In the next 3 articles, I’m going to speak about the mechanism of injury from the perspective of the spine, but take note:
The content that follows describes the mechanism for injury of all muscles, tendons, ligaments, and bones of the body – here-on referred to as tissues.
Now is a good time to mention, that if you have not yet read my post discussing “loading,” now would be a good time to do so because I’m going to reference those terms quite a bit.
Everyone should recognize that there is a difference between good movement form and bad. The problem is, it’s not always black and white.
For instance, for the longest time, people have been receiving (and then giving) the advice to “lift with your knees” in order to spare your back. On the surface you may think “why not, seems smart to not lift with your back;” however, the advice to “lift with your knees” is very poor advice because it will eventually cause problems with your knees while also not really sparing your spine (if you want to learn more about this here’s a link to my video: https://youtu.be/Xxuj0FpiOjw).
And while gym movements (i.e., squat, deadlift, etc.) have intricate details that are debated hotly, such as whether the “drive your knees out” cue is appropriate, most experts would agree on the general outline for what good form looks like with different lifts.
Outside of the gym, good form and posture seem to be ignored, but I would argue that understanding proper technique is equally important in the day-to-day lives of people who are not going to the gym.
Imagine a person for a moment, who has a disc bulge that is ACTUALLY the cause of their pain (because plenty of people have disc bulges and no symptoms). And let’s say this person’s pain is triggered by bending forward at the spine (flexion).
Think of how many chances this person has to implement poor form in the first 20 minutes of his day:
- Rolling out of bed and leaning forward to check your phone (you know you do it)
- Sitting and going to the bathroom (maybe leaning forward to finish that next level of candy crush)
- Leaning forward to brush your teeth
- Leaning forward to shave/do your hair/makeup
- Standing and bending in the shower (shaving/soaping up/etc)
- Sitting to drink coffee
Your discs are naturally more “filled up” for the first hour or so of the day, and I’m here to tell you, that this person who is “flexion/compression intolerant,” will absolutely trigger their pain if he does not have TREMENDOUS form and stability with all of the above tasks.
So why does this matter? Well, because
this person could have the best list of stretches/exercises YouTube, social media, and Google have to offer (sarcasm intended), but if he does not eliminate the movements that trigger pain throughout the day, it won’t matter one bit.
Look, I know everyone wants the ‘sexy’ answer: do 3 sets of 10 of this, this, and this, and your pain will be cured. And that would be great. But it doesn’t exist.
So what? Just don’t do any of those things first thing in the morning? Just wait it out until an hour or 2 has passed and I can safely (and probably urgently) go to the bathroom? Of course not.
The non-negotiable first step for getting you out of pain, is figuring out what got you into pain in the first place, aka, your mechanism of injury….
Because it will allow you to reverse-engineer your injury, so-to-speak
Once you figure out the mechanism of injury, your rehab, and your life, become MUCH easier.
Let’s start with posture…
I know, booooo not a fun answer.
But those who would tell you that your posture doesn’t matter are flat out wrong, and here’s why:
Let’s start with our definition of posture so we’re all on the same page here. Posture is your body’s positioning at any one time in space. More importantly,
posture (as well as movements) determine the types of load on your joints, muscles, and other soft tissues.
And while there are certainly preferable postures,
there is no single posture that we should be frozen in throughout the day.
This, by the way, is the point people are trying to make when they tell you “posture doesn’t matter.” What they SHOULD be saying is what I’ve just mentioned, because although there are certain postures that are better than others, sitting or standing in one position all day long is NOT the answer to your problems.
The body was designed to move, and you should be doing so often.
I have family members who will roll their eyes at me when I tell them to stand up from their desks and walk around to reduce the back pain that they casually ask me about at the dinner table. “OMG that’s what you get paid for, I can do that!” They’re convinced that since it’s never hurt in the past, that they must have a special case, with a cool name, and a very unique injury mechanism.
Nope.
9 times out of 10, they simply have spent a few days extra hard at work, less mobile, and their body doesn’t like it.
“Dude, I walked 5 miles this morning!”
Great! Then what did you do? If your answer is: well I had work (meaning you sat for the rest of the day) then you’re missing the point.
If this is reading as arrogant – understand that I’m messing around with my family members, if this is something you’re guilty of, I completely understand and it is not at all your fault. Genuinely. I’ll explain in a bit.
Let’s come at this from a different angle.
