Lower Back Pain

Q: Why is it that many adults develop lower back pain in their forties? I've read that this is the time when many small injuries add up to create larger, painful problems. Is that true?

A: There are many categories of patients with back pain and lots of different reasons for back pain. One category fits the scenario you describe above, and that's pain from the discs, or discogenic back pain, including disk protrusion and disc herniation. This type of back pain is almost always a result of cumulative trauma, but a spinal disc can accumulate trauma without indications, which explains why you can have sudden lower back pain that seems to come out of nowhere.

Look at the prevalence of sitting in our culture: sitting down, driving, sitting in front of your computer. This forward bending of the spine is a huge contributing factor in disc problems. The good news is that, as you age, disc problems usually go away as the spine stiffens. So you have less pain, but occasionally other problems may crop up. However, generally most people grow out of back pain.

Q: Is it possible to treat lower back pain without visiting your doctor, chiropractor, or orthopedic surgeon? If so, how?

A: It's extremely important to understand that while some people can be their own doctor, it's a dangerous thing to do. There are many reasons for back pain, even cancerous tumors, and you always want to have those possible red flags assessed by your doctor. That said, after the assessment, you can focus on getting rid of the cause of the pain. You might have to change your movement strategy, for instance, by locking the spine and lifting through the hips when you lift weights. You might have a motor problem, meaning you don't use the muscles properly, or you might have a motion problem, meaning you move in way that overloads the back. These corrections should be the first components of any therapy program but often require competent professional expertise.

Q: What is the most startling and/or interesting thing that you've learned about the human spine in your work at the laboratory?

A: The fact that you can predict who's going to have back trouble by watching their motor patterns. Also, the number of people who say, "This worked for me, so it will work for you." Every back, every patient is different. There is no single approach for bad backs.

Q: What is your view of Pilates and/or other core-oriented exercises for keeping the back strong?

A: Pilates is like any group exercise: It will help some people and hurt others. The problem is that not all Pilates instructors have come out of a homogeneous system for training. There are some wonderful Pilates instructors out there who can recognize problems in their participants, or they do qualifying tests to see what participants can handle. But very few Pilates instructors have that expertise. Consider exercise like a vitamin: If you don't take enough, you're vitamin deficient. If you take too much you can poison yourself. There's an optimal dose for exercise for every person, and people's tolerance for exercise depends on their age, injury history, and so forth. Joseph Pilates developed his exercises as a self-healing process and to help himself overcome a respiratory disorder. Because he got better, he became a prophet. But some of the moves are quite problematic for some people.

Q: I've read that you feel sit-ups are too tough on the spine. What is your favorite alternative exercise?

A: I don't feel that sit-ups are too hard—I've measured the load on the spine when you do a sit-up and proven it's not a good thing to do. The National Institute for Occupational Health and Safety (NIOHS) publishes a hazardous level for back compression, and that level is created with every sit-up. I prefer a modified curl-up, which can be done in progressions, depending on where you are now and what shape you're in.

For more information on Stuart McGill and his book, Ultimate Back Fitness and Performance visit www.backfitpro.com