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FrameWork for the Lower Back: A 6-Step Plan for a Healthy Lower Back (FrameWork Active for Life)
Free Ebook FrameWork for the Lower Back: A 6-Step Plan for a Healthy Lower Back (FrameWork Active for Life)
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About the Author
NICHOLAS A. DiNUBILE, M.D., an orthopaedic surgeon, specialist in sports medicine, and best-selling author, has served as orthopedic consultant to the Philadelphia 76ers and the Pennsylvania Ballet. His advice has been featured in The New York Times, the Wall Street Journal, the Washington Post, and numerous magazines including Men's Health and Newsweek.
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Excerpt. © Reprinted by permission. All rights reserved.
STEP 1Think "Back"Roger Schwab, founder of Main Line Health & Fitness in a Philadelphia suburb, is an oft-requested personal trainer for top U.S. athletes, and the provider of a first-rate exercise facility. What's really special about Roger is his innovative work in establishing Main Line Medical Exercise, a facility that incorporates the latest in biomechanical equipment and routines to restore and maintain one's frame. The words he contributes here are worth heeding:Understanding the basic physics principle of applied force as it relates to structural integrity is a good first step toward understanding how you can achieve a healthy back and maintain it to keep it in top functioning shape.When force exceeds load-bearing ability, injury must occur. Thus, as the inherent forces of nature cannot be altered in most cases, we must concern ourselves instead with enhancing the structural integrity of the lower back frame members--five lumbar vertebrae and the soft tissue that supports them: disks, cartilage, ligaments, and muscles.You don't have to know every intricacy of back anatomy, but you should be familiar enough with the basics. Let's start with the backbone, or, more accurately, the back "bones," or vertebrae. A healthy spine forms a couple of gentle S-curves. There are built-in shock and friction absorbers and stabilizers for the two facet joints that each vertebra has with the one above it. Spongy disks, together with soft cartilage, prevent bones from directly rubbing against each other, while ligaments keep the vertebrae aligned.You were born with a critical anatomical component that is the first line of defense against back dysfunction--deep muscles that help keep vertebrae in line, and superficial muscles that extend from the vertebrae to the ribs. It could be argued with confidence that the lower back is the most vulnerable area of the body and that the role of its muscles cannot be overstated. And that brings us to the purpose of this book.BALANCING ACTYour "backbone" is a protective enclave for your spinal cord, a critical anatomical part for movement. That bony architecture protects a vast network of spinal nerves: The cord runs right down the center (it's a high- speed--not a dial-up--line that transmits signals), and there are tributaries on each side that end in nerve roots in soft tissue. Your ability to sense touch in one part of your arm or leg is attributed to one nerve or another, and each muscle group is fired by a certain nerve. When it comes to back problems, they often are not related to the muscles themselves (although that's where you feel it); you are most likely having "referred pain" that comes from:* A herniated disk that squeezes out from where it should be--between two vertebrae--into the spinal canal or into the foramen (where the nerve exits at each level)* A spur or arthritis in a facet jointBoth conditions press upon or irritate nerves. While they usually have the most serious consequences, including surgery, a lot has to happen before that point, and a lot can be done before or after such conditions present to reverse course.Muscles support the skeleton and move the body in the case of lower back muscles with flexion (lengthening of the deep and superficial muscles and contraction of the abdominals) and extension (lengthening of the abdominal muscles and contraction of the erector spinae and the gluteus maximus). Trunk rotation is produced by the external obliques and the internal obliques. Lateral flexion is primarily the responsibility of the quadratus lumborum muscle that works with the obliques, the latissimus dorsi, the iliopsoas, and the rectus abdominis on the side of the direction of movement. But enough with the anatomy lesson; what's most important is the overall message: There's a lot going on that's connected to the part of your back that hurts, and the muscles are key players.Your lower back muscles hold your frame in place and expand and contract to accommodate all of the twists and turns of normal and athletic