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Question from a Reader: Back Pain, Roman Chair, and Exercise

Posted Nov 17 2008 6:05am

This is a long one.

I received an email from a reader (thank you Ms. S for sending in your question) asking me about her back trouble and an exercise in comparison to the Roman Chair. Because the email has several things we can learn from, I'm answering it in a slightly unusual way: you'll notice that the email text is in red and my thoughts are in black within the body of the email itself.

I hope you find this helpful (remember - I answer emails in the blog).

Hi. I hope you are able to receive my email response to your last post on the roman chair. I have had pain for over four years in my groin and legs. It especially flares up after doing any kind of leg lifts lying on my back. Leg lifts while lying on your back create high levels of compression in the lumbar spine as well as high shear forces (this is a force that tries to slide the vertebral bodies apart). The L4-5 region can refer pain to the hip and groin. This may be happening because of the force generated by the exercise.

I have realized that I had to keep my spine neutral and it has helped tremendously. This keeps the force distribution balanced through your spine.  You should strive for a neutral position during your waking hours.

My question to you Sir if I may is does the exercise that is called the triple treat bad for the hips and back. It is done lying with your back on the floor and your legs on top of a big ball. You raise your hips off the floor, holding it in that position and bending the knees bringing the ball in and out. Would that not cause more issues? It is the number two exercise that is given when you have back issues beside the dreaded superman. By the way I have two bulges and tears to my S1/L5 and L5/L4 spine. I have been told that my herniation and bulges are not significantly enough to be causing my groin and leg pain. All my doctors are puzzled by this which has been very disheartening to me as I am a young forty-two year old personal trainer and mother. I don't know of a study that has looked at the "triple threat" exercise that you described but from my analysis, I would classify it as about the same degree of difficulty and level of risk as the "superman" and I would not prescribe it for you. Sometimes clinicians make the mistake of associating the degree of disc damage with the degree of injury. There is no correlation. The issue is whether your spinal tissues can withstand the force that they're exposed to or not.

I do not look like I have issues because I do things everyday to make my day better. I stretch twice a day and do my pelvic tilts along with my plank work. Stretching is something I prescribe very carefully in people who have disc injuries.  Any stretching you do should avoid movement of the spine itself (so no twisting, bending, etc). Plank exercise is a good choice since it has relatively low compression and shear forces.

I have issues with the pool because it causes my knee on my operated side(hip scope in 2004)to burn and causes a chronic cyst to act up. It is so frustrating because I have different issues on both side of my body that I cannot address because it flares up other issues. I found your site when looking for answers and you have been the most helpful along with Dr. Jolie . I tried following her suggestions but I have a lot of issues with doing the split lounges and the full squats. It causes my knees to flare up so bad that it took about three months for me to bend my knees or to sit with my legs extended in front of me like a hamstring stretch. The outside of my knee would burn so much. Your knee pain may or may not be related to your spine problem. It's hard for me to tell without seeing you. Split lunges and squats may be more force than what your spine and knees can withstand. Again, this is where email has limits. There is no substitute for an interview and examination.

I had my MRI retaken of my back and it had not change at all and that is with all of the proactive, conservative approaches. I have had numerous therapy, chiropractor, facets injections, one epidural and twenty eight decompression therapy sessions. The most helpful thing I have done so far is to get myofascial release therapy. But I am right back to square one in terms of my issues at every visit. I especially have a lot of muscle soreness and pain in my entire glutes. It feels so bruised when he gets into the layers of my glutes. Can you please help me with any suggestions that you may have. Giving you specific advice is difficult, if not impossible, but I can give you my thoughts. I often start people with your type of problem with three things:

  1. Reduce the amount of sitting at one time and in total during the day. Do this by getting a pedometer and shoot for 10,000 steps per day. The more you sit, the worse it is for your spine. If you must sit, use an inflatable beach ball (with just a small bit of air in it) behind your lower back. This will give your spine support and help reduce the forces on the back side of the spine. Sit less and walk more.
  2. Every two hours, lie down on the floor and place your lower legs on a Swiss Ball. You may need to place your trunk on a couple of pillows. In this position, slowly roll your legs back and forth a very small amount (as soon as you feel your buttock come off the floor, stop the motion and go the other way). The excursion is usually only a couple of inches. It should be relaxing and easy to do and not painful. Do this for 10 minutes.
  3. Learn how to "Lock and Load" and use it everyday. Lock and Load is a phrase we use to describe the process of engaging the spinal stabilizer muscles. Some people call this "drawing in" or "hollowing out" the abdomen but it's not either of those things. To learn how to get your abdominals and spine muscles to work, lie on your back again with your feet on the Swiss Ball. Place your hand on your lower abdomen. Now, imagine a burning candle a few feet in front of you. Purse your lips and try to blow out the candle. You'll feel tension in your abdomen. This is the kind of tension you need in your abdomen all day long, every day, for the rest of your life. You must learn how to produce it and vary it according to the task. If you're sitting in your chair, you need a very light amount of tension. If you're going to lift a heavy box, you need a lot of tension. This is a key step. Without mastering this, all other exercises become very difficult to do.

People have asked me, "That's it? That's all I have to do?" To which I respond, "For now." In most cases, if people follow these instructions, they feel better in a few weeks. Better but not well. Some give up because it seems too simple or because the process is too slow. Rebuilding your spine strength takes time. There are no short cuts. So, if you're looking for a quick fix, my approach is not for you.

When I was recovering from my disc herniation earlier this year, I spent a lot of time in positions to reduce the pressure on my spine. I was often frustrated, scared, worried and tempted to try to do more things to feel better faster. But, I tried my best to look at one day as just one day and stay focused on what I needed to do now. There are many other things included in rebuilding your spine strength and for that matter your life. You can read about all the things I did here. It may give you some additional perspective.

One last thought. You might try locating a physical therapist, board certified in orthopedic physical therapy, in your area and asking about his or her approach to your problem. If it seems that the approach is organized around eliminating your symptoms without teaching you what you need to do, keep looking.

Be well.
Doug Kelsey

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