The Spinal Frontier

Rule number one for total physical fitness? Where your back goes, all else follows. Keep yours in top shape with our guide to strength, flexibility, and injury treatment.

A strong back means a healthy back (Eyewire Images)
Owner’s Manual: Your Back

The stats aren't pretty. More than 80 percent of us will have back pain at some point in our lives, and it's the second most common reason we see a doctor (numero uno: headaches). Nonetheless, most athletes know as much about the inside of the human back as they do about the innards of a heart-rate monitor—and doctors are often in a similar state of ignorance. Whereas knee problems can be quickly diagnosed with an MRI and often solved with routine surgery, lower-back pain involves so many variables and moving parts—tendons, muscles, and multiple joints—that pinpointing the problem can be similar to reading tea leaves. Without a proper diagnosis, the infamous but ambiguous "bad back" plagues many to the grave; surgery, meanwhile, is a last resort that can't solve every problem. Depressed yet? Don't be: There's plenty of information out there to make sure you never start resembling Quasimodo. Even better, we've done the homework for you. After talking to dozens of back specialists and combing through the latest research, we've devised a back-specific exercise-and-treatment plan that will keep you upright and in the game forever. Taking apart your heart-rate monitor is up to you.

Get a Diagnosis

Understanding what causes a sore lower back is the first step toward recovery—and prevention. Here are the most common injuries.

Q & A

How long should I stay in bed after a back injury?
As little as possible. Inactivity reduces blood flow essential to healing and, most significantly, prevents your back muscles from staying strong. "There's no danger in getting up and moving around," says Dr. Marjorie Eskay-Auerbach, a Tucson-based orthopedic surgeon and expert in lower-back care. "Use your pain as a guide and do whatever you can tolerate. That might mean putting the mountain biking on hold, but you can probably still go for a walk." Swimming and riding a stationary bike are other recommended low-impact recovery activities.

Human Back

L-Dopa

1. Lumbar Strain
WHAT IT IS: An unfortunately vague diagnosis that accounts for about 90 percent of all lower-back injuries. It's caused by a pull or tweak of any of the muscles, ligaments, connective tissue, joint capsules, or cartilage in your lower back. HOW IT HAPPENS: Lift something heavy without bending your knees, land awkwardly, wake up with a random soreness—all are probably strains or sprains. WHAT IT FEELS LIKE: A hard-to-pinpoint ache or stiffness that can radiate into your rear end. PROGNOSIS: With proper rest and low-impact exercise, most cases remedy themselves within three months. The bad news: It often recurs.

2. Herniated Disc
WHAT IT IS: A tear in the outer fibers of a disc, the shock-absorbing pad between the vertebrae, which may cause the disc's jellylike nucleus to push through the fibers. Also called a slipped or ruptured disc. HOW IT HAPPENS: Causes can be similar to those of a strain or sprain. Discs also lose fluidity with age. WHAT IT FEELS LIKE: If minor, you'll feel the type of ache associated with a lumbar strain. The discomfort becomes worse if the slipped disc presses against a nerve; even more acute if the disc rubs against the sciatic nerve, causing shooting pain (called sciatica) and possible numbness in one leg. PROGNOSIS: More than 95 percent of people recover through rest and therapy. Steroid injections, which control pain and swelling for several months, are a common treatment for the hardest to cure.

3. Compression Fracture
WHAT IT IS: A break in the bone structure of the vertebra. It's most common in the vertebrae about two-thirds of the way down your back. HOW IT HAPPENS: A sudden impact coupled with flexing your back—think of lurching forward when smacking hard on the landing of a big jump on a bike or skis. WHAT IT FEELS LIKE: Intense pain directly on the spine where the fracture has occurred. PROGNOSIS: You'll typically wear a back brace for upwards of six weeks while the fracture heals.

4. Spondylolysis
WHAT IT IS: Something as bad as it sounds, unfortunately: a crack in the solid part of the vertebra. Like a herniation, it occurs at the base of the spine. Worse still is isthmic spondylolisthesis, a crack that forces a vertebra to slip over the one below it. HOW IT HAPPENS: Some 4 to 8 percent of people are born with the defect. It can develop into isthmic spondylolisthesis, which can occur during growth spurts or as a result of repetitive exercise, like a stress fracture. WHAT IT FEELS LIKE: Either one can cause pain that's no different from the typical strain or sprain; amazingly, in some cases there are no symptoms at all. PROGNOSIS: Taking a break from pain-causing activities and doing core-strengthening exercises is usually sufficient, though surgery may be required.

