Lately, it seems social media is exploding with self-proclaimed gurus advising avoidance of just about every exercise. I admit, I've done it myself. But, it seems the pendulum has swung so far that almost any training exercise is considered harmful. Recently, a client questioned if the oblique crunch exercise he was performing could hurt his back? He explained about reading on-line that crunches caused back pain. So I explained the exercise was only part of his core program and the primary goal was to increase mobility which he lacked. Perhaps we are doing more than good sounding the alarm by suggesting specific types of movements are bad for all. Before you know it we will all be walking around like stiff robots.
Over the years, clinicians have debated about which types of exercise are the most beneficial to alleviate back pain. Some exercises are backed up by research and some of it anecdotal. But even today there is no consensus on appropriate exercise to alleviate back pain. Maybe because no two backs are the same? But a common debate about abdominal crunches causing lower back pain has existed for decades. The argument centers around whether or not abdominal crunches actually create back pain instead of eliminating back pain. Dr. Stuart McGill is one of the leading researches on this topic and offers compelling evidence against performing crunches in his research. His primary argument is repetitive flexing of the spine can damage the discs which creates pain. However, this biomedical model which suggest pain is caused by tissue damage alone is being challenged by many in pain research. Leading pain researchers Lorimer Moseley and David Butler published a book on pain called "Explain Pain". The authors believe pain should be thought of in a broader context using a biopsychosocial model which considers beliefs, emotions and culture not just damaged tissue. Moseley and Butler describe pain as output from the brain based upon perceived threats or dangers. This is highlighted in chronic pain where tissue damage may be absent indicating pain persists as a feedback output loop from the brain and not the tissue. Pain is very personal and subjective which explains why some people with similar chronic ailments have different pain tolerances.
Regardless, whether or not back pain comes from tissue damage or a negative feedback loop is debatable. However, each person and each injury is uniquely different.Therefore each prescribed exercise should be customized for the client based on assessment. When assessing each client, not only is objective information necessary, but subjective information like beliefs, anxiety and fear are equally important when selecting appropriate back exercise and dose. For example, if someone is fearful of a specific movement or exercise then it's probably not a good idea to begin with that movement but rather discuss the anxiety eventually easing into it helping to overcome the fear. Likewise, considering whether an exercise is functional is equally important. Continually flexing the spine like an abdominal crunch just isn't functional. However, personally I like the feeling of muscle fatigue during abdominal crunches so I do them. But for some, abdominal twists may be more appropriate because the twisting motion provides some mobility of the muscles and spine. Yet, the core muscles are more often used for bracing the spine. For example, a running back who slices through the defense isometrically contracts his abdominal muscles bracing against tacklers so a lateral walking pallof press may be more appropriate. But essentially all three exercises could be implemented into a core program.
With good intentions, perhaps we've played a role in exacerbating fears in our clients by instructing them to avoid movements like crunching, bending, twisting and stooping. Research is absolutely necessary but rarely is it absolute. It's probably a little overkill to say any one specific exercise is bad for everybody and should be completely eliminated. Regardless, I take new and old techniques, research and methodologies with a grain of salt. What it really comes down to is each exercise should be based upon individual needs not the masses. Likewise, moderation is always helpful when training any part of the body. If you do a 1000 crunches a day for 6 months you probably will aggravate your back, but if you do 1000 of anything for 6 months you will likely do more harm than good. Move, do exercises in moderation and train the whole body and you should be fine.
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