This is Spinal Fact

May 2, 2004
Outside Magazine
Outside magazine, April 1995

This is Spinal Fact
By Dana Sullivan

I'm barely 30 years old. Exercise every day. Have decent posture and never lean over to pick up anything heavier than a PowerBar without bending my knees and flexing my hips. Still, every few months, sharp pains shoot through my lower back. It's happened on a ski slope, after cycling, and when I'm just sitting at my desk. Fortunately, the pains last only a few seconds, and they haven't been debilitating. But apparently that could change without notice.

"Your back is subtly trying to tell you that you're doing something wrong,"says Dr. David Kell, a physiatrist with the Center for Sports Medicine at St. Francis Memorial Hospital in San Francisco. "One day it might not be so subtle. You'll bend down to lace up your shoes and suddenly be incapacitated." I am distressed. And Kell, a spine specialist, tells me I'm not alone. Eight out of ten Americans between the ages of 25 and 45--even the most fitness-conscious among us--will experience a bout of back trouble, whether it's seconds of discomfort or several weeks of intense pain. Unfortunately, when it comes to back pain, it's very difficult to pinpoint exactly what's wrong. According to Dr. Stuart Weinstein, a physiatrist with the Puget Sound Sports and Spine Physicians group in Seattle, the three most common back problems--soft tissue injuries (strains), joint injuries (sprains), and disk injuries--can be caused by virtually the same activities, have very similar symptoms, and all occur in the lumbar, or lower, region of the back.

Physicians do know that evolution is at least partly to blame for the vulnerability of the lumbar spine. Our simian ancestors tromped around on all fours, which took some of the pressure off. The human spine still hasn't developed to the point that we can walk upright without risk; our lumbar region bears all the weight of our highly evolved posture. Add any activity that involves twisting or arching the back (swimming butterfly, rowing), sudden starts and stops (sprinting, playing tennis), or prolonged lifting (backpacking, weight lifting), and the risk of injury increases.

Read the Signs, Maybe
A soft-tissue strain is the least grave of the three. Sore, aching muscles or sudden muscle spasms are typical indications that you've pulled a muscle or tendon in your lower back. A lumbar sprain is more dire but is usually caused simply by bending or twisting too far. It's a common injury in sports that require you to be seated or flexed forward and to twist your upper body--paddle sports and skiing are familiar culprits. The pain can be acute, or start as a minor ache and get worse during the course of a few weeks.

Sprain pain is usually confined to the back, but a disk injury may send pain shooting down the backs of the legs. That's because a disk that's injured--again, by bending or twisting just a little too far or too fast--can bulge or rupture and press against a spinal nerve. This is what's commonly, but incorrectly, referred to as a slipped disk. But that comes later in the game. On the initial injury, you may or may not feel a tear or hear a pop, and the pain may or may not be acute.

Gray enough for you? Unfortunately, that's the way it is: If your back hurts, you hurt your back. In a lot of cases, that's all we have to go on.

Buttress Weak Construction
The spine is constructed of 33 vertebrae, roughly cylindrical bones, bumpered by intervertebral disks, fibrous rings with jellylike middles that keep the vertebrae from rubbing together. The advantage of this setup is that you can bend and rotate from your neck to your hips. The disadvantage: There's no one big bone acting as an anchor, so your spine is particularly vulnerable to injury. And it only takes one injured joint or disk to mess up the whole system. "Imagine a bike chain with a few links that have rusted together," explains Weinstein. "It can't move smoothly."

So it is with a damaged spine--but since the human body is a more adaptive machine than any bike out there, you may not feel enough discomfort to keep you sidelined. "Nonetheless, you've exposed your spine to repetitive microtraumas," says physiatrist Dr. Jeffrey Saal, executive vice-president of the North American Spine Society and an associate professor of physical medicine and rehabilitation at Stanford University School of Medicine. "Eventually, they'll manifest themselves somewhere." Indeed, most athletes will try to compensate for a reduced range of back motion elsewhere in the body, and vice versa. Tight hamstrings, for example, stress the intervertebral disks when you bend over. Any incompletely healed foot injury might cause you to favor the other side of your body, putting excess strain on the muscles, tendons, and ligaments around your spine.

"The biggest misconception athletes have about the spine is that it supports the body," says Saal, who has rehabilitated a stable of professional athletes, including Joe Montana, whose back problems are almost as legendary as the quarterback himself. "It's really the other way around. Your body supports your spine." Deprived of support from the muscles around it, the spine can be knocked over with just eight pounds of force, Saal explains. "Without sufficient muscle strength, 80 to 90 percent of the strain from walking, running, lifting, or anything else is placed on the disks. And they're not designed to act as a support system."

Call Upon Your Corset
Whether you've already heard your spine's cry for help or you haven't had a problem yet, stretching and strengthening the muscles and connective tissues that support the spine can spare you some suffering and improve your performance (see "The Cure for Spinelessness" below). Weinstein tells me that I should continue my daily stretches and crunches, but that I should also pay close attention to my obliques, lats, and erector spinae muscles, building them into a tight corset that will keep my spine aligned and soak up the stress that's constantly dumped on its underqualified bones, disks, and joints.

That's what I'm counting on. Not surprisingly, none of the spine doctors I consulted could tell me what's actually causing my brief bouts of pain. Nevertheless, they all suggested that I take particular care to stretch properly and concentrate on my form during strength training. My workouts take 15 or 20 minutes longer, but I go at them with a little less fear.

Dana Sullivan is a frequent contributor to Outside's Bodywork pages.

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