Back Injury Prevention Using Neutral Spine Exercises

Back injury prevention is a concern for many people. In industry, it is a major issue for safety professionals. In sports, preventing back injuries is important to athletes as well as strength and conditioning coaches. Fitness professionals also take a special interest in preventing back injuries for themselves and their clients of all fitness levels. Injuries can be prevented in many ways, and training to improve the strength of the back and core is important in the process. However, exercises to strengthen the back and core must be safe, effective, and functional. While exercising the back and the core, it is important to maintain a neutral spine so that the intervertebral discs are not weakened due to repeated trunk flexion or hyperextension. This is why exercises that maintain a neutral spine are so useful in back and core strengthening (front plank, side plank, bird dog, and vertical core exercises).

Learning Objectives:

1. Understand the research and risk factors for back injuries, and discuss the mechanisms of injury.
2. Be able to explain, demonstrate, and apply neutral spine exercises for clients.
3. Understand how to apply horizontal and vertical core training exercises.

Back Injury Overview

Back pain is one of the most significant health care issues in North America. Sixty to 80% of the population (including fitness professionals and personal training clients) will suffer from back pain or back injury at one point in their life (Andersson, Fine, & Silverstein, 1995). Stuart McGill, Ph.D., spinal biomechanist at the University of Waterloo, Canada, indicates that strains to the muscle and tendon are the most common cause of low back pain (2007). Most back injuries are caused by micro-traumas from sub-failure magnitude loads that eventually lead to a severe strain (McGill, 2007). For instance, the injury mechanism leading to a disc herniation is repeated trunk flexion (Tampier, et al., 2007).  

True Core Stability

McGill (2010) indicates that core stability has little to do with the ability to balance on a gym ball. Exercising on an unstable surface is the ability to maintain the body in balance, which can be important and fun, but does not address the unstable spine. True spine stability is achieved with a balanced strengthening of all the muscles including the rectus abdominis, quadratus lumborum, latissimus dorsi and the back extensors (McGill, 2007).

If our clients are sitting all day at a computer (a risk factor for back injury/pain [Videman, Nurminen, and Troup, 1990]), or lifting objects for work, or driving medium to long distances, their backs can already be at risk for injury. Therefore, trainers would want to be aware of the client’s occupational postures and risk factors and not make them worse by prescribing back/core exercises that would further exacerbate the risk for back injury. 

Rational for Neutral Spine Loading

This therefore makes a strong case for neutral spine loading. Some trainers believe that repeated spine flexion (crunches or full sit-ups) are effective ways to train the trunk flexors, but these muscles are rarely used in this way. Instead, they more often act as stabilizers, accelerators, and decelerators rather than flexors (McGill, 2010). For instance, in the activities of daily living, how often do our clients perform forceful trunk flexion using the rectus abdominis? The only time forceful trunk flexion would be performed would be if our clients are involved in competitive swimming (turning at the end of the pool), diving, gymnastics, pole vaulting, and other similar activities. Instead, many of our clients need a strong core for stabilizing the spine/trunk in activities such as pushing a door open, pushing a lawn mower, carrying groceries, holding a young child, or shoveling snow. Even our athletic clients require stabilizing core muscles for acceleration – deceleration and maintaining a strong upright posture for sports such as football, tennis, softball, ice hockey, swimming, hiking with a pack back, and biking.   

Neutral Spine Exercises

The following are examples of neutral spine exercises (horizontal and vertical) that are effective for strengthening the back and core, and therefore helping to prevent back injury.

Horizontal Core Exercises

 
Figure 1: Front Plank

• Front Plank – Bend elbows at 90 degrees directly under shoulders while balancing on toes with a straight body (head to toe). Maintain head in a neutral position and contract the abdominals to help maintain a neutral spine. (See Figure 1)

*Regression: Balance on knees instead of toes.
*Progression: Lift one arm forward in the air, or lift one arm and the opposite leg in the air simultaneously.