Use the Prevent Defense

Your core means your abs, right? Wrong, says Mark Verstegen, author of the new Core Performance book series (Rodale) and founder of the Athletes' Performance institutes, where pros like Detroit Pistons guard Chauncey Billups get training help. According to Verstegen, your core means muscles throughout your torso, hips, and shoulders, which are literally the backbone for daily and athletic movements. Follow this two-part workout he created to maintain a strong and stable back. Do the Mobility/Stability Circuit first, then transition immediately to the Strength Circuit (perform the workout two or three times per week).

MOBILITY/STABILITY CIRCUIT: Perform each of the five exercises in succession, then repeat the cycle for two complete sets.

1 DIAGONAL ARM LIFT
In modified push-up position (resting on forearms and feet slightly wider than shoulder width apart), extend right arm toward 2 o'clock without moving your torso. Hold for two seconds, then switch, extending left arm toward 10 o'clock. 6 reps each arm

2 MINIBAND HIP ROTATIONS
Stand in athletic position with a taut miniband just above your knees. Stretch the band by rotating your right knee inward and then outward. Don't move your pelvis or foot position. Switch after completing all repetitions with right leg. 12 reps each side

3 BACKWARD LUNGE
Step backward with right leg into a lunge, then raise your right arm straight overhead. Then side-bend to the left. Return to standing, switch legs, and repeat. Make sure your front knee does not move beyond your toes during the lunge. 6 reps each side

4 MARCHING GLUTE BRIDGE
Lying face up with arms at sides, knees bent, and heels on ground, raise hips until they are in line with your shoulders and knees. Bring your right knee to your chest; don't dip your hips. Return foot to ground; switch legs, repeat. 6 reps each side

5 QUADRUPED POSTERIOR ROCKING
On hands and knees, with hands under shoulders and knees under hips, push hips back as far as you can, stopping just before your pelvis starts to rotate under. Hold for two seconds and repeat. 6 reps

STRENGTH CIRCUIT: Complete two cycles, performing all three exercises in succession.

1 LATERAL-SLIDE SQUATStand with your left foot on a Valslide (valslide.com) or other material that will slide, such as a towel on a hardwood floor. Squat with your left leg to 90 degrees while sliding your right leg away from your body. Make sure your squatting knee doesn't go in front of your foot. Return to standing. Complete all repetitions, then switch legs. 10 reps each side

2 STABILITY CABLE CHOP
Holding a triceps pull-down rope with both hands (left arm extended, right arm in front of your chest) and left leg forward in a scissor stance, pull the cable by flexing your left arm to your left shoulder while extending your right arm away from your body. Then extend your left arm down and across your body without rotating your torso. Switch arms, repeat. 10 reps each side

3 ROMANIAN DEAD LIFT
Standing on left foot while holding dumbbells by your sides, pivot over so that dumbbells lower to the floor as right leg rises to parallel with the floor. Make sure your leg and upper body move as one stiff board, with your back never rounding. Switch legs, repeat. 10 reps each side

Work Smarter

Corporate suits may pretend otherwise, but evolution didn't prepare us for sitting in front of a computer ten hours a day. Your spine faces its highest daily load when you're sitting, and if you're slumped over filling out countless TPS reports, that pressure nearly doubles. Follow these guidelines to save your back without quitting your job.

Back Injury Prevention
L-Dopa

Q & A

Is it possible to have a herniated disc and not know it?
Yes. In a groundbreaking study published in The New England Journal of Medicine, more than half of the pain-free participants had some level of disc herniation. Lesson: Just because an MRI reveals a herniation doesn't mean that a simple lumbar strain isn't the root cause of your back pain. To be safe, get a second opinion from a physician who specializes in backs.

1. CHAIR Recline 10-20 degrees beyond vertical to relieve pressure on discs. Your chair should also provide support from your lower back up to your shoulder blades. For additional support, use a rolled-up towel behind your lower back. Swiss balls are OK for short periods, as they encourage good posture and strengthen torso muscles, but over long intervals they tend to cause slouching—with no support.

