Is Your Ab Workout Hurting Your Back?

[drfunction]

Is Your Ab Workout Hurting Your Back?-Reynolds G. New York Times 2009, June 17 (partial article here and link to full article below)


Some heads up from me--many of us are well trained and have our own opinions on abdominal training--so this article may be more helpful to our untrained friends with low back problems--or you may learn something for yourself.

Dr. Stuart McGill is one of the world's best when it comes to understanding the back and spine. Elite athletes, power lifters, etc… regularly seek Dr. McGill's advice.

I highly suggest searching his name in a search engine. He has been interviewed on another Fitness Forum. It’s worth the read. The interview is in 2 parts in that forum.

Stuart McGill, PhD, is a professor at the University of Waterloo in Ontario, Canada, an internationally recognized lecturer and expert in spine function and injury prevention and rehabilitation. Dr. McGill played football and lifted weights in his youth.

His rehab labs have produced more than 200 scientific publications that address lumbar function, low back injury mechanisms, mechanisms of injury prevention and rehabilitation and, most recently, issues related to high performance.

As a consultant, he has provided expertise on assessment and reduction of the risk of low back injury—along with rehab approaches—to government agencies, corporations, legal firms, professional athletes and teams.

McGill is also known for training and mentoring Dr. Cholewicki, (now a professor at Yale’s medical school, one of the top spine stability scientists in the world). Before Cholewicki became a doctor he was an Eastern European classically trained lifter who moved to Canada from Poland still holding some Canadian records in his weight class.

McGill gives credit to learning from Dr. Vladimir Janda, who taught him how to assess different kinds of movement disorders and syndromes.

Dr. McGill has authored books such as Low Back Disorders: evidence-based prevention and rehabilitation -2nd edition.

In his other book, “Ultimate Back Fitness and Performance”he has a new "squat clinic" that shows how to systematically go through the mechanics while looking for potential improvement opportunities.

In his books Dr. McGill credits many great academic personalities in the spine world such as: Harry Farfan, Bill Kirkaldy-Willis, Dan Chaffin, Bill Adams.

Dr. McGill also gives credit and learning (in his books and interviews) from academic clinicians such as: Craig Liebenson, D.C. (Doctor of Chiropractic), Shirley Sahrmann, Dick Erhart, Rick Jemmett, Paul Hodges, Andry Vleeming, Peter O’Sullivan, Clayton Skaggs.
　
Okay--shortened version of the NY times article:

The genesis of much of the ab work we do these days probably lies in the work done in an Australian physiotherapy lab during the mid-1990s.

The older concepts were: In subjects with healthy backs, the transverse abdominis (TrA) contracts milliseconds before the deltoid when raising the arm into flexion. The nervous system activates the TrA to brace the spine in advance of movement. In Low Back Pain patients TrA firing was delayed. Low Back Pain patients were trained to isolate & strengthen the TrA by sucking in their abdomen & a booming industry of fitness classes was born. The idea leaked into gyms & Pilates classes that core health was “all about the TrA.”

More current concepts: A provocative article published in the The British Journal of Sports Medicine asserted that some of the key findings from the first Australian study of back pain might be wrong.

There’s growing dissent among sports scientists about whether all this attention to the TrA gives you a stronger core/ back & whether it’s even safe.

“There’s so much mythology about the core,” says Stuart McGill, PhD, a highly regarded professor of spine biomechanics.

“The idea has reached trainers & thru them, the public that the core means only the abs. There’s no science behind that idea.”

The muscles forming the core must be balanced to allow the spine to bear large loads.

If you concentrate on strengthening only one set of muscles within the core, you can destabilize the spine.

Instead, he suggests, a core exercise program should emphasize all of the major muscles that girdle the spine – Abdominal Bracing - including the abs. Side bridge & “bird dog” exercise the important muscles embedded along the back & sides of the core.

As for the abdominals, no sit-ups, McGill said; they place devastating loads on the disks.

“Do not hollow your stomach or press your back against the floor,” McGill says.

