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low back flexibility, low back pain

Low-back flexibility

Low-back flexibility: Before you enter a match, here's what to do to keep your low back supple and help avoid getting hurt

Lumbar-spine pain accounts for 5 to 8% of all athletic injuries, and many sports-medicine experts believe that inflexibility of the lumbar spine increases the risk of low-back pain and injury in athletes(1). Supporting this contention, recent research with élite golfers has shown that golfers with a reduced ability to rotate their trunks were at increased risk of low-back pain, compared to golfers with better trunk rotation(2). In addition, pain-free golfers demonstrated over twice as much trunk-flexion velocity on the downswing, suggesting that they possessed superior overall low-back flexibility and range of motion, compared to golfers with back problems. Of course, such studies are subject to criticism. For one thing, it is not certain that observed low-back inflexibility is a cause of back pain; it may actually be one of the consequences. Nonetheless, it is logical to believe that inflexibility could increase the stresses placed on the muscles, tendons, and ligaments of the low back during activity and thus damage those tissues – or else produce enough fatigue in the tissues so that the structures they protect, including the spinal bones and nerves, might be at increased risk of harm.

Sitting on the bench

Thus, the athletic world in general tends to believe that improved low-back flexibility is an injury preventer, but – paradoxically – many common athletic practices and procedures actually seem to magnify, rather than lessen, low-back stiffness. For example, substitute players in a variety of sports, including basketball, volleyball, football, and hockey, often go through vigorous pre-game warm-ups to unkink various body regions, including the back, but then proceed to sit for extended periods of time on the team bench before entering the game. It is likely that this bench-sitting negates the potentially positive effects of the warm-up and stiffens up the athletes’ backs just before they are thrust into dynamic, low-back-stressing competition. To find out if bench-sitting prior to strenuous exercise is really bad for athletes’ backs, scientists at the University of Waterloo in Ontario, Canada, recently studied nine healthy male athletes from the university volleyball team, all of whom had been free of chronic or disabling low-back pain for at least a year(3). First, the researchers evaluated the players for stiffness during four key low-back movements – spinal flexion, spinal extension, lateral (side-to-side) bending, and counter clockwise twisting. All nine individuals then participated in a fairly rigorous warm-up consisting of two minutes of jogging, two minutes of footwork drills (sidestepping, high knees, etc), three minutes of medium-speed “suicides”, one minute of block jumps, one minute of three-metre line touches, one minute of fast “suicides”, and then 10 minutes of “pepper” with the volleyball (in which the ball is volleyed back and forth between participants standing in a rough circle).

Immediately after the pepper, the athletes completed one minute of stretching for the low back, one minute of stretches for the middle back, one minute for the hamstrings, one minute for the quadriceps muscles, one minute for the back-plus-hamstrings (utilising a seated forward lean with legs together), and then one minute for the glutes.

Immediately after this warm-up and stretching period ended, the athletes were tested for stiffness again. They then sat on a standard team bench for 30 minutes, after which their stiffness levels were evaluated one last time (to see what kind of stiffness they might exhibit as they entered a contest at about the 30-minute-post-warm-up point).

Flexibility of the low back during flexion and extension and lateral bending was measured with athletes positioned in a supine position on a “jig” which fixed the lower body at the pelvis on an immovable platform, and attached the upper body to a support which rolled on a virtually frictionless bearing system which allowed unrestricted, planar, “X-Y” motions. Axial-twist (rotational) flexibility was determined with the players standing on a turntable with their torsos fixed at the ribcage; to produce rotation of the lumbar spine, the turntable rotated gradually while the torso remained in place (for full details on how the flexibility measurements were carried out, see reference 4).

The warm-up increased stiffness!

The results were intriguing, to say the least. As it turned out, the very active warm-up – contrary to expectations – produced no significant decrease in stiffness for any of the four key spinal movements flexion, extension, lateral bending, or rotation. In fact, the warm-up was associated with an increase in low-back stiffness for many of the athletes.

In addition, the combination of warm-up and bench-sitting produced a pronounced increase in stiffness during low-back extension and lateral bending, compared to the pre-warm-up condition. As the scientists involved in this study concluded logically, “a warm-up on its own does not substantially alter spine stiffness but a warm-up followed by bench rest results in an increase in stiffness of the lumbar spine in some motions (extension and lateral bending)”. As the researchers said in their understated fashion: “Those with symptomatic backs in particular may benefit from addressing the additional stiffness from bench sitting before the resumption of play”. In other words, athletes who are destined to be substitutes in games need to acknowledge that their pre-competition warm-up followed by bench sitting will actually make their backs stiffer than they were before entering the stadium or arena on the day of competition. In this sense, the athletes have made themselves less ready for dynamic activity and perhaps more prone to low-back injury because of the traditional way in which they have prepared themselves for sports, with a warm-up preceding a bench respite. What should we make of this study? First, it is important to note that not all research links warming up with no change in flexibility. For example, in research carried out at the University of British Columbia in Canada, nine fit males (with average VO2max of 60 ml/kg/min) improved range of motion during ankle dorsiflexion and hip extension by jogging for 15 minutes and then engaging in a variety of lower-limb stretching exercises (5). A very interesting aspect of this study was that the intensity of warm-up appeared to have an effect on range-of-motion improvement, since hip-flexion range of motion improved when the warm-up jogging occurred at an intensity of 80% VO2max, but not at 60 or 70% VO2max. Interestingly, however, knee range of motion was not augmented after any warm-up, and it is possible that the low back may be like the knee, e.g. somewhat resistant to improvement in flexibility as a result of warm-up activity.

Does jogging tighten up the low back?

