Low Back Discomfort and Ways to Address It

Well, I got such a great response from folks about my knee discomfort post last month that I thought I’d discuss a similar issue around low back discomfort. Now to start off let’s be sure that we distinguish between pain and discomfort. We’re going to categorize “pain” as something that is sharp, chronic, rarely subsides, and often comes with referred pain, numbness or tingling down to the legs and even feet. By discomfort I mean the achy feel that comes from prolonged sitting, prolonged standing, or the classic “not sure what I did the other day, but my back is stiff”. This usually comes from an overdone level of activity such as heavy lifting, reaching, gardening, workouts, etc.

Discomfort is what we’re are discussing here. Remember, our job as fitness professionals and as active individuals is NOT to diagnose or treat medical conditions, including low back pain. This is NOT to serve as a guide for diagnosis, but an article to recommend some strength and flexibility exercise choices for clients that report discomfort in the low back. If you at all suspect other structural issues, always refer the client or yourself to a qualified health-care provider. Remember folks, our world is about motion and exercise, not medical conditions. Now on with the show…

So why would someone’s low back be prone to being sore or stiff with extra activity? Most likely it is because their back is what we like to call “hyper-tonic”. It has more tone to it than normal. Now I know we all want to be toned up, but not like this. A hyper-tonic low back is one that has a level of constant tension in it that is higher than normal. This also generally means that the fibers in it are shorter than normal. We also may not feel the effects of this tension until we overdo something. So, a group of muscles that sits at this level of tension let’s say, is already angry. An increased level of work placed on these angry muscles, well, gets them really ticked off, and they in turn let you know it. Along with angry low back musculature, the hip flexors are often just as angry and as they go, very often so does the low back.

Now without having to go into detail too much about how this works (if you want to know the detail just email using the info below), the ab muscles and glutes (butt muscles) are actually the opposite. They are a bit more mellow than normal, in fact we’ll call them drowsy. This all puts the body in a position that favors this mish-mash of angry/drowsy muscles and leads to more and more discomfort and maybe even more serious issues.

How does this all come about in the first place? Well there are a couple schools of thought on this and I happen to believe both play a part in this widespread problem. The first one being quite simple, we sit A LOT as a society now. When we’re seated, our hip flexors maintain a shortened position and are just asking to become hyper-tonic (aka angry) over time. This can often lead to an angry low back. The second one being about available motion. Just like we talked about with the knee, if the segments above and below the one in question don’t have enough motion, our body will find it elsewhere. In this case, we’re talking the shoulders/thoracic spine and hips/pelvis. Our low back vertebrae (or lumbar spine) are fairly mobile relative to the thoracic (stabilized by the rib cage) and sacral/coccygeal (stabilized by the pelvis and/or fused) vertebrae. So whatever motion my body may not have at the shoulder girdle and hips, my body will find at my lumbar spine since that is a nearby segment with some extra mobility to it. That is, my low back takes the hit for what my shoulders and hips cannot do.

So how do we work with this?

1) Open up the front of the shoulders (increase mobility)
2) Strengthen the back of the shoulders and upper back (helps with posture maintenance)
3) Open up the hips (quiet angry hip flexors)
4) Increase glute activation (wake up drowsy glutes)
5) Stretch the low back (quiet angry low back muscles)
6) Wake up the abs/core control (wake up drowsy ab/core muscles)

That’s a tall order, so I’m going to give you a few suggestions when consulting with other fitness professionals, or if you are a casual exerciser, about what to look and ask for.