***Gently lift your head & shoulders, hold briefly & relax back down.***

These 3 exercises – “the Big Three” - Bird Dog, Side Bridge, & Curl-Up can provide well-rounded, thorough core stability & avoid the pitfalls of the all-abs core routine.

“I see too many people,” McGill said “who have six-pack abs and a ruined back.”

Full article: http://well.blogs.nytimes.com/2009/06/17/core-myths/


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“If I have seen further it is by standing on the shoulders of giants.”-Sir Isaac Newton and Bernard of Chartres. (Bernardus Carnotensis)


　

[TPT]

^^^

drfunction.

what exercies do you recommend for the 'core?'

do you think bodybuilders should care about their cores?

[B7emm]

working my abs seems the help my lower back pain. the more often i work my abs the more stable my pain level seems to be.

[TPT]

The genesis of much of the ab work we do these days probably lies in the work done in an Australian physiotherapy lab during the mid-1990s.

The older concepts were: In subjects with healthy backs, the transverse abdominis (TrA) contracts milliseconds before the deltoid when raising the arm into flexion. The nervous system activates the TrA to brace the spine in advance of movement. In Low Back Pain patients TrA firing was delayed. Low Back Pain patients were trained to isolate & strengthen the TrA by sucking in their abdomen & a booming industry of fitness classes was born. The idea leaked into gyms & Pilates classes that core health was “all about the TrA.”

these data presented by hodges and collegues were very influential.

More current concepts:

A provocative article published in the The British Journal of Sports Medicine asserted that some of the key findings from the first Australian study of back pain might be wrong.

we need to find this paper and apprasie it.

[drfunction]

TPT: What exercies do you recommend for the 'core?'

**DF: Depends on patients pain level or an elite athlete looking to prevent injury. Yes, we all need to work complete core. Not just abs. A balance of all the core muscles. Gluts, Erector Spinae, Multifidus, Lat, Abs,TrA,obliques, etc. I once heard it described like a spider web. You can't just cut one section out of a spider web. It will disturb the whole web.

TPT: do you think bodybuilders should care about their cores?
** DF:Of course. If they want to train for multiple years without injury. Can't compete if you are injured. But my Fav muscle is the multifidus.

Key points: The Multifidus is the fastest muscle to atrophy when not used. (Complete bed rest studies on this-- within just days of bed rest)
The Multifidus is the most medial lumbar muscle. (Deepest to the spine)
The Multifidus has a close relationship to the facet joints and by controlling the sliding movement of the facets, controls the distribution of stresses and loading on the vertebral joints.
The Multifidus is the only muscle that's primary function is to protect the vertebral joints.
The Multifidus almost runs the entire length of the spine and is innervated neurologically by each vertebral level.(unlike most muscles with single/double nerve innervation)

4 Interesting studies on Multifidus. I have many more but these were handy.

1. Clin Biomech 1996;11(1):1-15 Cholewicki J, McGill SM. (This study is worth a full read) Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Summary: Utilizing intramuscular EMG and cineradiography while a weight lifter performed various lifting strategies, it was shown that the stoop position during lifting a weight could cause a momentary subluxation of lumbar vertebrae. This was accompanied by sharp pain and immediate multifidus activity. In contrast, while lifting weights with the lumbar spine maintained in lordosis, no such situation occurred.
----------------------

