Why your back hurts

What causes back pain? Sometimes it's muscle spasms--if muscles are stretched out for too long a period, they'll cramp. Same thing if they're contracted or shortened. Moving the back in ways the muscles aren't able to support will do it, too.

The intervertebral disks can also cause problems--if they are consistently pressed off to one side, they can move, bulge, or even break. Since they surround the spinal cord, you can imagine that could cause some serious pain!

Most people with back pain have muscle problems, which are easily correctable, and even disk problems can be improved with good exercises and back control. So here are some things to help your back not hurt any more.

<disclaimer> As always, this article is no substitute for the advice of a good orthopedist, chiropractor, physical therapist or osteopath. If you've got pain, get it checked out before doing any of this, and discuss these exercises with your doc! I am completely irresponsible for anything that happens as a result of doing this stuff (unless, of course, it's good! ;) ). </disclaimer>

Neck and shoulder pain:

If you get cramps and muscle spasms at the top of your shoulder, where the neck meets the head, your problem is often the scalene muscles.
Stretch: The scalenes, by pressing one ear to your shoulder (keep the shoulders down!), and turning your nose down towards your toes. Do this both sides.
Strengthen: Your upper back muscles, by doing seated rows. Keep both shoulders down, pulling the weight towards you with your shoulder blades. Bend your elbows just enough to get the shoulder blades as far back as you can. Be sure the line from your elbow to your shoulder points backwards at the end of the pull.
Posture: Line up your ears with your shoulders, and keep your neck in line with the rest of your spine.

Mid-back pain:

If your back hurts in the middle of the spine, or right around the base of the rib cage, you're probably overstretching your rhomboids and erector spinae.
Stretch: Your pectoral muscles, with the classic doorway stretch: Make right angles with your arms, stand in a doorway, and press your palms and elbows into the door jamb. Lean forward slightly until you feel the stretch in the front of your shoulders and across your chest.
Strengthen: Your rhomboids, with the seated row described above. Emphasize pulling the shoulder blades down without arching your back.
Posture: Keep your shoulders back and your rib cage lifted up (not forward!) whether you're seated or standing.

Lower back pain:

Ah, this is a common one. The lower back takes the most pressure of any of the spinal segments, so be nice to your back to keep it happy! There are many, many things that could be going on here. I'm going to address the common problem of tight back muscles combined with weak stomach muscles.
Stretch: Your lower back muscles--the erector spinae and quadratus lumborum--with a child's pose. Sit on your heels (toes out behind you if you can!), then put your hands on the ground in front of you. Keeping your butt on your heels, stretch your hands out in front of you until you get into a comfortable position and can feel your back start to relax. Hold this for about 20 seconds, then walk your hands to a vaguely 45-degree position to one side (here's your quadratus lumborum stretch!) Hold for another 20 seconds, then change sides.
Strengthen: Your stomach. And not just by doing crunches! Here's a couple of great ways to get in touch with your stomach muscles and get them to work better. First, lie on your back, with your hands on the bottom of your rib cage. Breathe in, feeling your rib cage swing open like window curtains. Breathe out, closing the ribs/curtains. Then move your hands to just inside the bony points of your hips. Breathe in, opening the ribs/curtains. Then breathe out, feeling the muscles under your fingers tighten as you close your rib curtains. Keep your back in a nice neutral position, never moving throughout this exercise. For a bit more challenge, do mini-crunches (keeping your lower back still!) using this breathing. When your stomach muscles activate properly, they take a lot of pressure off the lower back.
Posture: Find neutral spine by lying on your back and gently pressing your lower back to the ground (if it hurts, don't do it!). Then arch it up as high as it'll go (painlessly!). Do this a couple of times to feel your range of motion. Then find the midpoint--congratulations, you're in neutral spine! Sit and stand in this back position for best results!

Lower Back Bonuses:
Lower back pain is so common, I'm going to give you another couple of options to keep you healthy and happy. Try these out once you've figured out the ones above.
Bonus stretch: Straighten your arms and press the pinky side of your hands down to the ground to get a good latissimus dorsi ("lat") stretch--good for mid-back pain as well.
Bonus exercise: Do the breathing on all fours, again not moving your back. Pull your stomach in against gravity. If you're feeling really solid, test yourself by taking one hand off the ground. See if your back is still flat and straight--no tilting allowed!

Let me know how these work for you! You can also keep your back happy by moving around during the day--put your body in different positions, stand, sit, change your desk around until you can sit up straight rather than having to hunch over your computer, try a stability ball for a chair (I like mine, but not everyone finds it useful (see 8 below).), or just stand up and stretch every so often. Here's a hint--drink a lot of water, and every time you have to get up, stretch a bit on your way back.
Don't worry; be healthy! For all the geeks in the crowd, check out the bibliography and extra info below!