 
Figure 2: Side Plank

• Side Plank (Left and Right Sides) – Bend elbow under directly under shoulder while balancing on stacked feet. Contract the abdominals to maintain neutral spine. Try to keep top arm 6-12 inches from the top leg. (See Figure 2)

*Regression: Balance on stacked knees instead of feet.
*Progression: Move elbow forward so that it’s under the head, or hold a hand weight with the top hand.

 
Figure 3: Bird Dog

• Bird Dog – While on all 4’s, maintain a neutral spine and extend right arm out in front of body and left leg backward. Lift R-arm and L-leg (with pointed toe) simultaneously, keeping elbow and knee straight. Lift as high as comfortable. Finger tips and toes should touch the ground each repetition. (See Figure 3)

Perform reps of R-arm/L-leg, and then switch to L-arm/R-leg.
*Regression: Lift only one arm, or lift only one leg.
*Progression: Move arm in 3 different positions - start with reps of the arm in front of the body, then move arm to the side, then move arm straight back beside the body.

 
Figure 4: Stir the Pot

• Stir the Pot – (This is an advanced exercise using a stability ball). Maintain elbows on the ball and toes on the ground. Stabilize with abdominals while maintaining a neutral spine. Perform repetitions by moving elbows in a circle clockwise, then counter-clockwise. (See Figure 4)

 
Figure 5: Standing Arm Chop

• Standing Arm Chops – Place feet slightly wider than shoulder width with knees bent. Hold hands together with fingers interlocked and elbows straight. Perform repetitions by moving arms up and down as fast as possible. (See Figure 5)

*Progression: Hold a medicine ball (as seen in Figure 5) or Theraband soft weight.

• Standing Arm Rotation Swings – Body position should be the same as Figure 5 above. Perform repetitions by moving arms side-to-side with little trunk rotation and a lot of arm/shoulder movement (so that the core has to accelerate – decelerate the arm movement). 

*Progression: Hold a medicine ball or Theraband soft weight.

 
Figure 6: One-leg Pelvic Stability Running

• One-Leg Pelvic Stability Run – Stand/balance on one leg with opposite knee flexed at 90 degrees and raised to hip height. Maintain pelvis parallel with floor. Lean forward (maintain a neutral spine, rather than flexing forward) bending balance leg and extending opposite leg backward. Mimic running by moving arms forward - backward. Perform repetitions balancing on the right leg, then perform repetitions balancing on the left leg. (See Figure 6)

Vertical Core Exercise Workout: 
Perform 2 - 3 sets of the exercises in the following order:
(These exercises can be added to the Horizontal Core Exercise Workout above or completely separately on another day)

Standing Arm Chops: 20 – 40 reps (moving arms as fast as possible)
Standing Arm Rotation Swings: 20 – 40 reps (moving arms as fast as possible)
One-Leg Pelvic Stability Run: 10 reps with each leg

References

Andersson, G. Fine, L. & Silverstein, B. Musculoskeletal Disorders.  Ed: Levy, B.S. & Wegman, D.H.  Occupational Health: Recognizing and Preventing Work-Related Disease. Little, Brown and Company, Boston, 1995.

McGill, S. (2007).  Low back disorders: Evidence based prevention and rehabilitation, Second Edition, Human Kinetics Publishers, Champaign, IL, U.S.A.

McGill, S. (2010).  Core Training: Evidence Translating to Better Performance and Injury Prevention, Strength and Conditioning Journal, 32(3), 33 – 46. 

Tampier, C., Drake, J., Callaghan, J., McGill, S. (2007).  Progressive disc herniation: An investigation of the mechanism using radiologic, histochemical and microscopic dissection techniques. Spine, 32(25), 2869-2874.

Videman, T. Nurminen, M. and Troup, J D, (1990).  Lumbar spinal pathology in cadaveric material in relation to history of back pain, occupation and physical loading, Spine, 15(8), 728-740, 1990.