2. HIPS/FEET Distribute weight on as much of your body as possible. Your hips should be slightly higher than your knees, your butt as far back as possible, and your feet flat on the floor. Use a footrest if you can't achieve the proper position due to chair or desk height.

3. HANDS Avoid reaching for your keyboard or mouse. You should be able to place your hands comfortably in your lap and then raise them a few inches to reach both keyboard and mouse.

4. MONITOR The top of your monitor should be at eye level. Make sure you can read the screen easily and that it's not backlit.

5. UPPER BODY You should be reclining with your head, neck, and shoulders in line with your torso and relaxed—beware of too-high armrests that keep your shoulders shrugged.

Row This Way
If you use an erg, or rowing machine, you already know it delivers one of the most grueling workouts you can get on a piece of stationary exercise equipment. But a study published in The American Journal of Sports Medicine in 2002 found a correlation between rowing an erg for more than 30 minutes and back injury. Dr. Timothy Hosea, the team physician for the U.S. Rowing Team, says to follow these rules for a safe and effective workout.

1. Maintain proper technique (back straight, abs engaged)
2. Stick to a high-stroke, low-resistance workout (22-24 strokes/minute)
3. Get off and stretch if rowing for more than 20 minutes

Build a Better Back
For some injuries, the only remedy is spinal-fusion surgery, which alleviates pain but decreases flexibility—a result of cementing two vertebrae together. Until now. New artificial discs and other products may enable today's patients to enter limbo competitions. In October 2004, Charité became the first artificial disc approved by the FDA; ProDisc-L was given the green light last August. "It's definitely the most exciting area in terms of spine surgery today," says Dr. Richard Guyer, president of the North American Spine Society.

Chill Out

Our aching Lab Rat tests the world's most expensive ice pack

Q & A

Ice or heat after injury?
It's generally recommended to use ice for the first three days (up to 30 minutes every two hours) to prevent swelling and pain. Do not hit the hot tub. After that initial window, though, do what feels best. There's no set prescription, but anything that reduces pain is good.

Game Ready

Game Ready Control Unit

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Winter arrived, and its bitter winds bore multiple injuries: Turned my ankle in a late-season soccer game, bashed my knee against a rock during a backcountry ski tour, tweaked my back on a trail run. Then came my high-speed yard sale on a beginner's run in Colorado, during which I cantilevered facefirst into the slope with such force it broke my goggles, wrenched my right shoulder, and whiplashed my body into what contortionists call a "scorpion" a highly unnatural backbend in which your feet wrap over your head and touch the ground.

 

Staying upright much less fit was becoming a daily war of attrition. Since I was spending so much time nursing sprains and strains, I invested in my own personal rehab wonder. A 26-year-old Swedish masseuse named Brigitta? Alas, no. I got a Game Ready.

Game Ready (gameready.com) is a portable device about the size of a toaster oven. It pumps ice water and air through a variety of articulated cuffs that fit over injured body parts ankles, knees, back, shoulders, etc. In essence, it's a high-tech update on RICE (rest, ice, compression, elevation), offering a few distinct advantages over a bag of frozen peas. Game Ready's cuffs Velcro snugly over odd-shaped body parts; they inflate like a blood-pressure sleeve to combine compression with penetrating cold; and they don't turn warm and mushy after 20 minutes.

Originally developed by NASA to help cool space suits, the technology migrated into therapeutic application in 1998 for treatment of acute injuries. Since then, it's become a staple in training rooms, physical-therapy clinics, and, more recently, private homes. (But it requires serious soreness to warrant your own personal unit expect to pay about $2,500, depending on the joint wraps needed.)

Trainers and therapists have long appreciated the value of cold for treating injuries, since it's the swelling that contributes most to pain, slow recovery, and scar tissue. "A common denominator in almost all outdoor-sports injuries is joint swelling," says Jeremy Rodgers, 33, a certified athletic trainer at the Colorado Sports Chiropractic Center, in Louisville, Colorado. "From a rehab standpoint, if you can control that swelling, that's the number-one predictor of a good outcome."