movement. And there's more to them than one might think at first because they don't just work in the rear. Their sinews spread to the sides, to the front, and down your legs; a lot of what goes on biomechanically in those areas is directly connected to the spot you reach for when you have a backache.BACKBOARDLesson: Key PlayersLumbar Vertebrae and DisksNerves and Spinal CordFacet JointsLower Back LigamentsLumbar and Core MusclesThe core of your frame is much like that of a dwelling you build, with "walls" that support the overall structure and bear measured loads. You have abdominal muscles in the front (anterior muscles), back extenders, oblique muscles, and then deep within you have the interpelvic muscles. If one wall in your house isn't in great shape, the entire structure is susceptible to collapse. And so it is with your biomechanical frame. It is a never-ending balancing act.A strong lower back muscle network protects against the impact forces prevalent in sports, accidents, and many if not most activities of daily living. Keep your muscles toned, primed for action, and the rest of your back members will move freely as they were designed to do, and they won't place undue stress on nerves or another lower back member, or encroach on your spinal cord. That's the key to fluid motion and the avoidance of sciatica, inflammation, tightness, and sprains. That's the key to being active and pain free.WEAK LINKS AND STEALTH AILMENTSEven if you're proactive regarding your fitness, weak links and stealth ailments lurk, and they're responsible for most back injuries and pain. Knowing a lot about them is far more important than anatomical knowledge because you can do something about most of them and hedge your bets against compromised movement or disability, and pain.WEAK LINKS"You're only as strong as your weakest link" may often be said, but that doesn't mean it doesn't always have meaning. If you're not on a comprehensive exercise regimen, whatever weak link you have will snap a lot sooner:* POOR AEROBIC CONDITIONMuscles need oxygen like engines need gas, and they and other frame members, such as intravertebral disks and ligaments, need blood supply to stay healthy. (Much more on the critical importance of aerobic conditioning in Step 4.)* OVERWEIGHTIt stands to reason that the more your frame has to support, the harder it has to work and the more susceptible to injury it is. (Step 4 also has some juicy tidbits on frame-appropriate nutrition.)* IMBALANCESWe touched on this in the preface, and it's something that crops up throughout these pages because of how they work against you--not only physically but also nutritionally and emotionally.* OLD INJURIESThis is a big one--the number-one predictor of future back ailments. Your body is just like paper, metal, and wood: Its cracks and tears and breaks can be "glued," "taped," "stapled," or "welded," but it may never be as strong as it was originally.* REINJURYIf I had a dime for every patient who showed up in my office with a reinjury (lower back or otherwise), there wouldn't have to be a cover price on this book. I'm not just talking about sprains; I'm talking about tears and fractures. There are a few primary reasons for this:* Incomplete rehabilitation* Strenuous recreation too soon* Improper warmup of affected area* Poor nutritional support* Medication camouflageA vicious slide ensues as each rehab from injury only restores you so far, and you're not where you were before. That's your new baseline.I won't mind it at all if no one shows up in my office for the above. That'll happen when a lot more people are on the FrameWork Lower Back Program.* AGING EFFECTSGray hairs and wrinkled skin aren't the only consequences of advancing years. There are tissue changes (cellular, biochemical, biomechanical) all over, with marked impact on your frame:* Probability of injury increases.* Severity of injury increases.* Time to heal increases.* Degree of healing decreases.Here's the bad news when you pass 40 years of age:* Bone loss occurs.* Loss of human growth hormone (HGH) and muscle mass is significant, and becomes precipitous after age 50.* Loss of collagen and change in its structural integrity are steady (tendons and ligaments have loads of collagen).Here's the good news: The advance of all of the above is slowed, and at times even halted or reversed, by the FrameWork Lower Back Program.