1) Pec major/minor stretches, latissimus dorsi (lats) stretches: usually shows up as stretches that you see people doing in a doorway or with their arm up on a wall
2) Scapular (shoulder blade) retraction exercises: usually some form of bringing the arms from a position in front of the body to one behind it while maintaining elbows out away from the torso
3) Hip flexor stretches
4) Types of squats, lunges, or deadlifts: these need not at all be heavy and must be done perfectly to target glute activation otherwise other muscles may try to step in and take over the motion
5) Low back stretches: usually involve a rounding of the low back while standing or “on all fours”
6) All types of core exercises including, but by no means limited to, variations of ab crunches

There are all kinds of ways to accomplish the above and this should serve only as a starting point of discussion and research for the best selection of exercises to “wake up” and “quiet” the right muscles for your or your client’s specific needs and body. This is to get you thinking about programming, not serve as the detailed guide on it. There could be other muscular imbalances at play and a thorough motion analysis is warranted before beginning individualized programming. And don’t forget my mantra “When in doubt, refer out.”

Got questions? Please email me at rich@oraclefited.com

Thanks for reading and talk to you soon!

Rich

About the author:
Rich Fahmy MS is the Director of Education for Oracle Fitness Education, a company that specializes in continuing education for health and fitness professionals (more info can be found at www.oraclefited.com). He is a trainer’s trainer; and some, although very few, would say he’s a cross between Chuck Norris, a Real Man of Genius, and The Most Interesting Man in the World. And by some, that means just him.

This entry was written by rfahmy, posted on March 28, 2010 at 10:40 pm, filed under Life is Fitness, Lifestyle and Spa, Los Angeles, Santa Barbara and tagged , , , , , , . Leave a comment or view the discussion at the permalink.

Common knee discomfort issues and what to do about them!

by Rich Fahmy

I’ve been getting asked a lot lately by client and trainer alike about knee discomfort for exercisers. You know, the knee discomfort that appears usually as the subtle tugging feeling or tightness felt at the outer side or front of the knees. And can at times escalate to pain.

Let’s talk about the knee a little. It essentially is a pretty helpless joint. By this I mean it does what the ankles and hips tell it to do, the knee is at their mercy.

So what’s the point? The point is that when a client or you has knee discomfort, it almost always is never the knee itself, but what lies above and/or below it. To put it quite simply: the motion I don’t have in my hips and ankles will be found in my knees. Remember when we move, our body will get us from ‘point A’ to ‘point B’. It may not look pretty and it may not be the most efficient or optimal motor recruitment pattern, but it will find a way. So it is quite common that my knees take the hit for the lack of mobility of the joints around it. This sets up overuse patterns, and structures that normally would be responsible for let’s say, stabilizing the knee in a particular plane of motion, end up doing even more work than needed. This often leads to some form of pain and tendinitis.

**READ THIS** It should be noted that our job as fitness professionals and as active individuals is NOT to diagnose or treat medical conditions, including tendinitis. This is NOT to serve as a guide for diagnosis, but an article to recommend some flexibility exercise choices for clients that report discomfort in the knee. If you at all suspect tendinitis or other structural issues, always refer the client or yourself to a qualified health-care provider. Remember folks, our world is about motion and exercise not medical conditions. “We now return to our regularly scheduled programming.”

While traditional muscle group exercises for the quads and hamstrings, usually in the form of leg curls and extensions, will do fine at strengthening the muscles surrounding the knee, they may not do much, if at all, to increase motion in the joints that are impacting the knee.

So what do you do exactly?

1) The idea is to increase the mobility of the hips and of the ankles so they can do their jobs, and the knees won’t have to pick up the slack. There are all kinds of ways to do this but to keep things simple, seek out good stretches for hip flexors and calves, these are the most common muscle groups that reduce the available motion in the hips and ankles respectively. And if you or your client doesn’t even have any knee issues, these are good to do anyway.

2) It’s a good idea to also build stability in the joints of the lower body. It is one thing to increase the available motion in a joint with flexibility exercises, it’s entirely another thing to train the body to actually know what to do with the new-found motion once it has it. For the sake of keeping things simple again: for the lower body this just means get your clients standing and actually bearing their weight. If they are sitting on machines all workout long, the body isn’t learning to manage and stabilize their body weight with their lower body. You can then try staggering a stance, narrowing the width of the stance, or even trying single leg exercises if they qualify for them.

