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The Mobility-Stability Continuum- Lumbar Spine

7/8/2010

After hearing some good lectures at the seminar last weekend, seeing some horrific stretches and exercises in the gym and doing what I do with people everyday, I was motivated to write more about this topic. I wrote a large part of this in the newsletter for Southridge but go into some more detail here. The concept of having stability versus mobility at different joints is something that is not understood by enough people.

The body has what is known as the stability-mobility continuum. If you look along the kinetic chain of the body, joints that need to be mobile and joints that need to be stable pretty much alternate. To sum it up, the ankles need mobility, the knees need stability, the hips need mobility, the lumbar spine needs stability, the thoracic spine needs mobility, the scapula needs stability, the shoulder needs mobility along with appropriate stability, and so on.

Most people move at all of the wrong places and do not have the mobility and stability needed to stay healthy and pain free. In this post, we will focus on the lumbar spine.

I work with a lot of people who have back pain and have successfully helped a lot of people get rid of it. I have also been around people and have studied work of people who are really really good at fixing back issues. One of the major causes of back issues is too much movement in the lumbar spine (low back area) with too much stress going through it. It is not designed to produce a lot of movement and doing so leads to lots of problems. Why does this happen?

Stiff Hips and Thoracic Spine

Many people have really stiff hips and terrible mobility in their thoracic spine (upper part of back). If you can’t move in either of these places where the body really should be moving at, you compensate by moving through the lumbar spine. This is a problem. If you are not around someone who can help with this, I suggest checking out any of Mike Robertson, Bill Hartman or Eric Cressey's products.

Poor Movement Patterns

Many people flat out do not know how to move the right way. Once someone learns how to move through their hips and thoracic spine while maintaining a stable lumbar spine, their problems usually subside.

Poor Exercise Programs

Probably about 95% of the population has absolutely no clue why they do what they do with their workouts and are doing more harm than good for themselves. We know that we need stability in the lumbar spine yet tons of people continue to train it to move. Crunches, stretches into extreme ranges of spinal flexion and extension, twisting through the lumbar spine, rounding the back and the list goes on. We need to stop training this area to move and teach it be stable. This has been proved time and again in the research. One problem is the fact that media and misinformed health
professionals give people the wrong information and they don’t know any better. Stop stretching and moving through your lower back!!

Weak and Improperly Trained Abdominal Muscles

Many people have terrible endurance and stability in their abdominals. The abs need to be trained to stabilize a neutral spine and properly control pelvic movement, not to flex the low back and round the shoulders forward as is done with crunches and poorly performed situps so often (ties in with poor movement patterns.) If you take anything away from this article, please do yourself a favor and stop wasting your time and making yourself worse off with crunches (at least the way most do them). Learn to train all different sections of your abs with effective exercises that train them to stabilize and work in conjunction with other muscles such as plank variations, side bridge variations, jackknifes, cable chop variations, rollout variations and neutral spine leg raises/leg lowering. Any kind of multi joint movement such as squats, deadlifts, chinups, etc. train the abs to a great degree and should always come first and foremost. The obliques are often very weak and neglected by many people (will go into more detail later). They are the most important part of the abs to bring up for many (no, crunches do not train the obliques effectively).

There also has to be a progression with the exercises you use. You can't just put a beginner with poor function on the floor and tell them to do an ab wheel rollout (I've seen someone do this recently and it wasn't pretty). You have to start with specific exercises that you can handle and progress from there. Otherwise, the back will take up unwanted stress and bad things will happen.

