>> Lori: Many of us have been there before.

Hurt our back.

Whether it was shoveling snow, raking up leaves, or picking up a heavy box.

Coming up next on being well, we'll talk with John Storsved, Professor of Kinesiology and Sports Studies at Eastern Illinois University, and our topic will be back pain.

John will also be showing us some easy exercises and stretches to help us strengthen out back.

That's coming up next, so stay right here.

John, thanks for coming on and talking to us about back pain, something we have all experienced.

I know you and I both have.

Why does back pain affect so many people?

>> Dr. John: Well, if you think about being human and being active, and whether you are a gardener, or weekend warrior, or athlete or competitive athlete, the forces that we put on our body have to transmit across our core, or our trunk, and so with that, we end up being susceptible to pulling a muscle or sometimes even worse-case scenario, hurting a disc, or maybe even getting a small fracture from overuse, injuries, a stress fracture, so it's just some of the researcher would say that when we went from being quadrupeds, or on all fours, and then evolving up to an upright position, we put a lot of stress on our back, and then if you think about our daily activities, we tend to bend forward, over and over again, and that's putting a constant stress on the spine.

And so, it's just one of those things that most adults will experience at some point in their life.

I think some of the statistics that I have seen is between 80 and 85 percent of all adults will suffer some back pain episode, whether it is completely debilitating or not, just depends upon the anatomy that is injured.

So, something that most of us, if we have not already suffered, will have it to look forward to at some point in our adult time.

So yeah, it's just very, very common, and something that we all end up experiencing at some level.

>> Lori: Well, and since so many of us have experienced it, we are going to talk about you know, a little later in this show, different exercises we can do, but let's first talk about, how do you know if you've hurt your back?

If its a muscle issue or disc issue, which is a lot more serious?

>> Dr. John: There are some very simple things to look for, if you are, with the weather turning as it is, the day getting nice and warm, the people are getting antsy to get outside and do more activities after being cooped up all winter, and so, if you go out and you've not done a lot of exercise over the winter, and you notice pain that is a pulling sensation, or stretching sensation, and it typically stays on one side or the other side, and is localized to the back, you are fairly safe in containing that to a muscle, a strained muscle, or a pulled muscle.

If you have a sudden grabbing type, shooting pain, or if you ever have any type of radiating pain, that is pain that goes from your spine, down one leg or the other leg, that is a more serious sign of a disc being involved.

In order to have that pain shoot down one of the legs, either side, typically that means that a nerve has been brought into the equation, and that is more likely to be a disc issue, and that is something that tends to be more serious, and more debilitating than just a simple muscle strain.

>> Lori: And you brought us a little spine.

>> Dr. John: Yeah, I brought over a really small model of a typical lumbar spine, just to kind of show the nerve distribution.

This is the front side, so towards your stomach, and then the small little, these are called the spineous processes, but in a lot of backs you can reach around and feel those bones on the back, and that's the very posterior back side, and then if the camera picks up the colors pretty good, you can see the yellow thats the nerve roots as they come off the spinal cord, and then the blue little segments are the inner vertebral discs, and the discs actually are the cushioning factor in our spine, and the best way that I can describe those, and this is what I use in my classes, we need to think of the disc as a jelly doughnut.

So, there's an outer crust, and then there's an inner gelatinous actually jelly portion of it, so when we do have a disc issue, and this typically comes from our constant forward flexion, bending over, tying our shoes, bending over to pick up leaves to put in our leaf waste bags, bending over to pick up dumbbells, whatever it might be, but the constant bending forward pushes the gelatinous material, the jelly inside the doughnut, pushes it back towards the spinal cord, and that's where we end up seeing the herniated or prolapsed disc where the disc actually pushes on the nerve itself.

Whenever we pinch a nerve or hit your funny bone, it's basically the same kind of sensation, but it's a constant pressure that causes these sensations to go down the leg, right side of left side.

>> Lori: Yeah, and then you get the numbness, >> Dr. John: Yep.

Numbness, tingling, foot feels like it is asleep, but we both, we were talking before this, we both have experience disc herniation, and they are not very fun things.

>> Lori: Yeah, and ironically when you have a herniated disc, your back usually doesn't hurt.

Other things do.

>> Dr. John; Yeah, and we'll probably talk about some exercises and things you can do if you are feeling like you've you know, maybe have a disc, or have that radiating pain, but part of the theory in controlling disc issues is to centralize the pain.

A physiotherapist from Australia, named McKinze, and there's a lot of back specialists who are physical therapists, who are trained in the McKinze approach.