Other research suggests that indeed the low back may require special treatment in order to improve flexibility – or at least prevent increases in inflexibility. For example, several years ago Henry Williford, Jennifer East, Furman Smith, and Lou Ann Burry of the Department of Physical Education at Auburn University found that warm-up routines which involved jogging actually tended to tighten up the lower-back area (6). In their study, Williford et al. placed 51 college students on different warm-up and stretching programmes. One group of students performed stretching exercises for 15 minutes per day, twice a week, for nine weeks; the stretches utilised were specifically designed to promote flexibility in the shoulders, hamstrings, ankles, and low back. A second group of students carried out the same stretching routines but completed a warm-up consisting of jogging before the stretches were attempted. After nine weeks, the two groups achieved identical gains in flexibility of the shoulders and hamstrings, but the jog-and-stretch group possessed significantly better ankle flexibility. Notably, the stretch-only students had much better low-back flexibility than the jog-and-stretch subjects; in fact, the jog-and-stretch athletes were unable to improve low-back flexibility at all during the nine-week study. The low back was the only area of the body which did not have its flexibility improved by both stretching and jog-stretching. The Auburn scientists concluded that jogging during warm-ups may in fact tend to tighten up the lower back, instead of loosening it.

So what should athletes do to promote better low-back flexibility prior to participation in sports, especially if they are designated as substitutes who will enter a contest after spending back-tightening time on the bench? It is clear that substitutes should not simply sit on the bench as they wait to enter games, it is also apparent that jogging on the sidelines is not particularly helpful. Perhaps it would be better to complete a series of movements which mimic the motions required in the sport, along with a number of stretches and exercises which loosen up the low back and facilitate flexion, extension, side-to-side bending, and rotation. In addition, players resting on the sidelines might utilise alternative postures instead of sitting on the bench with a flexed lumbar spine. Research has linked sitting with a flexed spine with an increased risk of lumbar-disk herniation(7) and a higher likelihood of injury (8). There is surprisingly little information in the scientific literature concerning the effects of various exercises and stretches on low-back flexibility. However, it is known that lumbar-extension exercises can be very favourable for improving low-back strength and mobility, even with relatively low training volumes(9). Therefore, athletes may be wise to include low-back-extension exercises in their warm-ups – and at somewhat frequent intervals as they wait on the sidelines before entering competitions (note, though, that athletes with spondylolysis, spondylolisthesis, or facet-joint irritation should not carry out extension exertions).

Action to take

Here are some postures and exercises which should be appropriate:

  1. Prone lying on elbows. Simply lie on your stomach with your weight on your elbows and your forearms and hips touching the floor or ground. As you do so, relax your lower back as completely as possible, remaining in the position for at least five minutes at a time.
  2. Prone press-ups. Lie on your stomach with your palms near your shoulders, as though you were going to perform a standard press-up. Then, slowly push your shoulders up, keeping your hips on the floor or ground and letting your back and stomach sag. Slowly lower your shoulders, and repeat about eight to 12 times.
  3. Standing extensions. While standing erect but relaxed on the sidelines, place your hands on the small of your back and lean backward with your upper body, gradually increasing the amount of backward lean. Once you have reached more or less full extension, hold the position for about 20 seconds; then, return to your straight-up position, and repeat. Over the course of your normal day, always employ this exercise following activities which put your back in a flexed position (for example, lifting, sitting, and bending forward).
  4. Progressive extensions with pillows. If your coach permits, lie on your stomach with a pillow under your chest. After a few minutes, add a second pillow, and add a third pillow after a few minutes more, as long as your low back does not feel uncomfortable. Stay in the position for at least five minutes, and remove the pillows one by one over a period of several minutes.

The bottom line?

It makes sense to improve the flexibility of your low back before entering an athletic competition. Unfortunately, the traditional practice of warming up and then sitting for a while on the bench just doesn’t get the job done. To keep your low back supple, you’ll need to utilise different postures and a variety of different movements and exercises, including extension exertions and postures.

Owen Anderson

References

  1. “Low Back Pain in Young Athletes. A Practical Approach”, Sports Medicine, Vol. 12(6), pp. 394-406, 1991
  2. “Comparison of Spine Motion in Elite Golfers with and without Low Back Pain”, Journal of Sports Science, Vol. 20(8), pp. 599-605, 2002
  3. “Low-Back Stiffness Is Altered with Warm-Up and Bench Rest: Implications for Athletes”, Medicine and Science in Sports and Exercise, Vol. 34(7), pp. 1076-1081, 2002
  4. “Passive Stiffness of the Lumbar Torso in Flexion, Extension, Lateral Bending, and Axial Rotation”, Spine, Vol. 19, pp. 696-704, 1994
  5. “The Effect of Warm-Up Intensity on Range of Motion and Anaerobic Performance”, Journal of Orthopaedic and Sports Physical Therapy, Vol. 27(2), pp. 154-161, 1998
  6. “Evaluation of Warm-Up for Improvement in Flexibility”, The American Journal of Sports Medicine, Vol. 14(4), pp. 316-319, 1986
  7. “An Epidemiological Study of the Relationship between Occupations and Acute Herniated Lumbar Intervertebral Discs”, International Journal of Epidemiology, Vol. 4, pp. 197-205, 1975
  8. “The Biomechanics of Lumbar Disc Herniation and the Effect of Overload and Instability”, Journal of Spinal Disorders, Vol. 1, pp. 16-32, 1988
  9. “Low Back Strengthening for the Prevention and Treatment of Low Back Pain”, Medicine and Science in Sports and Exercise, Vol. 31(1), pp. 18-24, 1999

low back flexibility, low back pain