Question
ive been training for a marathon and ran a race last sunday that was 4.5
miles. I went a lot faster then i normally would. I wear the right shoes from
mizuno and have exra support in them. I started to get a pain in the middle
of my back on the left side, very close to the spine. My muscle is sore and
tight, and my spine feels like its being smashed together. I don't have great
posture..so when i stand up straight and press my shoulders together my
back cracks in that area, but still doesnt make the pain go away. when i move
side to side or bend over to pick something up, or even take a really deep
breathe it feels like my rib is pushing against my back. It doesnt' hurt when i
swallow or cough, just a slight pain when i breathe deep. I also recently
started the bar method which is a mixture of pilates,yoga and ballet. I don't
know how to get rid of the pain, its driving me nuts. im not sure if its my
spine thats the problem or the muscle around it?

Answer
Dear Delilah,

This does not sound like a serious problem from a functional standpoint, and you seem to be very fit cardiovascular wise, but the fact that you can readily admit that your posture is poor is a huge factor.

Although you are a conditioned athlete, your posture needs to be trained just as the rest of your body.  We live in a gravity environment which means that all bodily actions are in direct opposition to gravitational forces.  Therefore if your posture is poor, it will result in the deformation of the normal spinal curves in relation to normal, and this will cause spinal fixations, ligamentous slack in some ares of the spine and tightness in others.  The overall result is that the large muscles utilized for power and movement have now been tasked with the chore of support...this is not their job,and fatigue, muscle spasm and pain is often the result.  So you likely have a combination problem, not just a spine or muscle problem.  Now what?

The bottom line is that you need to address this issue, improve your posture, and create structural support around the spine while eliminating the outward stress on the larger muscles of activity.  This is not easy, will require time and diligence to accomplish, and I would encourage you to see a chiropractic physician for spinal mobilization/adjustments while undertaking this task.  the first things you need to do is address your standing and seated postures, your work space, and movement patterns.  All chiropractors should be proficient in helping you with this, but ones with sport injury training, soft tissue mobilization certifications, or structural rehab training will be the best.  Ask them about the credentials and certifications they have received to make the best choices.  

For the immediate aspects, The Bar Method, sounds like a good choice, but there are other things you can do to help as well.  I am going to paste a copy of an article I had written sometime back for you to consider...information about posture and relief exercises to help with deconditioning of the spine. Please read over it and feel free to write back if you need to.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

Training for Stability of the Neck and Back匩ot What You Think!

A brief look around any boardroom, construction site, grocery store etc?will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments.  Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor!  Shouldn抰 you work to prevent injury and strain?  The obvious answer is yes!

The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma.  It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury.  Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity.  We stabilize bridges and buildings so they won抰 buckle or break, you need to do the same for your spine.  

That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won抰 necessarily target stability of the core or the spine.  Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor.  Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.  

Lifting technique is important for optimal health and the reduction of injury.  To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back).  This position will activate the musculature properly for stability while not recruiting the ligaments for support.  Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift.   Stooping should be avoided, especially with repetitive movements.  Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk.  This can easily result in a rupture of the disk.  In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer.  The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core.  You can easily accomplish this by sucking the belly button in toward the spine.  This activates the transverse abdominus muscle which is key for all movements.

One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair.  These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.  

Many of us spend the majority of our days at a desk, computer or workstation.  We need to consider and modify our workspace carefully.  Adding a support for the lumbar spine reduces disk pressures.  A seatback angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure.  Proper desk height is approximately 30 centimeters from the seat of the chair.  Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae.  The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.  

Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain.  Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead.  This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex.  This will also help reduce those 搘ork headaches?  Placing the monitor higher to induce a slight extension of the head is permissible.

Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key.  You must have a balanced and relaxed spinal cord for optimal function.  That being said, specific training is the way to achieve spinal balance and stability, and you don抰 have to go to the gym to achieve it.  If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.  

Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion.  Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion.  The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension.  If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body.  This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.

Moving on, posture is the next consideration.  Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary.  This is mostly common sense, and your mother has telling you to do this since you were a child.  Exercise your postural muscles while walking.  Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground.  Pull your shoulders back, breathe deeply, and take confident long strides.  This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures.  You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance.  Complex postural issues and stability issues need to be addressed by a professional.

Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability.  If you don抰 have good posture and spinal symmetry, a traditional workout program will only make those problems worse.  It is essential to incorporate stability into your spine and your life before starting any exercise program.  You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity.  If you have any cardiovascular issues, a stress test should be performed.  Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.

All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics.  Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications.  To learn more about postural correction check out www.idealspine.com. In addition, a Certified Pilates instructor, www.nypilates.info, www.pilates-trainning.com or Certified Personal Trainer www.nsca-lift.org, www.ncsf.org  can have great benefit.  Remember to check their qualifications as well.

J. Shawn Leatherman, BA, BS, DC, CCST, CCSP?br> Director of Clinical Rehabilitation
Suncoast Healthcare Professionals