According to Sahrmann (a goddess among physical therapists and a top expert in movement impairments and corrective exercise), the most important outcomes of abdominal exercises are obtaining the control that is needed to do the following.
1. Appropriately stabilize the spine
2. Maintain optimal alignment and movement relationships between the pelvis and spine
3. Prevent excessive stress and compensatory motions of the pelvis during movements of the extremities.
(Taken from "Diagonosis and Treatment of Movement Impairment Syndromes")

She says that a primary role of the abdominals is to "provide isometric support and limit the degree of rotation of the trunk" during daily activities. This point is huge because many people practice terrible movement patterns and posture throughout the day, even with light tasks. In her book, she also states that "a large percentage of low back problems occur because the abdominal muscles are not maintaining tight control over the rotation between the pelvis and the spine at the L5-S1 segment." She also goes on to say that "they are not preventing excessive anterior tilt of the pelvis or spine during activities that involve lower extremity musculature. In contrast, excessive abominal muscle activity, shortness, or stiffness contributes to posterior pelvic tilt and lumbar flexion." (Also taken from "Diagnosis and Treatment of Movement Impairment Syndromes")

Since the external oblique controls or prevents anterior pelvic tilt and pelvic rotation, effective exercise for this muscle should involve moving the legs to train its influence during this kind of movement. In his presentation at Perform Better, Mike Boyle also made a nice point in saying to think of the obliques as "anti rotators" instead of rotators. So, we must train them to control pelvic and leg movement, stabilize against rotation or at least control rotation and to effectively stabilize the spine.

Too many people overwork the rectus abdominis (6pack muscle) and make it short and contribute to a rounded kyphotic shoulder posture in addition. They do nothing to bring up the supporting cast and develop optimal back health and performance. This is not to say that rectus is not important because it is. Often times it is just overworked in people. I am not just talking about average joes with some back issues; a lot of athletes also train with a complete backward approach. Training the trunk correctly has a huge impact on performance as well. As an example, take a look at throwing a punch. Ideally, you generate the power with your hips, transfer the force through a stable trunk, and carry it out through the shoulder and arm. If their is any kind of leak through the trunk during the movement, the outcome will suffer.

A great way to train endurance in the obliques, quadratus lumborum, back extensors, lats, hips and the entire family is with side bridge variations. Stuart McGill has done some great work and research on the best ways to train these muscles the right way while sparing the back.

So basically, to sum this section up. The abs (and most muscles for that matter) need to be trained to do specific tasks (stabilize the lumbar spine), not just trained to be trained. So lets say that you do a few sets of 20 reps of crunches. Great, but when you get into a real time daily or sporting activity, those crunches will have no carryover to what you are doing. There are very few situations in which it would be beneficial for someone to do the movement of a typical crunch. On the other hand, if you train effective stabilization patterns with, lets say, a side bridge variation or an anti rotation cable hold, those obliques will kick in next time you are doing something in real time and your lumbar spine and lower back will be fine. There are actually some effective ways to perform crunch or curl-up variations if that is an area you are weak, but most do nothing close to them.

Finally, having optimal control in the abs has a huge effect on achieving optimal hip mobility. As I stated before, having good hip movement is also a huge factor in having a healthy back.

Poor Endurance in the Low Back Extensors

Some people have poor endurance in their low back muscles in addition to their abdominals. This provides very poor stability for their lumbar spines, allows more movement there and leads to even more issues. Bird Dog progressions are a great starting point here.

I also feel that it is important to have a strong back (I'm a powerlifter, come on now); however, without these other qualities that I have discussed, having a strong back will not always prevent injury and will not always equate to optimal performance and health. The first four sections in this post don't even deal with the back directly; thus, as you can see, it is usually not the back itself that is the problem. It is the areas surrounding it.

In conclusion, the lumbar spine should be a stable area, not a mobile one. Start treating it this way and watch your performance soar and your pain go away. I highly encourage you to check out any of Stuart McGill's work and research if you are interested in more on lumbar stability and the negative effects of repeated lumbar flexion. (Repeated lumbar flexion is the number one mechanism of herniated discs). I have also covered lumbar stability, back pain and ranted about crunches and misguided stretching in previous posts so go ahead and go through the archives and check em out.

To appreciate the proper training of the abdominals even further, in one of my next posts, we will take a brief look at the deeper anatomy of the abdominals, their true function and more on how they specifically tie into maintaining a healthy back. Its already in the works so stay tuned!

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The Mobility-Stability Continuum- Lumbar Spine

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