2. Kadler, M.D. et al. -Clinical Radiology 2000;55:145-149
Correlation between the MRI changes in the lumbar multifidus muscles and leg pain.
MRI's of 78 Back pain patients (17-72 years) with or without leg pain were analyzed for lumbar multifidus atrophy, disc degeneration and Nerve root compression.
Multifidus atrophy was present in 80% of patients with Low back pain and was bilateral in most cases and at L4/L5 and L5/S1 levels together. Muscle atrophy was more common in older patients and females. The correlation between multifidus atrophy and leg pain was significant. Atrophy of multifidus may explain referred leg pain in the absence of other MR abnormalities and should be assessed in MRIs of lumbar spine. Multifidus are innervated unisegmentally by the medial branch of the ramus. Multifidus wasting may be caused by the Lumbar Dorsal Ramus Syndrome: Low Back Pain with referred leg pain induced by irritation to structures innervated by the dorsal ramus nerve, (facet joints, multifidus, interspinous ligaments, or by myofascial injury) due to acute or chronic trauma which initiates myofascial pain, spasm, and ischemia. This triggers self sustained vicious cycle that promotes muscle atrophy. Structures innervated by the medial branch of the posterior primary division (AKA dorsal ramus) of the spinal nerves multifidus, facet joint capsule, interspinales, medial intersversarri, superspinous and interspinous legaments, and legamentum flavum.
---------------------------------

3. Richardson, PhD,BPhty, Jull, BPhty, GradDipManip Ther, et al.
Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain. 2nd edition Edinburgh, Churchill livingstone 2004: 59-73
The Multifidus is the most medial lumbar muscle. (Deepest to the spine)
This muscle has 5 separate bands which stem from spinous processes and laminae of lumbars in the lumbar region.
The deepest and shortest fascicle arises from the vertebral lamina (laminar fibers) and inserts into the mammillary processes of the Vert 2 levels below with L5 fibers inserting onto the sacrum.
The other fasiciles arise from the SP and are longer.
Some of the deepest Multifidus fibers attach to the capsules of the facet joints.
The Multifidus has a unique segmental arrangement and the capacity for fine control of movements of individual lumbar vert.
The Multifidus is segmentally innervated by the medial branch of the dorsal ramus.
Each nerve innervates only the fascicles that arise from that vertebrate indicating a direct relationship between a Vert segment and its Multifidus.
The segmental Multifidus can control a segment to match the applied load.
Multifidus muscle bulk increases caudally from L2 to S1.
The Multifidus is the largest muscle spanning the lumbosacral junction.
In contrast, the cross-sectional area of the lumbar longissimus and iliocostalis decreases on progression caudally.
The large size of the Multifidus at the lumbosacral jct compared with the lumbar erector spinae suggests that the Multifidus is the most capable of providing support at this level.
It is the L4-5 and L5-S1 segments that have the highest incidence of pathology in low back pain.
The Multifidus has a close relationship to the facet joints and by controlling the sliding movement of the facets, controls the distribution of stresses and loading on the vertebral joints.
The Multifidus is the only muscle that's primary function is to protect the vertebral joints.
------------------
4.Bogduk, M.D., PhD. Clinical anatomy of the lumbar spine and sacrum. New York, Churchill Livingstone 1997: 133
The lumbar dorsal rami (nerves) divide into a medial branch, a lateral branch and a variable intermediate branch.
The lateral branches are distributed to the iliocostalis uscle, but can all so be cutaneous.
The intermediate branches have only a muscular distribution, to the lentissimo muscle.
The medial branches that are most relevant because they supply the facet joints.
Each divides into multiple branches to supply the multifidus, the inversions muscle and ligament and two facet joints.
Each medial branch supplies the facet joints above and below its course.
The muscular distribution of the medial branches to the multifidus is very specific. Each medial branch supplies only those muscles that arise from the lamina and spinous process of the vertebra with the same segmental number as the nerve. The principal muscles that move a vertebrate segment are innervated by the nerve of that segment.

[Ninja Loco]

Not my ab workouts, no, and I run a pretty serious gammut. Actually I dont consider it an ab workout but a full core workout. For some reason only back workouts still tend to bother my lower back, but only for a day or so.

[TPT]

TPT: What exercies do you recommend for the 'core?'

**DF: Depends on patients pain level or an elite athlete looking to prevent injury. Yes, we all need to work complete core. Not just abs. A balance of all the core muscles. Gluts, Erector Spinae, Multifidus, Lat, Abs,TrA,obliques, etc. I once heard it described like a spider web. You can't just cut one section out of a spider web. It will disturb the whole web.

definately. and thank you for the references.

what exercies or routine? supervised and unsupervised.

bodybuilders dont usually include these in their routines and usually need initial supervision.

