stretch multiple times per day. If serious soreness occurs, you need to back off a litle "The “T” stands for intensity and that is the tricky part of stretching. If you were at rehab, they would ‘measure the joint angle and stretch you a certain number of degrees past your existing range, Without the equipment and the trained rehab assistant, we are left with stretching until you feel “mild discomfort” “This is very subjective. There are people that grimace when they hear the word stretching and those that stretch to the point of injury. Somewhere in-between isthe happy medium where you create an overload ‘on the ROM but do it safely. "The first “T” was for time. If you are doing static stretching, you will start by holding a stretch for 15 seconds and then relaxing, You repeat that three times and then move on to the next muscle group. Over ‘a span of weeks, you increase this to 30 seconds and eventually a whole minute. With dynamic stretch- ing, this is usually measured in distance. You will do high knee walking for 20 yards or to half-court on the basketball court. Again, static has been shown to slow sprinters times if done immediately before competition. This applies to a very small percentage of the population, ‘The last “T” was type of stretching and we just discussed two of the mor 4 ‘There are many others. Ballistic stretching is the bouncing stretches we did ae a rome “Reach for the sky now touch your toes and reach for the sky ..” would be a good example, Thea largely discouraged for anyone. Another variation is called “proprioceptive neuromuscula¢ faci (PNF). There are LOTS of types. facilit ‘Two last basic ideas. When you injure something (jam a finger playin, ig basketball, etc,), it and gets stiff. It feels like it would help to stretch it. DON’T! It needs to heal, and stretching , at this, 4104 « LIFETIME FITNESS: God has Plans for You! stage does not help healing, Later on, the rehab process wil include regaining the ROM. Last ofall, new sa pes may make you sore. The day ofthe stretching willbe fines howeves 24-48 hours later, younotice sei spot and you wonder what you did to cause it. Thea, there will be more sPOMs ‘And more. This is falled “delayed onset muscle soreness” (DOMS). It is nor: nal and does not reflect an injury. It no fun, ata joes indicate that you are creating an overload. Dorit let it become excessive and dont let it hang and for long periods of time. It should be gone in a day or two. Student's Name One of the components of a healthy back is good low back flexibility. As we studied in this depends partly on genetics, but largely on your willingness to stretch. An easy test of flexibility is and Reach Test. This is an advanced version of “can you touch your toes?” Procedure. You will need a ruler and a step. Sit in front of the step with your pointed up, and the soles of your fe saan Ge face of the step slightly apart. Place the ruler between. Your feet on the flat of the step. Place one hand on top of the other and slide them forward along the ruler. Keep your knees straight! Move slowly and hold the furthest distance you On reach and note that spot on the ruler either in inches or in centimeters. Subtract the distance the rules hangs OVS the edge of the step. Ifyou carvt reach the edge of the step (where your feet are), note the distance short of the step you rexched. This will show up on the chart as a negative number. Circle your results on the chart below (from topend sports), and retest later to see if you are making progress. Take it from somcon® who laid on the floor for two weeks, you WANT to make progress! Example, If you reach eight inches on the ruler and the ruler is hanging three inches, you score will be five inches over the front of the step Women Centimeters Inches Superior 330 3115 21 to 30 BtollS, 11 1020 451075 Average 110 10 05to4 | Fair t00 =25t00 Poor =8 0-15 =3t0-6 Very Poor <15 26 Men, Centimeters ches > | Superior 327 3105 Excellent to2

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