Part II: What exercise do I choose for my lower back?
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Introduction
After last week’s article we now have some general principles to start applying to exercises. The next thing to consider is what is an exercise? Our previous article defined physical activity (PA) as anything that uses energy and requires movement by your muscles. For more specifics on PA, read here. There are many variations on the definition of exercise. For the purposes of this article we will be using the definition supported by the American College of Sports Medicine, “Exercise is a type of PA consisting of planned, structured, and repetitive bodily movement done to improve and/or maintain one or more components of physical fitness” (1). Physical fitness is more to do with being able to do the daily tasks you want to do (1). So it could be read in such a way that exercise increases the capacity of the building blocks to do the things you want to do (physical fitness). Whereas PA is an overarching term made up of things like exercise, physical fitness, dance, sports etc.
How does this relate to our lower back topic? Well, as we talked about in our social media posts this past week, the lower back is capable mostly of forward and backwards movement, with limited sideways and rotation movement. In the professional world we organise these directions into what we call planes of movement.
What are the planes of movement?
Forward and backwards is the sagittal plane.
Sideways is the frontal plane.
Rotation is the transverse plane.
Because the lower back is mostly able to move in the sagittal plane, this is the main focus when it comes to planning and structuring repetitive exercises for the lower back. The goal being to improve the forward and back components of the lower back which might be needed during daily tasks or PA that you enjoy.
The other planes are important too! But, it is most important to reclaim forward and backwards movement in the lower back so that you can move your pelvis below and your rib-cage above (2–4)! Many aches, pains and injuries stem from loss of flexibility, strength and control of this area and thus it is worthy of your attention to rehab!
There are many other reasons to train sagittal plane capacity. If you check out Figure 1, think of the capacity as max flexion (touching toes) at one end and max extension (bending backwards) at the other. It is useful to have strength and control of this entire range; especially since sagittal mechanics are necessary for equal force distribution across the spine (5). Force distribution is achieved through a normal, what we call lordosis (or extension), in the lower back and middle to lower neck and a normal kyphosis (or flexion) in the middle to upper back and upper neck. Now, while normal is mostly relative to an individual due to different bone sizes and soft tissue density, at the crux of it we are just wanting to see that one can assume a certain shape to their spine to improve force distribution (see standing straight in Figure 1). It is totally expected to move out of this shape for various activities.
Figure 1 - A doodle of max flexion, extension and somewhere in-between - courtesy of yours truly.
Lastly, how we walk and run is dictated by our sagittal capacity. How do we get from A —> B? When we walk the direction of our mass is primarily in the sagittal plane (6). Basically our pelvis moves forward. This is intuitive. We don’t walk sideways, unless we need too! Rotation helps with propulsion and frontal plane helps keep us on the tracks (6).
So, other than general principles of exercise, what else must we consider?
When considering exercise prescription, how do we get to the hardest of hardest and easiest of easiest? If we start somewhere in the middle with an external weight (say you are holding kettlebell) and go easier, we begin to reduce the weight until there is no weight. Once there is no weight, we focus on body position relative to gravity. Then we start increasing contact points you have with the ground i.e. how stable will you be? One-foot, two? Hands and knees? Lying on the stomach or back? As we get closer to the ground, there is more contact made, increasing our base of support and thus increasing the ease of movement. To go harder, we can go down two roads, or combine the two. Either increase the weight or reduce the base of support, eventually adding in multi-tasking or environmental randomness e.g. other players on a sports field, focusing on an external object like a ball, problem solving etc.
How can we use gravity?
Gravity is an important variable when considering exercises and how you move yourself. Without it, we would lose strength and cardiovascular health quite predictably (7,8). This is seen with astronauts if they don’t perform strength and cardiovascular exercise (7). Astronauts have to create an environment where there is some other form of resistance because there is no passive (for lack of a better word) resistance from gravity. Gravity even helps us develop muscle strength when we are foetuses! While there are many other systemic reactions to gravity, by the third trimester gravity is needed to develop your spinal and leg muscles (9). What this means is your muscles develop before you are even born because of gravity. Some people even get de-conditioned to a state where they must start their rehab journey by using their muscles in gravity neutral before gravity opposed environments.
So where do we start (the crux of it)?