TPT: do you think bodybuilders should care about their cores?
** DF:Of course. If they want to train for multiple years without injury. Can't compete if you are injured. But my Fav muscle is the multifidus.

Key points: The Multifidus is the fastest muscle to atrophy when not used. (Complete bed rest studies on this-- within just days of bed rest)
The Multifidus is the most medial lumbar muscle. (Deepest to the spine)
The Multifidus has a close relationship to the facet joints and by controlling the sliding movement of the facets, controls the distribution of stresses and loading on the vertebral joints.
The Multifidus is the only muscle that's primary function is to protect the vertebral joints.
The Multifidus almost runs the entire length of the spine and is innervated neurologically by each vertebral level.(unlike most muscles with single/double nerve innervation)

interesting functions of multifidus including becoming stronger when lengthened. very different from other muscles when put on stretch.

key is how do we get people including bodybuilders to self-palpate and activate multifidus and what are the best ways? that is usually difficult to do likely because of the location of the muscle, lack of muscle endurance, and motor control. it is not this large phasic muscle that we love to activate through large movements. and its endurance based through isometrics where we're largely 'weaker' or lack the motor control.

[HammerStrength12]

^^^

drfunction.

what exercies do you recommend for the 'core?'

do you think bodybuilders should care about their cores?

I strongly believe that all bodybuilders should care about their cores.

I, for one have to because of a disc herniation I suffered. If you're gonna squat and deadlift heavy, core strength is essential to maintaining neutral alignment and protecting the spine.

[Electric_Road_Guy]

Whenever i do any form of leg lifts, hanging, laying, doesnt matter, my lower back makes and audible 'click' and fuck does it hurt.
My core has suffered a bit cause of this. So I find myself with the 4... but cant quite get back my 6.
Well, that and the fat i still have left over... :-)
Least im admitting it... lol.

[jamesinark]

Hey there as you can probably see for yourself ,I'm new to this forum and just recently having stumbled upon it while doing some research for another subject I found this thread and can't help but ask a few questions.I am dealing with a bulging disk at L-5/S-1 and also L-4/L-5 with some spinal stenosis as a result.When I finally sought treatment I was too far gone for anything but convential surgery and/or pain management.I went along with the usual forms of treatment (not doing much of any thing)and I got worse.Worse as in 5 different bouts of temporary paralysis.To sum things up I have lifted weights intermittently for a year or so at a time for the last 20 years or so,and decided that doing something was better than just degenerating little by little.I've found that my self designed core strengthening program has helped enormously along with getting back to working out seriously for the last year has brought me a long way from where I was.I was reading the previous posts on here and couldn't agree more than with the first one.does anyone have any more specific advice on exercises for the lower back?Any new input other than my own would be greatly appreciated as You can never stop learning.

[ob205]

James,
I would recommend reading the works of Stuart McGill, since I think he is the foremost expert on the matter. Also, this is a question for someone more qualified than myself, such as TPT or other forum expert. My one exercise I would recommend, assuming it is not contraindicated for your specific condition, would be reverse hypers. I know Louie Simmons, who invented it, used it to come back from a serious back injury and go on to set PR in powerlifting.

[jamesinark]

I already use reverse hyper extensions as part of my back routine.Every day that I go to the gym I spend at least an hour on abdominal exercises that I've found to help with my specific problem as well as the reverse hypers and just recently started to use some isometric exercises such as bridging, and others mentioned at the beginning of this thread.Just looking for suggestions on other exercises that others have found to be helpful.I've just seriously started working out for the last year and have came a long way and would like to continue to learn more so I can keep making gains as well reduce my use of pain meds.

[ob205]

Did I just read that correctly you spend 1 hour on abdominal training ALONE! I and almost anyone else would consider that over training! Give us an example of 1 hour of core work. Also, are you doing a lot of flexion movements for abs? That may not be the best thing for spinal health.