A way to relieve low back pain while increasing spinal BMD?
Background. In a recent Update I cited a study which found almost a 10% increase in lumbar spine bone mineral density (BMD) in six months of doing a low back exercise program with the MedX® Lumbar Extensor Machine. During the exercise period the participants took no approved osteoporosis medication such as Fosamax, Actonel or Forteo. One of the men in the Men's Osteoporosis Support Group has been in contact with me about this study while he looked for an alternative method that would be cheaper, could be done at home, and would give equally positive results. Thanks, Eddy, for all your efforts. He has located a Website which explains a program which could possibly have results similar to that of the MedX® Lumbar Extensor Machine. The developers of the PowerBack program state that, ". . . an industrial mining company saw an 80% decrease in its low back injuries and its monthly workers' compensation liability claims for low back pain plummet from over $14,000 to under $400." Such results are truly impressive, and would be even more so if they could be obtained by doing the exercise program at home.
Method. Here is what the author of the PowerBack program, Edson O. Parker, M.D., suggests as the way to obtain the best results for increasing the strength of low back extensor muscles while decreasing low back pain.
Training is performed at least once, but ideally, at least twice per week. Each session takes only about 10 to 15 minutes, including warm-up stretching and abdominal crunch exercise preceding the actual lumbar exercise. After several minutes of stretching, the patient performs one set of abdominal crunches, which takes from 1 to 2 minutes. Then the patient mounts the RC [Roman Chair], and hangs the upper body vertical for 15 to 30 seconds to stretch the lumbar muscles, followed by one set of lumbar extensions (raising the upper body from the vertical to the horizontal position, then lowering to vertical is one repetition), to volitional fatigue or 'failure' (can't do anymore repetitions), followed by another 15 to 30 seconds of hanging vertical to stretch the lumbar muscles, prior to dismounting the RC. Under the PBP [PowerBack Program], that training protocol can be performed for five sessions (Introductory Program), for 10 sessions (Limited Program) or 20 sessions (Standard Program), depending on the physical status and motivation of the patient. The maximum cost for even the longest Program (testing and 20 training sessions) is less than 25% of the cost of other currently available programs, obviously being very cost effective.
Explanation. Dr. Parker's program is done in a medical environment, apparently only in the Las Vegas area. If you have access to this program, you might want to try it if you have either low back pain or decreased lumbar spine BMD. It also appears that an individual could tailor his/her own program using a Roman Chair and the exercise routine as outlined above. Here is a Website with an example of the Roman Chair. At the bottom of the page you will also see a graphic showing the method of exercising lumbar extensor muscles using the device. Note that this exercise program differs greatly from most all other back/stomach exercise programs--at least the ones that I've seen. The main difference is that these programs use a crunch or a sit up, which is an exercise of flexion not extension. Think of the these terms by looking at your hand. If you make a fist, that is flexion, if you open your fist that is extension. As concerns back movement, doing a crunch is flexion, whereas going from the the flexed position to the horizontal is extension. But, if you do this as part of a crunch or sit up, you aren't actually exercising the back extensor muscles because you aren't working against gravity and your back touches the floor which prevents their exercise. The key to the Roman Chair is that the flex basically relaxes the back muscles while it works with gravity. But, as you extend the back muscles and move up to the horizontal position you are working against gravity which improves muscle strength. Do an online search to see the Tuff Stuff Roman Chair which is recommended by Dr. Parker. You will note this machine is more horizontal than the other one. And Dr. Parker suggests that you make no effort to go beyond a pure horizontal position during the extension movement. Dr. Parker suggests starting quite slowly for the first couple of weeks and doing no more than about five extensions. This is because those muscles have not been adequately exercised with whatever previous activities you've done. Then gradually begin to add a rep or two as you work out until you reach about 40 reps. At that time you can add five pounds of weight in your hands to gradually increase the difficulty of the exercise and the strength of your lumbar spine extensors. Continue this program at least twice a week for the rest of your life to prevent low back injuries. Remember it should take only about five minutes for the warm up crunches and stretches along with the 40 reps, so this isn't something you need to dread doing two or three times per week. The benefits will be worth the effort and time.
Comments.
1. Alternative method. I have found that I can also do this exercise using the arms of my rather large couch at home. My feet are stabilized against a wall with my legs against the arm of the couch as I face the middle of the couch with the cushions removed. I then lean forward and flex toward the middle of the couch, followed by extension back into the horizontal (straight-back) position. I definitely feel the "burn" in the lower back muscles while doing this exercise. But, I think the ideal method would be to buy a Roman Chair, which I intend to do. The couch forces you to exercise in about a 45 degree angle. It would be more desirable to use the Tuff Stuff Roman Chair that lets you work out in a horizontal position.
2. Disclaimer. Note that you should discuss this exercise routine with your care provider before starting it. This is especially true if you have severe lumbar spine osteoporosis. The study referenced in the Update used only the MedX® Lumbar Extensor Machine to achieve the impressive increase in BMD in only six months, so don't necessarily expect the same results with the Roman Chair method. Additionally, this study didn't study low back pain, the participants were lung transplant recipients on high-dose corticosteroid therapy who suffered severe loss of BMD without any medication or exercise therapy. I have found nothing in the literature to indicate the Roman Chair lumbar extensor exercise program has been shown to improve lumbar spine BMD, only that it decreases pain and low back injuries. So whether the the Roman Chair program will increase your spinal BMD is very questionable at this time, although logically it seems that it should. Studies do indicate it might very well decrease low back pain, although that isn't guaranteed either. If you decide to start this Roman Chair lumbar extensor exercise program, please contact me and let me know how it works for you.