Abdominal wall (12)
Task completion. To reduce compensations from other areas and focus hypertrophy and muscle recruitment we want to stay within the parameters of whatever technique is decided upon for the task you want to do (10,11). The technique is typically confined to whatever the prime contributors associated to the task are. For example, with the lower back, locally we have the big spinal erector muscles on the back (along with some smaller guys deeper to them), the abdominal muscles that wrap around the front and sides, the diaphragm (with its lower back attachments) and to some degree the psoas (12). These are the muscles that either connect directly, or a very close indirect attachment, to the lower back. Therefore we want these muscles used mostly during the exercises we choose!
Conclusion:
Back muscles (13)
Exercises are planned, structured and repeated to help build the components needed for daily physical tasks. This enables us to be physically active. We must consider where each individual’s starting point is. Your starting point is an exercise that you can complete. What is the required technique? You are looking for task completion. Not almost completion. Once complete, progression is based on the variables of environment, current skill level, and individual needs for the task you want to do. Variables we can play with to make an exercise harder or easier are gravity, external and internal environment changes, load or range alterations, and either multi-tasking or singular tasks.
Enjoy!
[C]
The sagittal biased exercises are listed below, loosely in order from floor to standing while thinking about gravity, load and all the other principles talked about in Part I and Part II.
+ Gravity neutral
+ Gravity on the floor
Back muscle focused
Mobility
Flexibility
Strength
Abdominal muscle focused
Mobility
Flexibility
Strength
+ Gravity + not quite standing yet
Back muscle focused
Mobility
Strength
Abdominal muscle focused
Mobility
Strength
+ Gravity + standing + load
Back muscle focused
Strength + Flexibility = Mobility
Abdominal muscle focused
Strength + Flexibility = Mobility
+ Gravity + standing + load + environmental complexity (randomness, sports, weather, surfaces, other humans etc) OR internal complexity (cognitive load)
Once we enter into this category we are focused not isolating back movements. This was already lost a few categeroies back. The activities under this category start to blur the line between exercises and physical activity. You’ll likely get more benefit in doing activity specific movement. For example if you are needing to do sports that involve cutting, sprinting and jumping then focus on this, or just go play your sport! If you just want to hang the washing out, then get out there and do it! Live on the edge a bit :). We have some videos on our channel around these things but there are just far too many physical activities to account for.
If you have made it this far, thank you for reading and I hope you find this as useful as I have!
References
1. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 10th edition. Philadelphia: LWW; 2017. 480 p.
2. Ferrero E, Liabaud B, Challier V, Lafage R, Diebo BG, Vira S, et al. Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity. Journal of Neurosurgery: Spine. 2016 Mar 1;24(3):436–46.
3. Farfan HF. The biomechanical advantage of lordosis and hip extension for upright activity. Man as compared with other anthropoids. Spine (Phila Pa 1976). 1978 Dec;3(4):336–42.
4. Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011 Sep;20 Suppl 5:609–18.
5. Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J. 2010 Nov 1;19(11):1824–36.
6. Fuller E. Center of pressure and its theoretical relationship to foot pathology. Journal of the American Podiatric Medical Association. 1999 Jun 1;89(6):278–91.
7. Hargens AR, Bhattacharya R, Schneider SM. Space physiology VI: exercise, artificial gravity, and countermeasure development for prolonged space flight. Eur J Appl Physiol. 2013 Sep;113(9):2183–92.
8. Alkner BA, Tesch PA. Efficacy of a gravity-independent resistance exercise device as a countermeasure to muscle atrophy during 29-day bed rest. Acta Physiologica Scandinavica. 2004;181(3):345–57.
9. Sekulić SR, Lukač DD, Naumović NM. The fetus cannot exercise like an astronaut: gravity loading is necessary for the physiological development during second half of pregnancy. Medical Hypotheses. 2005 Jan 1;64(2):221–8.
10. Beardsley C. Hypertrophy: Muscle fiber growth caused by mechanical tension. 1st edition. Strength and Conditioning Research Limited; 2019. 351 p.
11. Beardsley C. Strength is Specific: The key to optimal strength training for sports. 1st edition. Strength and Conditioning Research Limited; 2018. 328 p.
12. Standring SS, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st edition. New York: Elsevier; 2015. 1562 p.
13. Thompson JC. Netter’s Concise Orthopaedic Anatomy, Updated Edition. 2nd edition. Philadelphia, PA: Elsevier; 2015. 416 p.
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