If you’ve heard Dr. Riley say once that you should work out at home, you’ve heard it a million times. But are all workout exercises good for you? We’ll find out right now by talking to him. With Dr. Sean Riley from Tulsa Spine and Rehab, a team of specialists under one roof with one mission, helping you get moving.
You recommend home exercise, we know this. Are there exercises that maybe you should avoid?
Sure, home exercise is a integral part of most treatment plans here at Tulsa Spine Rehab. We want to develop some accountability for the patient. We discuss about providing tools for the patient to manage some things on their own and home exercise is a vital part of that. Once we get things moving, we want to get you moving on your own and we’ll many times develop roadmaps and give you things to work on, very specific things so you’ll know what’s safe for you, what types of things that you need to be staying away from.
On that note, interesting discussion I had this morning. 23 year old college student, competitive tennis player, had a long standing history of low back and coming fresh off this just did the consult with him this morning. And as I’m walking him out front and he said, “Dr. Reilly, what are…” I talked about the plan and some things that we’re going to do in the clinic related to chiropractic and some therapy.
We’re going to use a little bit of laser on him, do some massage, he said, “What do I need to be doing in the meantime or what should I stay away from?” And I said, “You really don’t have any restrictions. I want you to keep moving, stay active.” He said, “Well that’s great. I go workout at the gym.” And he mentioned he’s liking some boxing stuff and CrossFit and he said, “My trainer has me… Is it okay that I continue to do sit-ups?” And I was like, “Whoop, okay. That is the one thing that I don’t want you to do.” And he kind of looked at me like I had three eyes and said, “I don’t understand. I’ve been doing sit-ups for such a long time. How else am I supposed to exercise my abs or my core?”
Little side note, most of us know, most of the listeners know that the core is that area made up of the central part of our body, maybe from the thighs to kind of that thoracic or mid-back area, the abdominal region, the glutes, that core fitness is obviously it’s a hot topic. It’s spoken about, but for rightfully so, because the core is the area that actually protects your lumbar spine and hopefully prevents injuries, maintains bracing and stability of that area.
His question was, “Well, how am I supposed to exercise my core if I’m not doing sit-ups?” And so I said, “Let’s call in Jeff.” I said, “So Jeff, think about when you bend over improperly to pick up some laundry up off the floor.” One of the most common things, injuries that I see is patients come in, they bending, lifting something up off the floor, and it’s typically not the weight it’s the way they’re moving. And what I mean by that is he kind of, he’s looking me and he was like, “Well, I will bend over.” And I said, “Well just do it for me real quick.” He essentially just bent over like most people would, but he was bending or flexing throughout his low-back. Does that make sense Charlie?
Perfectly.
As opposed to hinging through his hips, he just bent over and he flexed throughout that low-back or lumbar spine. And he said, “So… ‘I go, “There you go, you just kind of reaffirmed why I don’t want you doing crunches or sit-ups.” And he said, “I don’t understand why.” And I said, “Well, do you feel like that’s good for you to do repet… How did that feel?” And he goes, “Well, it kind of put pressure on my low back.”
Right.
And I said, “Could you imagine doing that repetitively, a 100 times a day?” He goes, “No, you’re exactly right.” He goes, “I just got confused because I’m laying down.” I said, “There’s no difference. Obviously more specifically, you’re putting more load throughout your low-back because you’re repetitively flexing.” A lot of us will use those preacher machines at the gym where our legs are supported. We’re actually kind of going way back into extension and coming up.
Mm-hmm (affirmative).
You’re just putting such an excessive load or amount of stress on the lumbar spine that it can reproduce injury. I’m just not a fan. I feel like it’s such an old school way to exercise and so obviously his next question was, “So what do I do?” I said, “Great, here’s a handful of things,” and I’m a big fan of doing a lot of supine on your back supported core work. Meaning if you’re laying down Charlie and you start doing bicycle motions with your legs or leg lowering drills or the scissor. Does that make sense? Are you-
Perfectly.
Can you visualize?
Yeah.