Until next time…

Rich

About the author
Rich Fahmy MS is the Director of Education for Oracle Fitness Education, a company that specializes in continuing education for health and fitness professionals (more info can be found at www.oraclefited.com). He is a trainer’s trainer, and some, although very few, would say he’s a handsome man’s man. And by some, that usually refers to himself and his mother. Contact him at rich@oraclefited.com.

This entry was written by rfahmy, posted on February 15, 2010 at 5:50 pm, filed under Bodywork, Fitness, Life is Fitness, Los Angeles and tagged , , , , , , . Leave a comment or view the discussion at the permalink.

Why eating close to bedtime may actually help you lose weight!

by Rich Fahmy

Tis the season of resolutions so I thought a little discussion on a popular weight loss myth would be a nice blog post for January. The myth is one we hear a lot, especially in the form of random advice people start dispensing immediately upon hearing that your resolution is to lose weight. It comes in a few different forms but it usually sounds something like this: “Don’t eat past *insert favorite time here* o’clock because food just sits there in your stomach and turns to fat while you sleep!”

Let’s take a look at this one with a little common sense and a little science and hope we can debunk this one for good!

A little common sense:

First and foremost, digestive and metabolic enzymes don’t wear watches. Science has yet to find an enzyme that at 6:30PM says “Halt!! All calories consumed from here until sunrise will now be shuttled to fat stores!!” And what happens if I’m on a flight from LA to NYC, do I have to stop eating at 3:30? So unless you can convince me of the magical Fat Fairy that flies around at night causing all calories consumed within 3 hours of bedtime to be stored as fat, I’m not buying it.

You may then ask, then why did it work for my office mate or friend? Well very simply, it was an easy way to cut calories. To lose weight, we need to move more and eat less. And if I’m the type of person that normally plows through two servings of Ben & Jerry’s Chunky Monkey at 8PM; and I now suddenly stop because of this myth then it’s not because of the timing, it’s because I removed 600 calories from my day. So it made me eat less automatically, irrespective of time of day.

A little science:

The myth often rests its logic on the idea that we must somehow metabolically shut down so everything we eat just “sits” in our bellies and we don’t do anything with it but store it as fat. The truth is that even though our internal organs only make up about 5-6% of our body’s total mass, they make up for a whopping 60% of our resting metabolic rate. For example, the brain alone burns about 109 calories per pound of its mass per day which means a 3.1 pound brain (or about 1400g, the average for an adult human) would burn about 338 calories a day just on its own! What’s the point here? Most of the energy we expend is expended to keep us alive and functioning and since when we sleep, we need to be alive and functioning too, we don’t necessarily shut down or down regulate vital functions, and these vital functions burn a hefty amount of calories.

If we try to examine actual numbers, available studies reveal that sleeping metabolic rate is about 95-97% that of waking metabolic rate for an equivalent amount of time. That is, if I were to burn 1492 while awake and not doing anything but sitting there and hardly moving for 10 hours, I would burn 1416 calories while asleep for the same 10 hours. That’s not enough of a difference to account for the massive weight gain that people blame on this myth. Remember though this compares sleep to just sitting there awake fairly motionless, so think of it like this: if you surfed the web for 8 hours and slept for 8 hours, the number of calories you burned would be within 3-5% of each other.

So how does the bedtime snack help?

Well, one of our main goals when losing weight is to not be hungry. To put it simply, we overeat when we’re hungry. So appetite control is vital during our battle of the bulge this resolution season. So long as in a 24 hour period, I’ve burned more calories than I’ve consumed, I will lose weight in that same period even if some of those calories came at 9PM. If a little snack closer to bedtime will keep you from waking up at 1AM and taking out one of those familiar white cartons of leftover Chinese food in the fridge, then for Pete’s sake have the snack! It can actually help keep your calorie intake in check.

Happy New Year and here’s to a great 2010!

About the author:

Rich Fahmy M.S. is the Director of Education for Oracle Fitness Education, a company that specializes in online education for health and fitness professionals. His only New Year’s resolution is to not make resolutions, which either makes him a master of irony or a hypocrite. That part is still up for debate.

