Part 2
CB Athletic Consulting, Inc. Training Report
Issue #127
Inside this Issue:
- Research-based Core Training for Athletes: Part 2
1 - Core Strength for Athletes: Part 2
John Gray is a Ph.D. Candidate in Spine Biomechanics at the University of Waterloo, working with internationally-renowned Spine Biomechanist, Dr. Stuart McGill, Ph.D. He is also a Certified Kinesiologist with the Ontario Kinesiology Association, a Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association, an NCCP Certified Weightlifting Coach, and the co-owner of First Line Kinesiologists, Inc.
CB: In issue #126 we discussed how someone can herniate a disc. Can you tell us what actually happens to the disc injury during rehabilitation? Do you rehabilitate it by using the big 3 exercises?
JRG:
Basically, once a disc injury happens, it will never go back to the way it was before. The best case scenario is that it will stay the same, and not progress into a more serious injury. Once the disc fibres are damaged, they're done. It’s like how cartilage in your knee doesn't grow back or repair itself after it's injured.
If the injury is a disc bulge, then you have to make sure that the dangerous movements (e.g., spine flexion) are minimized or removed so that the disc injury isn't made any worse. Otherwise, it could easily progress to a full-blown herniation, which often requires surgery.
Some bulges don't require surgery, but the contents of the disc are right beside the nerve root(s). If the disc contents ever squeeze out and press onto the nerve roots, then it can affect the body parts that are supplied by that nerve (e.g., the leg).
The most serious condition is when pressure on the nerve is so great that the person loses reflexes associated with that nerve. Then it is considered a medical emergency because the nerve can actually die and leave the person with paralysis.
Herniations are usually handled with McKenzie-type exercises (sloppy pushups), or surgery in more serious cases. So, the big 3 is really there to teach movement awareness (how to stay in a safe, neutral, position) as well as help to recondition the muscles around the spine. That way, the person has the muscular endurance to be able to move without re-injuring themselves.
CB: Do other sports have similar postural and low back issues as hockey? Can you provide a couple of examples and sample solutions?
JRG:
(Non-impact) back problems in sport are usually caused by repetitive motions that the body has adapted to over the course of time, and is specific to the movement patterns of that particular sport.
For example, many tennis players have pain in, and are susceptible to moving into, extension-rotation (toward their serving side); and many young gymnasts develop problems with the posterior elements of their vertebrae as a result of the repetitive high loading caused by dynamic extension maneuvers. As a result, young gymnasts typically have lordotic spines, and can easily move into that direction, often over only a few vertebral levels.
The basic principles for are the same in each case – to teach the athlete to first sense the aberrant movement pattern, and then avoid going into the aberrant movement pattern during activities (whether that be sport, exercise, work or leisure). It can sometimes take a lot of patience and practice, but the key is to develop these movement habits so that they become automatic. Training for strength won't address the underlying movement impairment.
CB: When working with young athletes, I find that a lot of the taller male athletes already suffer from low back pain. Is it common for taller kids to have more back pain? Is it inevitable? What are some solutions?
JRG:
In my experience, I don't think the issue is height as much as proportion.
I've observed young athletes who had great height and proportional muscle mass who played at a very high level, and without any incidence of pain. But some young athletes experiencing a rapid period of skeletal growth (without the corresponding muscle growth) are often not as well coordinated or powerful. As a result, it seems like these athletes just don't have the muscular capacity to protect their joints from impacts and avoid accommodating postures (prolonged spine posture at its end range of motion) that place the low back at risk for injury.
This situation is made worse in athletes who are very self conscious and adopt postures (e.g., bent-over, slouched postures, etc.) that de-emphasize their height. Unfortunately, this can also feed into the whole posture-loading issue I commented above.
I think that the best prevention solution is to keep a close eye on signs of overtraining and fatigue. Often, young hopefuls will push the limits of their bodies in training, only to suffer from pain and injury in the long term.
Parents and coaches have to keep a close eye on the signs of accommodating postures, discomfort and pain. They need to be proactive in modifying the conditioning and sports training programs to keep forward progress. Most importantly, they need to keep it fun, and be positive influences for our young athletes. Pushing a young athlete who may be considered "lazy" or "unmotivated" could possibly lead to longer term injury and a short career.
CB: Do you see any low-back pain symptoms that are unique to the female athlete? How do they differ from males? Are the solutions the same?
JRG:
In my experience, there are no direct gender differences for low back pain in athletes. However, we do tend to see more hip restrictions and especially hamstring tightness in males, which as I mentioned can be a factor in discogenic back pain in the longer term.
There are some considerations, however. For example, a female athlete with knee pain (caused by femoral anteversion, or a growth spurt) will often avoid knee flexion during dynamic movements, especially those requiring forward bending. If she is trying to avoid feeling knee pain, she will tend to move more through her hips and spine. This places a greater responsibility on the low back and hips to bear the repetitive loads of playing a sport, and may be a causative factor in back problems later on.
CB: Thanks John. In the third and final part of the interview John will discuss core training as it relates to the office worker.
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