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Low back pain (LBP) is a widespread phenomena that is estimated to effect roughly 85% of individuals at some point in their life (1). In fact, globally LBP is the leading cause of disability (2). Considering the prevalence of LBP it’s important to gain a better understanding of the complex mechanisms and potential avenues for successful treatment and prevention. This article is neither diagnostic or a recommendation for treatment protocol. It’s simply here to inform you on the various intricacies of the subject so when you seek out professional help from a qualified physical therapist (which is the course of action I recommend) you are better equipped to be an active participant in your own treatment.

Whether you’ve been following our content for years or you’re just starting to dive in, you’ve likely noticed we start many of our corrective strategies with bracing and spinal mechanics. We don’t do this to over simplify the process but, because so often the dysfunction or issue in question is driven by poor spinal mechanics. Bracing is a logical place to go for people with back pain or other issues directly related to their spine, but it’ll also explain some ways in which spinal mechanics influence the mechanics of distal joints, like hips and shoulders.

In this landmark article I’ll explain the flexed spine and neutral spine controversy, how to understand it, and why movement patterns are the key to successful rehabilitation. Let’s begin – There is no joint range that the body naturally has that is bad for you. Yes, and lumbar spines do flex, and for a very good reason. Now it’s time to make like Charlton Heston and strap yourself in for some time travel (except we are going backwards in time).

On occasion, I refer to a formative patient I had in my chiropractic practice many years ago. I call him Carl. Carl was a big strong guy that had lifted heavy and played hard for most of his life. While his prior activity was apparent in his physical frame as he sat in front of me, it was juxtaposed by his emotional state. Carl was crying…and not just a trace tear on the cheek, either. This grown man was sobbing and fortunately for me, it was tears of joy. He had suffered a disc injury while lifting, and subsequently re—injured it several times. He’d seen a handful of chiropractors who painfully bounced on him to try to get some magic crack, but made him feel worse about as often as it made him feel better. He’d had more needles stuck into him than his mother’s pin cushion. He’d seen many physicians and surgeons who had all given some sort of advice that resembled “Stop lifting” or “These opioids should take the edge off” or “We can cut you open and snip that out”. He’d heard about poor surgical outcomes and was leery of going that route. His fear of surgery was rivaled by his fear of lifting which had now bled from his sport life into other, more personal facets, including lifting his child, lifting the garbage and lifting his socks from the floor. Carl felt like he was waiting on the edge of something worse, and he was incredibly frustrated that his source of solace-­‐lifting-­‐could have seemingly turned on him like a traitorous friend. But he wept at that moment because of what we had just done in the clinic.

March 10, 2016 Stuart McGill, University of Waterloo and Backfitpro Inc. Most patients rarely receive the most important part of the prescription to get rid of back pain from their doctor – the knowledge and understanding of their condition required to become their own best advocate. They remain clueless and frustrated, left in the dark about what behaviors must be stopped in order to alleviate the cause of their pain. As well they need guidance as what is required to build a pain-free foundation that will allow them to get back to enjoying all their usual activities.

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