Why you shouldn't be lifting with your legs (or your back)

I tend to hear a lot of; "Don't lift with you back, lift with your legs and use your knees."  I know these people are trying to spare their back by lifting with their legs but they are not using the right cues.  I found this picture about so-called proper lifting technique:

First, the picture of the "proper lifting technique" shows lumbar flexion (bending low back) which is not good for your back (I'll give it to you if you are saying that there is less than in the other example).  Secondly, the person's feet aren't flat so he isn't stable and there is significant stress on the knees with lifting like that. 

So if you should not lift with the legs, what should you lift with?  You should be lifting with your hips.  Your glutes are designed to do hip extension which is what you are trying to do when you are lifting something from the ground.  Olympic lifters learn how to lift extremely heavy weights by learning to stabilize their "core" and using their glutes to do most of the lifting. 

I'm an advocate of learning how to squat and deadlift using hips to accomplish standing.  So spare your knees and legs.  Let the hips do all the work. 

Are you using a disc herniation machine at the gym?

With all the machines that are in fitness facilities, there are a number that are good at helping to increase the chance you will injure one of your discs.

We know that there are two things that are not good for the health of your back (even if you are doing these exercises to improve your core.) The first is prolonged flexion.  This includes sitting for long periods and being bent in flexed postures for long periods of time.  A good analogy would be like if you took a metal rod and bent it for a long time.  You would find that the longer it bends, the more quickly it will deform and will likely break at some point.  This can also happen to your back (over a very long period of time). 

The second thing that is not good for the health of your back is repetitive flexion.  This is what is commonly seen at the gym.  In order, from bad to worst, here are some repetitive flexion exercises at the gym that will increase the chance of disc injury:

1.  Sit ups
In my opinion, there is no safe way to do sit ups (nor is there a need to.)  Sits ups are the perfect example of repetitive flexion.  Its like taking a metal rod and repetitively bending it back and forth.  Sooner or later, you will end up with a weak spot and it will break.

2. The Weighted Sit up Machine
This one is a beauty!  Not only are you doing repetitive flexion, but you are also compressing the spine while you do it.

3. The Leg Press Machine
To be honest, I've seen someone injure their disc on four separate occasions by doing extremely heavy weight.  Why did they injure their disc?  As they lower the weight, their knees come towards their chest.  As that happens, you flex your lumbar spine.  Now you have to use a tremendous amount of force to move the weight back to its starting position.  Its usually at this point that the person may feel a "pop" and a tremendous amount of pain.  

Interestingly enough, most gyms have a few variations of a sit up machine and leg presses.  Might you reconsider using them? 

How you hurt your back while picking up a sock off the ground

I can't even tell you how many times I have heard this story.  "I don't understand how I hurt my back picking up my sock off the floor this morning." 

What happened?  There are a number of things that contributed to the "incident."  It seems to occur most often in the morning.  The reason for this is that the type of cartilage that makes up the discs in our back (fibrocartilage) and the jelly like material in the middle (nucleus pulposus) like to absorb fluid overnight while we sleep.  This is the reason we are a bit taller in the mornings that we are in the evenings.  As the discs absorb fluid overnight, the become more rigid making us feel stiff in the morning.  With more rigidity in the discs, bending forward will cause the front of the disc to squish, pushing the jelly more towards the back of the disc.  This pressure can cause irritation and pain when you pick up your sock off the ground.

So has this person "blown a disc?" "slipped a disc?" "herniated a disc?"  When you go to your doctor, they will ask if you have pain going down your leg(s).  They will likely do orthopedic testing that includes ranges of motion and neurological testing.  They will also most likely do a straight leg raise (SLR) test.  A positive SLR would be indicated if it reproduces the same sciatic pain down the leg.  If this is positive, it is a good indication for a disc herniation pressing on the sciatic nerve.  The test is considered negative if no pain is felt down the leg (even if they have pain in their back). 