Think about what’s going on there in your low back when you’re doing all that… The motion with your lower extremities or your legs, your back supported correct?
By the floor.
So your backs… It’s in a safe position-
Right.
… So obviously my back’s against the ground, it’s staying supported, and I’m doing all that. I mean, go out and do a 100 leg lifts.
Yep.
I mean, you want to talk about a core work. You won’t be able to get out of bed the next morning.
Sure.
But it’s really doing a good job for protecting that lumbar spine. A couple things, I think that’s a fantastic way to exercise your core, but also staying away from the sit-ups, the crunches, those types of things is a good way to prevent exacerbation of low back pain.
Now, I’ve seen your video on advanced dead bugs where your back is not flat on the floor, but you actually have a little bit of an arc in it.
You made my day, Charlie. You’ve watched my videos. Fantastic example. That is exactly what I’m talking about. We use a drill here in the clinic called dead bug, advanced dead bug, advanced dead bug was Swiss ball and essentially it’s a fantastic core drill that’s most importantly, it’s safe and you’re using your arms and your legs. But that back, like you said, is staying supported at against the ground. That’s a great example Charlie.
Your back is not literally flat against the floor, but it has a little bit of an arch and you maintain that arch is what you’re saying?
Absolutely. You’ll hear us talk about neutral spine in the clinic and what we’re trying to do… Neutral spine means as you move your legs, your arms, you’re doing different types of things, we’re maintaining that slight curvature in your low back. We don’t want you to flex or flatten out and we don’t want you to hyper-extend or create too much of a curve in the low back. And as we promote neutral spine, many times our brain just kind of forgets how to maintain that neutral spine. With daily activity, we lose that neutral spine and that can set us up for injury, increased pressure on the low back and so forth.
When you go to the gym, Dr. Reilly, and you get on the machines where you’re working your abs and you sit on it, it’s supporting your back and you’re just crunching. Are you saying those are bad exercises?
I’m still not a huge fan. I mean, the only advantage you’re going to have the machine kind of I would say helps you cheat a little bit and keep you a little more neutral, but there’s so many things that you could be doing for abdominal work as opposed to crunches and those types of things. I just would take them out altogether if possible.
What about planks? You’re talking about keeping your back on the floor. If you’re planking, you’re going to turn around the other way. Now you’re elevating your back and your backs facing up and you’re doing planks. Is that causing the same kind of problem that sit-ups do?
Exactly the opposite. I’m a huge fan of planking. There’s a neurosurgeon that I work closely with here in town and we’ve had lengthy discussions and we’re like, “Okay, if there’s one exercise, one safe exercise that you could do postsurgical low back or patients with chronic low back pain, what it would be?” And we both agree it would be a plank. Think about it, you’re holding that position and you’re staying in a neutral lumbar spine and obviously as we start to fatigue, you start to dip your butt a little bit. You’ll extend in your back and you might increase your low back pain or exact opposite.
You’re butt will kind of start to go up a little bit higher and you’ll get into flection. But ultimately just like the name implies plank, we want you to be straight from shoulders down to your heels or shoulder to tailbone. You want a good neutral stabilize spine. And once again, it’s just a static hold. Like I said, going back to the discussion I had with my buddy, if kind of desert island, you got one thing to do that’s safe, it’s going to be planking, big fan of those.
If you’re going to work out at home, you want to make sure they’re safe exercises and one resource to get safe exercises is to subscribe to our weekly newsletter, our E-newsletter because Tulsa Spine Rehab sends them out throughout the week and you’ll get a new exercise each week.
Absolutely. There’s a lot of good resources, information on there because that’s the thing, here at the clinic we want to provide our listeners with things that they can be doing on their own. Two reasons, obviously to make them feel better, but more importantly to keep them out of this office.
That’s right. Keep moving, stay active, but do it smartly and don’t do any more of those sit-ups. Dr. Reilly, thanks for your help today.
Thanks Charlie. Appreciate it.
Learn more and find out how you can get moving at tulsaspineandrehab.com.
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