The McKinze approach is doing everything in extension, all of our exercises should be in a good posture or bring your back, back, if you will, so her theory was, that we need to bring the pain out of the limb, out of the leg, and centralize it to try to control it.

Countering all the forward flexing motion that we've done to push the disc backwards, if we do extension motions her theory is that will pull the disc more forward and take the pressure off the nerve, and that will actually centralize the pain, so like once you herniate that disc and you've got that radiating pain, it just seems like it is all trapped and you just, you'd love for some back pain, and get it out of your leg, yes.

>> Lori: Why does the lower back seem to be affected more than the middle?

>> Dr. John: Yeah, again, yep, if you think about the spinal column by itself, the vertebral column and the spinal cord and the disc, it is responsible for supporting the upper body weight, and so there's a lot of stress right there.

If you think about and the audience can think about people they've known or maybe when they've experienced back pain, typically if we somebody that gets a little bit too much front, if they get a little bit too much belly and added weight, that's going to pull the front part of the lower back more forward and add stress, and then also another time that we see a lot of back pain that is pretty transient, it goes away after the baby is delivered, but pregnancy can add a lot of stress on the lower back.

So, that's part of it, and it's just really our daily activities.

A lot of people sit in chairs for their work, they are not up moving around, that the discs will compress by sitting, and also the inactivity really weakens the core muscles and really sets us up for the chance to injure our back when we start to do exercises or yard work, or any sort of activity if we are not prepared for that.

>> Lori: Ok.

So, at what point if you have hurt your back, should you say, "Hmm, this is more than what I should be treating."

How do you know when you should go to the doctor?

>> Dr. John: Yeah, I would say that anytime that you have that radiating pain.

That's a significant sign of a disc issue and that should be something that you'd want the doctor to know about.

Just like I said, between 80 and 85 percent of people suffer from some sort of back pain, people who do have a disc issue, typically will resolve on themselves, they will have no major intervention, meaning they don't have to have surgery, you know, before it gets better.

Now it will feel like it's taking forever while you are waiting for it to resolve, but the body has got great capability to heal itself.

Even in my case, I know I was literally out of commission for a couple weeks, but I did end up getting a cortisone shot, that allowed the inflammation to settle down, and that's what kept me from having to have surgery.

But every, you know, most statistics will show if you don't do anything to aggravate it even more, you will get better without any major intervention.

Now there are some cases, where people have a chronic history, and end up having to have surgery, but radiating pain, pain into the Gluts, or the buttock, or further into the leg, on down to the toe, really is a significant back injury and you should see your primary care physician to find a course of action.

If you initially feel that strain, that pulling sensation, and you feel like your motion is limited, it's not excruciating, our over the counter medications like Advil, Aleve, Tylenol, the Advil-Aleve family is anti-inflammatory, so that's going to help with some of the inflammation.

Tylenol does not have the same property, but it will help with the pain, so if you take Ibuprofen, Aleve, you can still manage the pain with over the counter medications.

The one thing that I will say about home care, don't think it's as bad to go to the doctor.

You can take care of it by yourself by just simply resting, discontinuing activities that bothered it, but a lot of people make the mistake of putting hot pack, or heating, >> Lori: Yeah, I want to sit in my hot tub because that would make it feel better.

>> Dr. John: And while it does make you feel better initially, from the warmth, it's probably not doing a lot of good for the inflammatory process the body is going through, the first 24-48 hours after an acute injury, it's better to go with an ice pack.

Now, >> Lori: Which is not as comfortable, >> Dr. John: Not as comfortable, but it'll do the body a lot better in the healing process, than if you are to go and put a hot pack, or sit on your heating pad, or go into your Jacuzzi, or your whirlpool tub, that kind of thing.

So that's not what a lot of people want to hear, but it is better in that first initial stage.

And then after that, after the first two days, it's pretty safe to go with the heating pad, and to get some really good circulation going.

>> Lori: If you have chronic back issues, maybe not disc-related ones, but you go out and you rake leaves and your back hurts the next day.

Are there some, you know we are talking different types of exercises that are just not good for people with chronic back issues.

>> Dr. John: Yeah, the big thing that I try to emphasize, whether it is athletes or even to friends who typically have issues, is that it is very important to keep moving.

A lot of our medicine and a lot of our therapies have changed from decades ago where you were just prescribed rest.

Well, we know that if you rest too long or you lock up a muscle, it atrophies.

That means it wastes away.

So we would prefer that you do controlled motion or try to do your daily activities that won't bother the pain.

You might have to limit some of those things, but still, to keep moving, even if it is just walking where you might have been used to jogging or running.