It was a no-brainer to use Game Ready on my ski-wrecked shoulder. But I soon discovered another blessed application: routine workout recovery, especially for my lower back, which, since I'm a slouching desk dork most of the week, was agitated after almost every run. The therapeutic potency of cold and compression worked miracles my back was usually pain-free by the next day. My shoulder took a week to recover, but that was a lot better than three weeks. And no visits to my local rehab clinic required; I could ice several times a day while watching HBO from the couch. I even asked the Game Ready folks if they were going to make a full-body suit, which made them laugh momentarily.

Find Your Fix

If you suffer from chronic back pain, you're probably willing to try anything for a cure. But in the growing field of alternative medicine, you'll likely struggle when distinguishing sound advice from snake oil. Instead, let Daniel Cherkin be your guide. The 57-year-old associate director for research at Seattle's Group Health Center for Health Stud

Back Pain Relief
(Jonathan Carlson)

1. Therapeutic MassageMassage relaxes muscles and other soft tissues and increases blood flow and oxygen in affected areas, thus encouraging healing and recovery.
HAS IT WORKED? Cherkin led a randomized trial, published in the Archives of Internal Medicine in 2001, that found therapeutic massage effectively treated lower-back pain over the course of a year. Group Health subsequently included massage under its covered benefits for chronic back pain.
FIND THE RIGHT SHOP: In addition to becoming certified, therapists can enroll in courses that teach hundreds of specialized techniques. For the lower back, seek out those who have trained in neuromuscular and myofascial modalities. Consult the National Certification Board for Therapeutic Massage and Bodywork's online directory at ncbtmb.com.

2. Acupuncture
This traditional Chinese treatment has become mainstream in the U.S., with more than two million patients annually. Thin metallic needles are inserted just below the skin to release blockages in energy flow (called qi) and return the body to a balanced state. Acupuncturists may twirl the needles or apply heat or a slight electric current during the treatment.
HAS IT WORKED? Studies called for by the National Institutes of Health have shown acupuncture to be effective in curbing postoperative pain and nausea, as well as fighting the effects of arthritic knees. In the same study in which Cherkin found massage to help curb lower-back pain, he found acupuncture to be only slightly less effective.
FIND THE RIGHT SHOP: Forty-two states regulate acupuncture through the National Certification Commission for Acupuncture and Oriental Medicine; search for a certified practitioner at nccaom.org.

3. Chiropractic Manipulation
Fans and skeptics alternately laud and lampoon this treatment. The most common practice is an "adjustment," wherein the practitioner gives a quick, controlled force to a particular joint in your spine. The manipulation is sometimes punctuated by an audible "pop," which is the sound of the joint repositioning. This adjustment is believed to fix the spinal misalignment causing pain.
HAS IT WORKED? Even with numerous studies, the jury is still out. A randomized trial in 2002 found it to be as effective as conventional medicine. In Cherkin's own research, published in The New England Journal of Medicine in 1998, he found it to be "only marginally better than the minimal intervention of an educational booklet."
FIND THE RIGHT SHOP: Chiropractors complete a four-year classroom-and-clinical program and take state or national exams. Look for licenses and a degree from an accredited chiropractic college.

4. Yoga
Anyone who can do a cobra pose can't have back pain. Yoga incorporates controlled breathing while putting your body through a series of stretches and poses, in order to promote strength and flexibility.
HAS IT WORKED? Cherkin's colleague Karen Sherman led a study (published in the Annals of Internal Medicine in 2005) that found yoga to be effective in not only improving back-related function but reducing chronic pain over the course of a 26-week period.
FIND THE RIGHT SHOP: Without one certifying body, you're limited to asking instructors how long they've been teaching and what they've done to update their methods. Talk to current students to see if a teacher is right for you.

5. Alexander Technique
Developed by an Aussie Shakespearean actor (really), it's a hands-on technique for improving posture, coordination, and movement. During one-on-one lessons, a teacher guides you in various positions and movements, focusing primarily on the relationship between the head, neck, and torso. It takes about 30 classes to pick up.
HAS IT WORKED? Long embraced in performance circles—it's a required course in Juilliard's dance and drama programs—Alexander Technique was accepted as a component in most of Switzerland's national-health-care packages to combat chronic pain. Cherkin has not studied it.
FIND THE RIGHT SHOP: More than 700 teachers are registered with the American Society for the Alexander Technique (alexandertech.org); all have completed at least 1,600 hours of training over a minimum of three years. Beware of "bodyworkers" who have not completed such detailed training.

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