Olympic athletes, lifting with lordosis & bracing
Patients often ask how they may prevent low back injury while working out in the gym or doing housework. I have been using the Olympic athletes, especially the weight-lifters, as examples to help them understand the rationale behind the five type of exercises I always emphasize: postural, mobility, stretching, strengthening and sporting. The first and most important 'exercise' is postural. Without proper alignment of all the bones and joints in the body especially the spine, the weight-lifter would not be able to successfully lift such heavy weights or could risk injuring parts of the body especially the low back. To be able to align his spine and to perform his weight-lifting action, he needs the required range of movements of the knees to squat and the shoulders to fully elevate. He therefore has to perform mobility exercises to ensure such movements are available. To ensure such motions are performed smoothly without restriction, he needs flexibility of the surrounding muscles, ligaments and other soft tissues for his performance. Shoulder stretches are particularly important for the weight-lifters. Strength in the arms and legs is no doubt most important for him to lift the weight and to ¬¬stand up from the squatting position. But no matter how strong the arms and legs are, he would not be able to lift such weight without the strength and stability of his trunk. Core stabilization, the use of deep trunk muscles particularly transverse abdominis and multifidus to stabilize the lumbar (low back) spine, has become the base of all other strengthening exercises. Note that abdominal/stomach curl or sit-up to strengthen the rectus and the oblique abdominis has become less relevant for trunk stability required for most sporting/daily activities. We never should curl our trunk or bend to lift. In fact, the weight-lifter would tilt his buttock out to maintain a normal lumbar lordosis (low back S-curve) , the strongest and most stable position of the lumbar spine, to lift. He will exhale and even yell to brace his stomach in without curling his back. He may also wear a weight-lifting belt to help bracing his abdomen to increase the stability of his weight-bearing trunk. His own internal weight-lifting belt is his transverse abdominis (surrounding/bracing abdominal muscle) . It is rather ironic that patients are taught to do sit-ups/curls to train the rectus abdominis (front abdominal muscle) to "support" their back while we should never adopt such position when lifting and that maintaining the lumbar lordosis by back extensors (backward bending muscles) and bracing the trunk by transverse abdominis are so important and have always been practiced by the athletes. We do not lift 200 lbs but we may lift a 20 lbs box 20 times a day. Are we stronger than the Olympic athletes that we do not have to condition ourselves for the constant strenuous tasks we have to do everyday?