Do you know why so many watches want you to get in 10,000 steps per day? Because they realize that A) this is a healthy amount of movement, and B) most people aren’t going to knock it out in one attempt. It’s going to take several.
I can’t tell you how many times my competitive friends would have a steps competition with our watches, and after full days on a hospital floor, still found ourselves pacing behind the couch while watching TV so we wouldn’t lose.
Playing us like a fiddle, FitBit!
Seriously, my hats off to that, because it played our competitive spirits against us and FORCED us to stand up and walk, several times per day.
So back to your posture, I’d like to share a graph with you that I think will put this into perspective
The Y Axis is “load” (here’s where my article on loading is going to get important). The X axis is “time.” If you haven’t read the article yet, think of load as the amount of force that is placed on your spine.
What this graph is showing you is that if a consistent submaximal load were placed on your tissues (muscles, ligaments, tendons, bone), then these tissues will gradually LOSE their tolerance to the load over time.
“Failure tolerance,” is in reference to the point where your tissue “fails” – in most cases the tissue will tear.
And mind you, I’m not talking full, clean through the bone/muscle tears, these tears are usually “micro-tears.”
Think of it like this, if you went outside and chose a medium sized limb, grabbed on and hung there, you could reasonably expect it would hold you. BUT, if for example you have super-human endurance, and you held on to that branch for hours, days, weeks, the branch would start to sag. Trees are famous for their ability to bend, not break, but eventually the limb will get weaker and weaker, and either sag until your feet are on the ground, or more likely break like a twig (couldn’t help myself).
Did the tree break because of one specific instance in time? Of course not, you held a consistent load on the branch for an extended period of time, until it simply couldn’t hold you any longer.
Your body is very similar; however, as we will see in a future graph, if we allow these stressed tissues a chance to rest and regenerate, your body will literally heal itself (hang on to this point because “rest” may not be what you’re thinking).
Think about your day. How often are you sitting still, for an extended period of time without movement? Even when you do move, is it basically to change seats so you can eat lunch, and then go to your car, and then to your dinner table, and then to your couch…
See what I’m getting at?
Unless you’re at the very least changing position every 30 minutes, your body is under sustained loading that is weakening its ability to withstand forces.
And that’s in a perfectly healthy, non-painful person!
Now let’s think about the person who is flexion/compression intolerant with a disc bulge
– in other words this person’s body does not have the stability, motor control, or endurance to handle a rounding of the spine in ANY position.
For this person, not only will a sedentary lifestyle decrease his failure tolerance, but so will any flexion posture (see pictures below).
This person’s graph looks different. This person’s “applied load” is much higher on the Y axis, the failure tolerance is much steeper, and happens much more quickly.
Remember back to the list of chances people have to exacerbate a problem in the first 20 minutes of their day. How many of those utilize spinal flexion?
The answer is: all of them.
Which helps us circle back to our original point, why should YOU care about posture, and what you can do about it.
Once a movement assessment uncovers which movements cause your pain, then we have a CLEAR path to recovery and pain elimination.
So far as the person’s posture in the example is concerned, the answer is simple.
Absolutely NO slouching forward.
Not only that, we have to think about other postures this person might be in during the day that would allow the low back to round (because most of you have heard this advice before, and think you are already sitting up as straight as you can)…
…how about driving? Cooking at the counter? Sitting in your couch/recliner? Opening/closing doors?
All of these positions commonly put the spine into a flexed position.
That doesn’t mean torch your recliner, stop driving, and quit cooking. It means you need to be taught how to adjust your postures or set up your environment so that your back does not lose optimal posture.
A simple one for your car is make sure your hips stay above your knees, which will create a natural and neutral curve in your low back.
Lumbar pillows are also a common solution, although many people struggle to place them in the right position, and leave them thinking it’s ineffective.
Regardless of the technique, the important takeaway here is that we take your spine out of the position that causes it pain, so that it can rest, regenerate, heal itself, and most importantly, get out of pain!
Sedentary lifestyle and posture alone are not the whole issue. Fixing posture alone, and moving more often in your day is a good start, but it won’t get you the pain free life you’re looking for. Plenty of people who move all day, every day, still have issues with pain. That’s where the next article picks up…
Citations
- McGill, Stuart. Introduction to the Issues and Scientific Approach Unique to This Book. In: McGill, Stuart. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. 3rd ed. Backfitpro; 2016.