References:

1. M Elia Organ and tissue contribution to metabolic rate. In: JM Kinney, HN Tucker, eds. Energy Metabolism. Tissue determinants and cellular corollaries. New York: Raven Press, 1992:61-77.

2. L Garby, MS Kurzer, O Lammert, E Nielsen. Energy expenditure during sleep in men and women: evaporative and sensible heat losses. Hum Nutr Clin Nutr 1987; 41(3):225-233.

3. GR Goldberg, AM Prentice, HL Davies, PR Murgatroyd. Overnight and basal metabolic rates in men and women. Eur J Clin Nutr 1988; 42(2):137-144.

4. H Kumahara, M Yoshioka, Y Yoshitake, M Shindo, Y Schutz, H Tanaka. The difference between the basal metabolic rate and the sleeping metabolic rate in Japanese. J Nutr Sci Vitaminol (Tokyo) 2004; 50(6):441-445.

This entry was written by rfahmy, posted on January 10, 2010 at 12:37 am, filed under Fitness, Food, Life is Fitness, Los Angeles, Nutrition and tagged , , , , , , . Leave a comment or view the discussion at the permalink.

Don’t get mistaken for Santa this Holiday Season!

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A better balance during the Holiday Season

by Rich Fahmy

Ah yes, the holidays! Parties, gatherings and get-togethers all with one main event: your family? Nope, the food. Here are a few tips on eating less and moving more during the Holidays to help you survive the annual pre-resolution calorie debacle.

The idea is to burn either as many, or more calories than we eat this holiday season. This means we’ll either lose weight or at the very least maintain it. Finding the right energy balance of calories in versus calories out will be your best defense against looking more like the jolly guy in the red suit. So these tips are broken into two sections: burning more calories and eating fewer calories.

Burning more calories…

Park farther away from the mall even if the parking happens to be great

Take a few laps around the mall before you begin shopping

While you’re closing out the year at work…

Use a restroom farther from your desk than usual

Stand up and pace for phone calls that last 5 minutes or longer

While you’re on a conference call, do squats, lunges, jog in place, exercise with hand weights, just move more (you’re on mute anyway!)

Instead of a text/IM/intercom page/phone call/email, actually walk over to a co-worker’s desk and speak in person

While you’re eating on the go in between all the shopping and errands, walk into the restaurant instead of the drive-thru

When you’re cleaning house for the big shindig, use your non-dominant hand to vacuum, wipe, sweep, etc. The awkwardness of it will burn more calories than usual

Take along some bands or light dumbbells on vacation and be sure to be active while away, even if it’s nothing but a simple walk with a loved one

Be the person that passes out the presents and cleans up afterward

Offer to help with kitchen clean up duties

Eating fewer calories…

Before you go to a party, eat a healthy snack! The fuller you are before you arrive, the less munching you’ll do

Stay hydrated! Our body can mistake thirst for hunger, so keep the water flowing and avoid that classic pitfall

Brush your teeth after meals; the change of taste in your mouth will signal you’re full

Whatever you do, distract yourself from being near the buffet or snack table, focus on keeping a ten foot perimeter around it

Bring healthy dishes and snacks to the pot-luck

Go after leaner cuts of beef and poultry, and load up on veggies to keep you full

If you are to snack on some fudge, cookies, and so on, take only a few pieces, put them on a plate and WALK AWAY, do not graze at the table. This also assumes only ONE trip to the table.

Put these strategies to use and avoid having to say “Aw heck, I blew it! I might as well let it all loose till my New Year’s resolution!”

Have a safe and joyous Holiday Season!

Until next time,

Rich

About the author: Rich Fahmy, M.S. is a respected industry authority on personal training. He owns Oracle Fitness Education, a company that provides continuing education designed for fitness professionals. Visit www.oraclefited.com for more information.

This entry was written by rfahmy, posted on December 4, 2009 at 12:42 am, filed under Food, Life is Fitness, Nutrition, Press and tagged , , , , , . Leave a comment or view the discussion at the permalink.

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