But just doing something to keep the body active and to keep the circulation going because the circulatory system is really going to help flush out the inflammation and the a lot of the chemicals our body produces that really cause a lot of the pain.

So there are some things.

We have gone away from a lot of true sit-ups as far as trying to strengthen our trunks, because that puts us in that flexion position.

Really, as long as we can stay active, there is not a whole lot of exercise that we would say you need to stay away from.

I know there is a Canadian bio mechanist that's really done a lot of research in the last five to seven years looking at the back.

He will go and buy swine spines, hogs from the butcher shop and they stress them just to see what limits there are.

And a lot of the things that he is coming up with is really looking at keeping a neutral spine and doing some plank activities where you are trying to really maintain a very straight line exercise type of component.

One of the things that he has found with a lot of his patients his daily activities like sweeping, mopping, or vacuuming tend to be worse because you get a rotation component.

We always talk about lifting with your legs and doing things properly and that is important but often times when you have an acute episode, you want to really limit rotating factors.

So whether it is a way to get out of housework or whatever it may be, that is one thing that I have noticed too, that if I am reaching and twisting, that is more of an issue than if I am lifting something heavy in a straight plane or a straight line.

>> Lori: I find I can push a desk away, but pulling something is even worse.

Some of that twisting is sometimes like a golf swing may be problematic.

>> Dr. John: It is good to practice when we lift, to use our lower legs or our lower body, the legs and the glutes, because they are very powerful muscles and not put a lot of stress on the back.

So it is very important to lift properly, but what we see a lot times is people say well, I thought I was using my legs to lift and I moved then I moved the box in a rotation and it is the rotation component that gets them in a bad position and causes the strain to occur.

So, be very careful when you do lift that you turn your entire body and not twist it at the trunk.

>> Lori: Not just the torso.

What about exercises that are more pounding in nature?

Running, jumping rope.

Are those hard on the back?

>> Dr. John: Yeah, they tend to be because you just simply add the forces to the spine.

So again, it kind of goes hand in hand.

Typically, we see more back injuries as we age and as we age we tend not to do the jumping, pounding type of exercises.

But if there is somebody who is a runner, this is kind of spring marathon and spring 5k.

season coming up, there is probably people coming up on harder surfaces when the weather has been nice now.

So we do need to be careful about that, making sure that we have proper shoes in that maybe you ran in your shoes all summer and fall last year, it is probably a good idea to look at getting new, good cushion shoes if you are very active with running.

And also, watching the surfaces that we are on.

Our asphalts tend to be more unforgiving than grass or even an all-weather track that we have here on campus.

The wood floors that we typically see in a gymnasium do have some give to them, basketball courts, aerobic floors.

So those tend not to be too much of an issue.

But if it is something that you notice in yourself that a pounding exercise give you more trouble, then it is best to go to a lower impact.

>> Lori: So, you listen to your body.

>> Dr. John: Yes, absolutely.

Your body is greatly designed in order to try to prevent injuries from occurring and telling you.

Pain is a good thing at times because pain tells you something is wrong and you need to back off.

So, listen to your body if you are sore.

The other thing you asked about is when should you go to a doctor?

If you think it is something relatively mild but it just does not respond to your ice, your Advil or Tylenol and it has been a couple weeks, it is probably a good idea to go in and see your physician.

>> Lori: That is what I was going to ask.

How long does it, if you strained your back, how long should it take to recover before you are feeling better?

>> Dr. John: If we were in a perfect scenario where you had everything at your disposal, where you had ice packs and your Ibuprofen and you could limit your activity, we'd like to keep that within a seven to ten day window.

Again, the body, depending on how strenuous how much of a damaged occurred within that muscle tissue, the body does respond rather quickly.

So, if you are not better after ten days, then it is probably a good idea and go in and see your physician and maybe find out that there is something going on.

Again, as we age with our model right here, our spinal cord comes down through the vertebrae, there is a small tunnel and there is a condition called stenosis.

Stenosis is the narrowing of the tunnel.

Now, again, as we age, a lot of us go through a natural stenosis but some people do have a predisposition to that based on their heredity.

So that could also put stress on the nerves and cause some radiating pain.

We can't figure that out without some diagnostic testing like x-rays or MRIs.

So, if you have a condition that isn't getting better and it is waking you up in the middle of the night that is another red flag.

If something were to wake you up out of a sleep that would be something that I would recommend.

If someone were asking me, I would recommend going to see your physician.

>> Lori: Okay, quick question as whether we are shoveling snow or working out in the yard, some people you may see wear a back brace.

Is that helpful?