* STRUCTURAL DEFECTSSometimes bridges come tumbling down. Usually, that's a consequence of wear and tear; in a few cases, it's because of an inherent design defect. Some of us have scoliosis or another vertebral anomaly--bones misshaped or "misconnected" in some way. This is one of the two lower back weak links no one can do much about.BACKBOARDLesson: Weak LinksPoor Aerobic ConditionOverweightImbalancesOld InjuriesReinjuryAging EffectsStructural DefectsGenetics* GENETICSThe other one. It no doubt plays a role in structural defects and degenerative disk disease, but it has also been linked to arthritis and heart disease, as well as to other factors that impact the lower back: height, weight, athleticism, and ... pain.Yes, you read that right. A recent study by David H. Kim, MD, at Tufts University School of Medicine shed some light on why one person with a degenerated disk reports "discomfort" while another with the exact same condition clamors for serious meds. He and his team isolated two pain- modulating genes and their work points to as many as 12 others that might predict how surgical candidates respond to disk procedures. As I said, we can't do much about certain weak links, but "painstaking" advances such as this will improve the 75 percent success rate that is associated with disk surgery.So there you have it--the facts about potential threats to your chain of health. You'll get a lot more up close and personal with the ones most applicable to you in Step 3.STEALTH AILMENTSYou age in a fashion that's uniquely yours, and there are things going on that you're not aware of--yet. But you will be, sure as tomorrow follows today, because the silent wear and tear below is eventually voiced in nagging aches and injuries that compromise your active life and cause pain.* TIGHTNESSMost of us spend huge chunks of our day in sedentary activities or on our feet without moving about much. Cashiers, drivers, administrators, salesclerks, managers ... the list goes on and on. Their backs are essentially put in storage, until they're asked to do some serious work, lifting or recreating, and then it's watch out--just like that, something snaps.Those who have more active life-styles, such as nurses, firefighters, delivery people, and fitness enthusiasts, aren't necessarily out of the woods when it comes to lower back tightness. As noted above, physical imbalances can exist--even athletic, fit individuals can have imbalances from their own fitness or sports routines--and, as we'll discuss in Step 4, hardly anyone stretches properly for any activity, work or play.* WEAKNESSLower back muscle weakness is very common, and this is especially true of the lumbar extensor muscles. They are the double support system running parallel on each side of the vertebrae that you can feel in the center of your spine. They're also the muscles that feel great to get massaged when your lower back is sore. They can get quite nasty when they go into spasm, twisting you out of shape like a pretzel. Individuals who have recurrent lower back pain have been shown to have significant predictable weakness and atrophy of this important muscle group.With other injured body parts, once you are feeling better and using the body part normally, strength and mobility return (think of a limb that was in a cast: remove the cast and there is lots of muscle loss; start using the limb and things usually revert over time to normal). This is not so for the lower back extensor muscles, which remain in a weakened dysfunctional state until awakened or rebooted with the proper exercise sequences. Until the atrophy is reversed, the spine remains very vulnerable to persistent pain and recurrent injury.The other interesting thing about this pretty unique muscle group is that in addition to being the cornerstone of a healthy, durable lower back, once strengthened these muscles don't require as much work (i.e., exercise sessions) as most other muscle groups in your body. A little work done right goes a long, long way.BACKBOARDLesson: A Healthy Lumbar SpineThe spine gets vulnerable with age, whether you're having symptoms or not, so your disks become more like raisins. Instead of being white and football- shaped, they've shriveled up and gotten darker, because they've lost some water content. And that's what happens, too, when someone injures his or her back, as I and millions of others have. The result is a more vulnerable structure with less-than-optimal shock absorption capability.* DISK DEGENERATION AND HERNIATIONOn certain MRI scan sequences, any body part with fluid in it normally comes out white, and those spongy disks of which we spoke earlier, seen from the side, appear as smoky little footballs. A disk is like a grape, filled with water and healthy, when you're young. Thirty to 40 percent of us will have, by age 40, compressed, bulging disks or degenerated disks without necessarily showing any symptoms (a topic in Step 2). A study using MRI analysis was done with asymptomatic 40-year-olds who had never had a problem with their backs. Forty percent of them showed disk herniations and/or degeneration--accidents waiting to happen. On an MRI, their disks looked more like raisins than grapes, having lost most of their fluid