Injury prevention, the basics
Injuries are a common fact of life, and unfortunately they do pop up from time to time, especially with increased levels of physical activity. The best advice I could possibly give is that prevention is better than a cure. We could spend hours talking about ways to prevent and manage injuries all over the body, so I thought I’d spend this post discussing the basics around the spine, one of the most important and frequently injured areas of the body.
Our spine is quite literally the backbone of our body, providing a solid structure for our limbs to attach to, as well as providing crucial protection for our spinal cord which carries nerves coming from, and back up to, the brain. Most of us know this importance, however we generally do a very poor job of protecting our spine from injury. Around 85% of the human population can expect to have lower-back pain (LBP) to some degree during their lifetime. It is important to note that this figure all types of LBP including mild pain from muscular tightness during illness, as well as age related degeneration around the spine, injuries from exercise and workplace activities often result in severe pain and debilitation.
There are a number of mechanisms that can lead to spinal injuries, however the most common is incorrect spine positioning. Our spine has natural curves in four main segments, the cervical, thoracic, lumbar and sacrococcygeal. The curves in the thoracic and sacral curves are primary
curves, formed in early foetal development, with the secondary (cervical and lumbar) curves being compensatory and formed after birth. The secondary curves are a concave lordosis curve, with the cervical formed when the baby can hold their head upright and the lumbar formed when the baby can stand upright.
These curve in the opposite direction to the kyphotic/convex thoracic and sacral curves, allowing the spine to carry the weight of the head, arms and trunk under gravity while maintaining an upright posture. The compensatory curves are generally more mobile, and therefore at greater risk of injury through misalignment.
Injuries to the spine can commonly arise from completing a movement with the spine out of this natural alignment. Day-to-day we commonly see this in not only personal training, but just about any workplace. The key to preventing injury is maintaining neutral spine during the whole task you are competing, whether that is a push-up, squat, picking up a box or sitting for an extended period of time. For correct neutral spine alignment, the ears, shoulders, hips, knees and ankles should be roughly in line with each other. One simple way to feel for the correct lower back curve yourself is to lie on your back with knees up as shown below. Exaggerating the lumbar curve by poking your belly up will increase the curve, while flattening the lower back to the ground will remove that curve. Neutral spine is usually the mid-point between these two positions:
Below are a couple of pictures of some common mistakes we see working in fitness, and what the correct spine position should look like.
- Neck is extended (eyes looking ahead not down)
- Neutral spine (head up, chin down)
- Neck is flexed down (very common mistake)
In the push-up especially, we see a lot of people with incorrect neck positioning. The common mistake is head down, often a compensation to make the push-up range feel shorter in those with less upper body strength. As a correction, we will ask them to bring their head up, which they
often make the mistake of looking ahead instead, bringing the neck into increased extension, which is also an injurious posture for the neck. One cue I have found successful is to say head up and chin tucked in, which helps the client hold their head in the neutral position. Remember the head posture should be similar to neutral spine when standing.
Picking up a box
- Knees bent, but lower back is flexed
- Neutral spine
- Legs relatively straight and lower back flexed (common and dangerous lifting posture)
One factor that may lead to poor spinal mechanics and potentially pain is low core stability. Core stability is the ability to properly engage your core muscles, which is crucial to stability of the spine. This should not be confused with core strength, which is the maximum amount of force these muscles can produce. An important muscle in core stability is the transversus abdominis (TVA). TVA is a large muscle that wraps around the stomach and provides deep stability to the abdominal wall. Through its attachment in the back, TVA also helps to stiffen the spine and signal the deep back muscles to contract and further stabilise the spine.
One of my best tricks for activating TVA is to feel for muscle contraction on the stomach. Place your fingers on the front of your hip bone, and then move about an inch inwards and cough, you should feel the muscle contract under your fingers. Practice pulling your belly button back towards your spine, to contract this muscle in, you should be able to hold it and be able to breathe comfortably, if you suck your whole stomach in you will have trouble breathing. Another way to practice this is in the crook lying position (see above when finding the neutral lumbar spine position). A particularly helpful cue I have used personally is to pretend you are sucking your lower stomach in to put on a tight pair of jeans (something I’m sure most us have done once or twice!), ensuring that you can breathe comfortably at the same time. The key to training the strength of these muscles is to place them in a position where neutral spine alignment could be compromised (in a safe manner of course!). For more on this please consult one of our mobile personal training specialists.
I hope you have found this brief article helpful, let us know if you have any questions! As mentioned at the start, the key to a healthy/successful training program and life is to prevent injuries from happening. This is just a brief discussion limited to cervical and lumbar spines, and hasn’t covered what injuries can occur and their common presentations. There is plenty more to know! Two simple ways to prevent spinal injuries are to maintain neutral spine and keep your core active during all exercises and at any time when your spine could be put in a compromising posture.
Mobile Personal Training Specialist
4 U Body Fitness