Ill-Advised Low Back Rehabilitation Recommendations 

 September 28, 2010

By  Dr. Tripp Stover, D.C.

Mechanicsville, Virginia — I’m trying to work my way through the book Low Back Disorders: Evidence-Based Prevention and Rehabilitation, by Stuart McGill PhD and he make some very interesting points at the beginning of the book.  McGill points out that there have been many oversimplifications of low back treatment that resulted inadequate treatment practices and recommendations.  He really takes some shots at advice we’ve all heard (even if you don’t have low back problems).  They questionable recommendations are as follows:

– Strengthen muscles in your torso to protect the back.  It turns out several studies show muscle strength cannot precut who will have future back troubles (Biering-Sorenson, 1984).  It turns out muscle endurance is actually protective.  He goes on to say, “optimal exercise therapy occurs when the emphasis shifts away fro enhancement of performance and toward the establishment of improved health.  In many cases the two are mutually exclusive!”  Sounds like chiropractic to me.

– Bend the knees when performing sit-ups.  The literature is hard to bring together.  Believe it or not, Axler and McGill (1997) showed there is little advantage to one knee position over the other.  In fact there are far better ways to challenge the abdominal muscles while producing far lower lumbar spine stress.

– Performing sit-ups will increase back health.  There is mild literature support for the belief that people who are fit have less back trouble.  In fact, enough sit-ups will cause damage in most people.  Increased fitness clearly has support and is good, but the way in which fitness is increased appears to be critical.

– To avoid back injury when lifting, bend the knees, not the back.  If you can believe it, research that has compared stooping and squatting styles of lifting have not produced a conclusion as to which style it better!!

– Tight hamstrings and unequal leg length lead to back troubles.  There is little support for these notions.  It may surprise some that I’ve included this.  We as chiropractors are concerned when we see these two things in patients.  Unequal leg length is a significant finding for us.  But what isn’t said above is to Dr. McGill, “back troubles”, actually means: PAIN.  I would agree, hamstrings that are tight and unequal leg length are not good predictors of PAIN, but they are predictors of bio-mechanical problems.  Specifically, the possible presence of subluxations are indicated by unequal leg length measurements (functional differences, not anatomical).  However McGill closes by saying to “perform the provocative tests and discover whether these postural variables are true exacerbates in the individual and thus are justifiable targets for therapy.”

– A single exercise or back stability program in adequate for all cases.  This seems obvious, but some “gurus” advocate the strengthening of just one muscle group as a cure all to enhance stability.  Virtually all spinal muscles can be important to the stability of the low back.  Damage to any [emphasis mine] of the spinal tissues from mechanical overload results in unstable joint behavior.  His point is that the potential problems are numerous and regardless of which tissue is injured, there are complex problems that may need to be addressed.  “No simple, or single, approach will work for all cases.”

Dr. Tripp Stover, D.C.

Dr. Stover grew up in Richmond. He has been married to his wife Andrea since 2000 and they make their home in Mechanicsville with their children, Avery and Garnett.

Dr. Tripp Stover, D.C.

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