cushion. Also, your spine can age prematurely. This can be due to genetic factors or trauma. Even repetitive overload can cause degeneration as seen in football players, power lifters, and gymnasts. Spine MRIs of college football players (before they even join the professional ranks) have shown high levels of disk degeneration and vertebral problems.BACK STORYOne of the most troubling things I see is soft bone, especially when I operate on young female athletes to reconstruct their injured knees. To replace torn ligaments through the arthroscope, I must create anchoring tunnels in the bones. To drill into the bone of an 18-year-old male, I have to use power tools and all my strength. But with too many of the young women, I can simply rotate the drill bit with my fingers and the metal will easily pass through the bone as if it were butter. You don't need to be a psychic to know they are heading for trouble.* BONE DEGENERATIONIt's no secret that elderly folks have a lot less skeletal matter than they used to in their younger days (after all, that's why they "shrink" right before our eyes), but you don't have to be very old to have significant bone loss. Osteopenia, the stage before osteoporosis, is showing up on more and more body composition scans of 50-year-olds, and the battle has been joined to stop--and even restore in some cases--bone degeneration. And the weapons aren't just new prescription drugs; they include bio-identical hormone replacement, nutrition, supplements, and ... exercise. (Studies showthat weight-bearing activity builds both muscle and bone.)BACK STROKES
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Product details
Series: FrameWork Active for Life
Paperback: 192 pages
Publisher: Rodale Books; Second Edition, Revised edition (April 13, 2010)
Language: English
ISBN-10: 1605291978
ISBN-13: 978-1605291970
Product Dimensions:
7.5 x 0.5 x 9.1 inches
Shipping Weight: 12 ounces (View shipping rates and policies)
Average Customer Review:
4.8 out of 5 stars
16 customer reviews
Amazon Best Sellers Rank:
#796,405 in Books (See Top 100 in Books)
My daughter is a librarian, so I have had access to a lot of books and DVDs on the subject, but most of them assume that the reader is young flexible, and just wants something to help out for a few weeks until he learns to warm up for sports and lift with his legs. This one lays out a progressive rehab program that can be followed even by someone with a totally dysfunctional back. The author, an orthopedic surgeon, details where problems originate, and what specific stretches and exercises will strengthen them over time and in a progressive program which begins with first aid recovery immediately after injury and extends to maintenance after recovery. He also details why most back problems do not require surgery and describes those which do.
This book is a really good summary of what to do for lumbago. There are lots of other books, but the information is scattered and difficult to synthesize. After all, a normal person can't spent the entire day doing back exercises.This book presents a couple of routines that can be done to help your lower back pain. It won't be eliminated once and for all, but it will certainly help.The author has a very engaging style and the book is fun to read. I would also recommend his basic book "Framework" as a useful guide to health for the normal stressed out adult.
I like this book and the way the author discusses the structure of the lower back. There's a self-test to help you decide which exercise program in the book is best for you. I haven't started that program yet, so am not sure if I'll see positive results.
Great book, recommended for anyone with lower back issues
A Step by step guide, complete with detailed pictures to explain the recommended exercises, for strengthening your back and it works🌠.
Framework for the Lower Back is a must read for anyone that has struggled with Lower Back Pain. Myself being a Chiropractor, understands how these exercises, tips, and preventative measures explained by Dr. DiNubile, can help people avoid Lower Back Pain and help eliminate it all together. In Fact , I have reccomended the book to others and have received feedback that they are much improved already. Great Stuff-Thanks Dr. DiNubile
Written by a knee surgeon, it covers a full range of back problems. Expert advice on causes, treatments, diet and exercise. Many exercises are the same as those found in the Knee edition but there are specific exercises for your back which are helpful. If you're considering surgery, read this book first.
I have had chronic back problems most of my life so I bought this to see if it would help, so far so goodbut with a bad back only time will tell, havent had any problems lately
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