Many, many bodily joints and tissues need to function well to be able to fully bend forward. Poor hamstrings, though … they always get blamed!
To regain forward bending ability, I hardly ever loosen patients’ hamstrings. However, say a patient did simply need looser hamstrings - then clinical care is hardly needed. (Stretching is not rocket science!) With consistent home stretching, hamstring length better consistently improve.
In almost all cases, forward bending is limited because lumbar structures are moving improperly. Usually it’s that the joints themselves are misaligned. In other cases, compressed/adhered/trapped nerves create nerve tension that limits this movement (with or without contemporary joint malalignment).
Forward bending (lumbar flexion) is usually restored once we get the patients’ lumbar structures moving properly again. Importantly, using forward bending to achieve this is beneficial in only a small group of patients. More commonly I utilize lumbar extension or sidegliding.
So why do people say they “feel it” in their hamstrings? It’s either that they’re actually feeling the sciatic nerve(s) pull or that, in attempting to bend further, their body eeeks out more motion in the only structures it can – muscles and tendons – so they “feel it” there. Expert mechanical clinicians know better. --Laura
Just as important as the mechanical therapy I provide to patients to eliminate their symptoms is the education I provide regarding how to keep their spines healthy in the future. A terrific analogy I've learned from mentors enlists teeth brushing. Just as we recognize the significance of keeping our teeth healthy via flossing, brushing, and dietary habits, we should acknowledge that devoting a few minutes a day to our spines is a worthy endeavor. My goal with patients in this educational arena has two facets.
The first is simply teaching people to be aware of the movements and positions our spines adopt on a daily basis. Unlike our peripheral joints which tend to get a fair amount of both bending and straightening throughout the day, when we look at spines, the majority of people in the US spend their days in an imbalance in favor of forward bending (flexion). (The upper neck, however, is often hanging out more in a backward bent (extension) posture. Why? Because our lower necks are stuck forward, and we need to see ahead!) To be sure, certain manual jobs, or desk jobs in which the computer monitor absolutely has to be to your side, create movement imbalances in other directions. Likewise for someone who takes hundreds of right-handed baseball or golf swings per day or throws overhead regularly. Once this observational ability sets in - which undoubtedly takes time - the plan of attack is straightforward: reduce the imbalance. This is akin to reducing your teeth's exposure to deleterious foods and drinks.
The second piece to keeping our spines healthy, and preventing re-injury, is intentional movement. As I tell my patients, just as you brush your teeth twice a day, give your spine some good, healthy movement twice a day. In the most common scenario, this translates to bending backwards - all the way backwards - about ten times twice a day. Sometimes it is rotation or even bending forward. My patients leave my care knowing what their specific movement is.
Like most people, over my lifetime, my spine scale was heavily tipped in favor of forward bending. Sitting slouched at desks over books, slumping "comfortably" into couches and chairs, and later bending over patients added up to a lot of spine flexion. Did I ever bend all the way backward? Maybe a handful of times. It's no wonder I injured myself. Once I learned to look at how we position ourselves, however, I adopted several changes to narrow the gap between the amount of my spine's flexion and extension. Firstly, I almost always sit with a lumbar roll which places my lower spine (except L5-S1, which remains in 60% flexion in sitting) in extension, or at least neutral. If I don't have something to support me, I sit up straight, slouching only occasionally. Secondly, I spend more time lying on my stomach propped up on elbows while reading, watching television, or using electronic devices. Thirdly, given the choice, I often choose to stand instead of sit; for example, I will stand when using my computer on my high counter or when out at places like bars or concerts.
As far as the second component - deliberate movements - I have two go-tos. A few times a month, I'll notice I need to rotate my spine to one side so I'll do that. Most days, though, I move my neck, mid back, and low back into extension a few times. This tallies up to roughly 5 minutes per day, which is a more than reasonable price to pay to keep what I call the "body's fuse box" working correctly. -Laura
I approach fixing a patient's injury in three ways:
1. Find a specific movement to correct the injury.
2. Address and correct everyday habits (especially posture) which contribute to the injury.
3. Place the patient's activities which prevent the injury from healing on hold temporarily.
This video (about 2 minutes) is a nice example of how to correct everyday habits, including posture. Making these simple adjustments can make a world of difference to our bodies. (I'd prefer better posture on the bicycle, however. Or forgoing the biking for walking or jogging.) -- Laura
I got to give my two cents for this article. My number one piece of advice made the cut: give your spine some extension (backward bending) to combat all the flexion (forward bending) you give it! All that flexion with workouts and daily life usually leads to an imbalance in your spine and injury.
When we bend forwards, the front of the vertebrae come together, moving disc material backwards. When we move backwards, the opposite occurs: the back of the vertebrae move together, pushing disc material forwards. Movement of the nucleus (the inside of the disc) within the annulus (the outer part of the disc) is normal - to an extent. Unfortunately, it is quite common for the nucleus to be pushed outside its normal limits, resulting in injury. This is typically referred to as a disc protrusion, a disc herniation, or a bulging disc. When discs move out of place, in most cases they bulge backwards or backwards and to the side. In rarer instances, the disc will move to the side, forwards, or forwards and to the side.
Why do discs bulge? The imbalance of forces on our discs throughout our lives is largely to blame. Did you know we bend forwards about 4,000 times per day? And about how many times do we bend backwards? I would say rarely, if ever. Considering that sitting in a slouched posture is also bending the spine forwards, we tend to spend a great deal of time with our spines bent forwards. This not only creates a severe imbalance of forces on the disc, it also overstretches all the supports that are designed to keep this from happening. Is it any surprise then that one day the disc will move far enough to hit something it shouldn't and cause symptoms, signaling to the person that there is an injury? This is why many patients do not report a traumatic event that created their back or leg pain. (Or, in the neck, their neck or arm pain.) Generally, the injury was years in the making, and then one day the disc went farther than usual and hit pain-sensitive structures, such as a nerve.
Keeping this anatomy and biomechanics in mind, it follows that to fix an injured disc, patients will RARELY need to perform exercises that bend their spines forwards. (Examples include touching your toes, child's pose, downward dog, crunches, single or double knee to chest, or the figure four stretch.) INSTEAD, most patients need exercises that bend their spines backward, such as standing back bends or lying extension exercises such as cobras or upward dog. Ultimately it is my job to diagnose the patient's injury and then choose the SPECIFIC exercise for that patient that allows him/her to get back on track. -- Laura
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