Many individuals today suffer from back pain.  In fact, statistics reveal that more than 80% of individuals will experience acute low back pain and dysfunction.  While I treat a large variety of ailments and dysfunctions in my office - feet, knees, hips, shoulders, elbows, etc... -  I still tend to get my share of people coming in complaing of back pain. 

I begin with assessment and evaluation, and then of course treat accordingly.  Once the patient and I have worked together to relieve the underlying pain, I next spend time educating the individual as to what is causing the pain and what they can do to avoid it.  Oftentimes, this is then followed by specific exercises to regroove motor patterns and to strengthen weak and dysfunctional muscles.  Lastly, I try to educate the patient as to the importance of the little things that need to be given attention to each and every day.  After all, it is these "little things" that add up over the long haul that typically cause the dysfunction and resultant pain. 

Many cumulative injuries do not surface until the initiating event.  For example, many individuals will experience a herniated disc in their low back causing a radiation of pain down the leg by performing a simple task such as bending over to tie their shoe or picking up the morning newspaper.  Bending over was only the initiating event.  It is the thousands of cycles of spine flexion that ultimately herniate the disk.  The slumped posture while seated at work, performing abdominal crunches in the gym and sitting on a soft sofa when getting home were the underlying causes of the repetitive stress to the low back.  The individual was not in pain until the cumulative load and injury exceeded tolerance and were too much for the system to handle.  These little things are closely associated with the concept of capacity. 

Each of us has a capacity for work.  Capacity is the sum total of all or our activities (working, sitting, training, etc...) over a period of time.  This can be for a particular month, week, or single day.  The important thing to understand with regards to capacity is that it has a definite limit.  We all use up a portion of our daily capacity with every task we do, including tying our shoes, getting in and out of our car, lifting our children, and sitting at a desk.  It is by doing these daily tasks without attention, that one can quickly use up capacity and set themselves up for back pain and dysfunction.  Think about your capacity the next time you are you are doing these seemingly "insignificant" tasks because they are not insignificant at all. 

One of the strategies I teach in my office to spare the back is the concept of abdominal bracing.  Abdominal bracing is simply contracting all of the muscles in the abdominal wall without pulling in or pushing out.  The brace does not imply maximal contraction levels, but rather enough to meet the required load.  Based on research evidence and simple anatomy, this appears to be the strategy to adopt for back stability.   

The four layers of the abdominal wall (rectus abdominis and abdominal fascia, external oblique, internal oblique, and transverse abdominis) perform several functions.  As a group they work together to flex, laterally bend and rotate the torso.  Much emphasis in recent years has been directed towards training the transverse abdominis muscle, and to a lesser degree the multifius, both in the performance and rehab settings using the "hollowing" strategy.  Hollowing is an attempt to simply activate the transverse abdominis (TrA) in isolation. 

Some in the fields of training and rehab think of the TrA as the most important spine stabilizer, when in fact there is no justification for any special effort directed towards training the TrA.  The TrA is no more important than any other abdominal muscle.  In fact, there is no study that has measured spinal stability and warranted that these muscles receive special attention. 

All of the muscles and their ability to work together is of utmost importance in spine stabilization, especially given their criss-crossing architecture which cross-brace the lumbar spine.  Furthermore, the most important stabilizers continually change as the demands of the task change.  The act of abdominal "hollowing" (pulling in the abdominal wall)  should never be conducted for this is inhibiting to the other muscles necessary for stabilization and load transfer during performance.  Hollowing, or drawing in, is actually a weakening of the abdominal muscles as it can only be done when the abdominals and obliques are almost inactive.   

As all of the layers of the abdominal wall activate together during bracing a stiffness is created.  McGill has termed this phenomenon "superstiffness."   When the entire abdominal wall is activated (bracing), the layers of muscle bind together forming a composite such that the total stiffness is greater than the sum of its parts.  Another consequence of the bracing strategy is that the extensor musculature of the low back is also activated which results in the formation of a girdle around the trunk.  The brace appears to be a highly efficient strategy to enhance stability.   

Practice bracing now.  Sit up tall with neutral spine and slightly brace your abdomen.  Without going into flexion, stand up.  Remember, this is not a maximal contraction, but only enough to meet the requirement.  Practice the abdominal brace the next time you squat to pick something off of the floor.  In this example the bracing effort may be slightly more than while you are standing from a seated position.  Make it a habit now and soon your body will begin to do it for you automatically.  As a result you will be less prone to dysfunction and pain.  Practice this first strategy for stabilization and master it.  In newsletters to come, we will discuss some exercises and proper progressions for maximizing spine stability.  Using the bracing strategy is a key component for all of them.