>> Dr. John: You know, the research studies in weightlifting belts show that they do more harm than good.

And so when I walk around the big box home improvement stores and I think some of them, I don't know if they still do, but some of them require their employees to wear them.

They give people a false sense of security.

They also deactivate the muscle and so that when we do go to lift then, the muscle is relying on, oh this brace has it for me, I don't need to contract right now.

And so we actually see more harm than good.

We have our own built-in, anatomical lifting belt.

It is called your transverse abdominus, TVA, your core.

That is a big buzzword in fitness right now.

The transverse abdominus is just that.

It is a transverse so it goes horizontal across the waist and if you think about sucking your belly button toward your spine, you are pulling and activating that muscle [00:18:19.02].

So if you go to a fitness class right now, or you read any fitness magazines they'll talk about either drawing your belly button in, or activating your TVA or subdominus, and it's as simple as you can even do it while you are sitting here, just consciously thinking about pulling my belly button towards my spine, and that is our core.

Our core is made up of transverse abdominus, the rectus abdominus, which is the long muscles in front when you see somebody with that six pack look on the beach, or on the front of your fitness magazines, that's the rectus abdominus and transverse abdominus your pelvic floor muscles, your diaphragm, and then your back muscles.

That makes up our core.

And so if we activate and have a solid core, it really takes a lot of the pressure off of the spine, and the vertebral bodies, and then the spinal cord and the nerve roots themselves.

So, that's where we look at, so if now, I've got a father-in-law who tends to wear a back brace during the golf season.

He likes to get out and golf as soon as he can, and oftentimes over the years, he has had a chronic back thing, and so we, if it makes you feel better, go for it, but it's probably not as good as getting good exercise in prior to your golf season starting, or your tennis season starting, making sure, even if you walk on a treadmill over the winter, you are still doing enough to activate and keep those muscles nice and toned, or strong so that when you do more strenuous activity it's not a big leap for the muscle to go from nothing to a very violet golf swing, a very traumatic or powerful movement and it's not ready for it yet.

So, I'm all for if something makes you feel better, you know, that's fine, but avoid the back belt or the back brace, you are probably better off in the long run.

>> Lori: You are probably better off doing some core exercises which when we come back, you are going to do some demonstrations.

>> Dr. John: Yep, we'll have some demonstrations about just some simple things that anybody can do, very limited, or no equipment necessary.

And by doing those things, hopefully, you are in a position that you are ready for the spring and summer activities to come up.

>> Lori: All right.

Sounds good.

We'll be right back with more being well after this.

Don't forget you can watch more Being Well on line.

Just visit our YouTube channel at www.youtube.com/weiutv.

You can watch full episodes and demonstration segments from season one and season two.

>> Dr. John: So, today, what we are going to do is some stretches for flexibility, and then we'll progress into some core exercises for strengthening of the back So the first thing we want to think about when we are stretching is both the back side of the leg and the front side of the leg, and so Tiffany is showing us modified hurdler stretch, which is stretching the hamstring muscles, the posterior thigh muscles, that attaches to our pelvis girdle, and if it gets too tight, can pull and rotate the pelvis causing added stress on our back.

So to do this stretch, we are going to be seated comfortably on the floor, with out opposite knee, foot into the opposite leg bent with the foot at the knee, and she's just not going to lean over and try to grab her toe, but just sit at a nice posture, leaning forward slightly trying to reach above her toe.

Remember we don't want to do too much forward flexion and rolling around of the back, because that can add stress on the discs.

So she is getting a good stretch here just reaching out the traditional of grabbing the toe, or trying to get your forehead down to your knee is not necessary, for a good stretch.

The second stretch that we are going to do is going to focus on the lateral hip rotator muscles.

And so we are going to again, stretch your left leg, bring her knee up to her opposite shoulder, stretch the lateral gluteal muscles, and puriformus muscle.

The puriformas muscle is a very key muscle because it is very close to the sciatic nerve, and if that muscle gets tight, it can actually compress the sciatic nerve and cause pain similar to that radiating pain caused by a herniation.

Oftentimes we aren't sure when someone does have radiating pain, is it actually a disc, or is it the sciatic nerve compressed by the puriformus muscle.

This is just going to gently pull her knee to her opposite shoulder, and holding it for thirty seconds.

And then she'd relax and repeat that again, three to five times, and again this is focusing on the lateral hip rotators.

A second variation of this muscle I like to call it the figure 4.

Now we are just going to simply put her in a crossed leg position, and again she is still stretching those lateral hip muscles, she can actually lift this leg up and pull back on her leg, to get added stretch.