Lissa Michalak, NYC fitness pro
www.trainwithlissa.com

Bibliography and extra information:
There is a crazy amount of back pain research out there, which gives you some idea of how widespread a problem it is. Here's a small sampling of relevant studies etc., with a brief Lissa-summary above:

1. People often develop low back pain when they enter the workforce because of the new demands of daily repetitive motion, or unchanging body positions.
Van Nieuwenhuyse A, Somville PR, Crombez G, Burdorf A, Verbeke G, Johannik K, Van den Bergh O, Masschelein R, Mairiaux P, Moens GF; BelCoBack Study Group. The role of physical workload and pain related fear in the development of low back pain in young workers: evidence from the BelCoBack Study; results after one year of follow up. Occup Environ Med. 2006 Jan;63(1):45-52.

2. A classic study that found that sitting puts 50% more pressure on intervertebral disks than standing does. Lying down is the best, and slouching makes everything worse.
Nachemson A. The load on lumbar disks in different positions of the body. Clin Orthop Relat Res. 1966 Mar-Apr;45:107-22. You'll have to look this one up in the library-- there's no abstract online

These guys' research supports Nachemson's findings:
Sato K, Kikuchi S, Yonezawa T. In vivo intradiscal pressure measurement in healthy individuals and in patients with ongoing back problems. Spine. 1999 Dec 1;24(23):2468-74.

But these guys' findings contradict them:
Rohlmannt A, Claes LE, Bergmannt G, Graichen F, Neef P, Wilke HJ.
Comparison of intradiscal pressures and spinal fixator loads for different body positions and exercises. Ergonomics. 2001 Jun 20;44(8):781-94.

3. The title says it all: bending forward for too long gives you back muscle cramps. Yep, slouching is not good for your back.
Williams M, Solomonow M, Zhou BH, Baratta RV, Harris M. Multifidus spasms elicited by prolonged lumbar flexion. Spine. 2000 Nov 15;25(22):2916-24.

4. Did I mention slouching is really bad for your back?
Neuromuscular disorders associated with static lumbar flexion: a feline model. Solomonow M, Zhou B, Baratta RV, Zhu M, Lu Y. J Electromyogr Kinesiol. 2002 Apr;12(2):81-90.

5. Bad for the disks, too
Harrison DE, Colloca CJ, Harrison DD, Janik TJ, Haas JW, Keller TS. Anterior thoracic posture increases thoracolumbar disc loading. Eur Spine J. 2005 Apr;14(3):234-42. Epub 2004 May 27.

6. Still bad.
LaBry R, Sbriccoli P, Zhou BH, Solomonow M. Longer static flexion duration elicits a neuromuscular disorder in the lumbar spine. J Appl Physiol. 2004 May;96(5):2005-15. Epub 2004 Jan 23.

7. And, slouching forward with your chest and shoulders affects the whole back.
Harrison DE, Cailliet R, Harrison DD, Janik TJ. How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis? Eur Spine J. 2002 Jun;11(3):287-93. Epub 2001 Nov 1.

8. We don't know if sitting on a stability ball or other unstable surface is good for you or not.
O'Sullivan P, Dankaerts W, Burnett A, Straker L, Bargon G, Moloney N, Perry M, Tsang S. Lumbopelvic kinematics and trunk muscle activity during sitting on stable and unstable surfaces. J Orthop Sports Phys Ther. 2006 Jan;36(1):19-25.

9. Sitting can keep your deep supporting stomach muscles from activating properly (leading, yes, to back pain!) Which means, at least to my way of thinking, that the stability ball may be good to keep these support muscles active and alive. The study above didn't look at the transversus abdominis, while this one does, so it's hard to compare the two results.
Urquhart DM, Hodges PW, Story IH. Postural activity of the abdominal muscles varies between regions of these muscles and between body positions. Gait Posture. 2005 Dec;22(4):295-301. Epub 2005 Jan 19.

Enjoy!

***Melissa is a fitness professional, dance teacher, and performing Middle Eastern dancer based in New York City. She's currently developing the next Tae-Bo by fusing bellydance and Pilates into an effective and entertaining workout for dance experts and novices alike. Check out www.melisssasdance.com for more information on Melissa, and how she can help you love the way you look. Also watch for the launch of the BellyCore site!Training Notes is Melissa's monthly newsletter on all things health, fitness, and exercise-related. If you've got a question you'd like to see in a future issue, you can contact Melissa at me (at) melissasdance dot com.