There is lots that can be done to treat these patients (with disc herniations and without).  The patients without herniation respond effectively to movement.  The Cat/Camel exercise is great for increasing mobility and getting rid of some of the excess fluid in the discs   One recommendation for these people is not to keep them in one position for a long period of time (ie. having them lay on their front for 30 min).  Their back may stiffen up and they may have difficulty getting going again. 

Can good posture cure back pain?

People often tell me that they think they have poor posture and that their poor posture is causing their back pain.  Is this really the case? 

My question to them is; "What is good posture?"  There really is no consensus on what is good and bad posture.  In fact, there is no clear definition as to what posture is.  The best definition of posture that I have come across is; three curves to the spine (lumbar lordosis, thoracic kyphosis, cervical lordosis).  An example of neutral spine or normal posture would be what your spine would look like if you were standing or lying (most likely with 3 curves).


One of the problems with posture is that there is no good way of measuring posture.  Plumb lines may be helpful, but I would not consider them to be reliable or valid.  Our posture is made up of a number of segments (vertebra) so how can you tell if you have made valid or reliable changes to posture?  Seeing as everyone has a bit of a different spine (some people are taller, some people have different curves to their spine etc.) everyone would have their own unique posture.

For the question of whether poor posture can be the cause of back pain, the answer is that it most certainly can.  Just think about the last time you were in a prolonged posture (probably sitting at the computer right now, or on your commute to and from work).  Were you stiff when you stood up or got out of the car?

So how can we change posture to keep ourselves out of pain.  The best answer I have is to constantly change your position.  Keep moving!  It will reduce stiffness and help keep you out of pain. 

Why the Rotator Cuff should not be called a Rotator Cuff

The rotator cuff includes four muscles that attach to the humerus: Subscapularis, supraspinatus, infraspinatus and teres minor.  These muscles have long been thought to create rotation about the humerus in the glenoid fossa (shoulder joint).  However, recent studies have shown that large muscles are the ones who do rotation.  Muscles such as the deltoid have a longer lever, thus giving it more leverage to produce large movements. 

So what do the small muscles such as the rotator cuff do?  They COMPRESS or hold the joint in place to allow for rotation to occur.  Hence, the more appropriate term for rotator cuff would be the COMPRESSOR CUFF. 

I you are biomechanically inclined, compare the lever arms of deltoid and the compressor cuff.  An analogy would be like two people opening a door.  If one person was pushing at or near the hinges, and another person were pushing at or near the door knob, the person at the door knob would be the one doing the majority of the work. 

For rehabilitation of the compressor cuff, should not be limited to traditional rotator cuff exercises.  Though it may be a good start for rehabilitaiton, progression should include functional exercises that require compression.  Rehabilitation should be progressed to include pushing, pulling, lifting and carrying exercises.

Cases of shoulder pain

So I had two similar cases present to me with similar mechanisms of injury.  In the first case, there was a fall from a ladder.  During the fall, they grabbed on to one of the rungs of the ladder to prevent falling and felt immediate pain in the shoulder.  In the second case, the person was exiting their car and slipped, but grabbed on to the top of the door to brace themselves for the fall.  The person also experienced immediate pain in the shoulder. 

Both cases showed significant decrease in range of motion as well as increased pain.  Muscle testing was also found to be painful in both cases.  No other abnormality was detected. 

Both cases were referred for further testing and after diagnostic ultrasound (and an MRI in the ladder case) they were found to have a torn rotator cuff (supraspinatus tendon).  With the fall from the ladder, it was found to be a full tear and it was recommended that it be surgically repaired.  The slip and fall was found to be a partial tear of supraspinatus.  This was handled through passive care and rehabilitative exercises. 

Goals for both cases were to increase range of motion and decrease pain (post surgically and non surgically).  Once range of motion had been achieved, rehabilitation protocols were aimed at improvement of strength and scapulohumeral movement.  Unfortunately prognosis for both cases were considered long term and took months of recovery. 


In my next post, I intend to write about why the rotator cuff is a bit of a misnomer because it does not really rotate.