This again is getting the upper level of the hamstring, along with the lateral rotators, the puriformus muscle, and really giving a good stretch.

This is a great stretch for a lot of our runners.

These two stretches, we see a lot of tightness in the lateral hip muscles with our runners, and this is going to really target that, and take stress off the low back.

So, we've stretched the backside and the lateral side, now we need to stretch the front side of the pelvis.

So our flexor muscles, our quadriceps muscles, also attach onto the pelvic girdle, and if they are too tight, they can actually cause a tilting of the pelvis.

So we want to make sure we are getting all sides of the pelvic girdle, the muscles that attach in order to give nice neutral positioning.

So in this stretch, Tiffany stretched her left hip flexors, the quadriceps up into the pelvis, just going to get into a nice lunge position with your knee on the ground, two modifications for this, she can either lean very, start to lean forward, and that's going to stretch more of the lower part of the quadriceps muscle, you can hold that for 30 seconds, repeat it three to five times, or you can stay in neutral position and not lean forward, now she wants to roll her pelvis forward, without leaning forward too much, and then she wants to contract her gluteal muscles, or squeeze the gluts.

And by doing this, you get more of the attachment for the hip flexor on the pelvis itself, and this is a really good stretch, it's one of my favorite stretches for runners.

We oftentimes focus on the posterior and forget about the anterior muscles.

If you want to make this stretch more effective, you can take that same side arm, go straight up above the head, with a slight lean to the side, and that's really going to open up that front hip complex and give a great stretch to the hip flexor muscles.

Ok, so now we've done our flexibility now we can focus a little bit on some strengthening core muscles.

So we talked in the discussion portion, you really want to avoid the rounding of the back.

A lot of our research is showing that we need to focus more on the back muscles themselves and not so much on the ab muscles, so we are going to show here is a progression of the exercise called the plank.

So Tiffany is going to start off in the very early stages by doing a plank simply on her knees.

So she is going to get down on her knees, and then on her elbows, the big focus here is she wants to draw her belly button to her spine.

That is going to contract her transverse abdominus, the internal weight belt that we discussed in the other segment.

The other thing is, she wants to make sure she stays a neutral as possible.

She wants as straight of a line as possible through this motion.

Now, what you can do is start with a ten second hold and then progress up to a twenty second hold, and finally up to a thirty second hold, as you get stronger.

It doesn't look like it is that strenuous, but you'll find when you get down here, your back muscles, and your core muscles really start to burn with this very simple exercise.

And once you feel very comfortable doing the plank on your knees, you can progress to the next level, which is a traditional plank, which is up on your toes, and on your elbows.

So, Tiffany is going to go ahead and assume that position, get off her knees, same thing here.

We are going to keep a nice straight line between her shoulders, glutes, all the way down to her legs.

She doesn't want her bottom sticking up in the air, she doesn't want her back to sag, and the way we are going to accomplish this is she is going to draw that belly button up to the spine.

You want to contract that core and that's going to keep your trunk nice and level.

And if we want to modify this even more, once you get the traditional plank done, you can add more stresses to it by simply alternating a side step with the plank, maybe five to eight on each side, alternating like you are walking to the side, and that's going to give you even more of a stress and more work and exercise done and strengthening for your back muscles, and your abdominal muscles.

And then for the final progression, and when you really feel comfortable and your got a Swiss or stability ball around, you can actually add that to your plank motion.

The stability ball is going to really tax your core.

You'll find that you, again it's going to look like a rather simple exercise but once you get up onto your elbows on the ball itself, and starts rocking a little bit, you are going to have to work hard with your core to maintain that straight line.

Go ahead Tiffany.

So again, same general principles, contract the abdominal muscles, by pulling your belly button to your spine, nice straight line, she is doing a great job right there.

We don't want the back to sag, or the bottom to peak up in the air like we are going into a pyramid form.

So she's holding this nice long line, again, progressing from 10 seconds, to twenty seconds and then finally up to 30 seconds.

So, hopefully today, you've seen a few flexibility and strengthening exercises that you can incorporate into your fitness routine that can hopefully strengthen those back muscles, stretch them out and make the nice and flexible and pliable your lower extremity muscles and preventing any back injury from occurring.

Obviously before starting any of these, you would want to consult with your physician, especially if you've had any back injuries before, to make sure that you are not overdoing it, or starting something when you've got an underlying condition.

But these are great things that you can add in, don't take much time, you don't need hardly any equipment whatsoever, and you can get this into your routine so you can get outside and enjoy your activities without worrying about any underlying back conditions, or suffer one of those back conditions that we talked about.