Quick Back Pain Relief

At least 80% of North Americans will have back pain over the course of their lives, particularly in the lower spine. But it's never too late to build a better, stronger back.
"People go to their personal trainers or to exercise classes to get fit. Yet overall we don't really emphasize good back health," says Dr. Lyle Micheli, director of the sports medicine division at Harvard University Hospital in Boston. "Watching the way you walk, the way you twist and turn or how you lift and carry things - it's all got to do with good body mechanics and a strong back is a huge part of that."

Optimal back health, in fact, really begins with improving your core abdominal strength. "Rotation crunches, oblique crunches, Roman sit-ups - these are all good exercises to build up the core muscles and improve lower back strength and flexibility," says Dr. Micheli.
"Another thing that's not emphasized enough is the importance of having good strong quads, glutes and calves to lift with," he adds. "Without these your back is compromised every time you move straight up and down, lift a box or a child, or do any one of a thousand daily movements."

While intensity of lower back pain will vary from person to person, "In most cases we're talking about mechanical pain - something that's occurred as a result of strain, injury or poor body mechanics," says Dr. Micheli. "Some people complain of chronic pain, the kind that comes and goes but never really leaves. These problems are often associated with degenerative issues of the spine. But if a person has consistent back pain that lasts more than three weeks, or comes on out of the blue while they're sleeping and won't subside they should see doctor immediately. Bad things don't happen in the spine very often, but tumors can occur."

Recommending daily exercise, as well as 15 minutes within that time devoted exclusively to abdominal work, Dr. Micheli says that the Alexander Therapy - a century-old acting technique that teaches proper posture - can be used to improve lower back strength. As well, water therapy, in which strengthening and stretching exercises are done using water for resistance, can also offer relief to lower back pain sufferers.

Back to the Future

"The key to pain back is preventing it from coming back," says Dr. Micheli, who recommends these simple exercises to nip back problems in the bud:

LOWER BACK STRETCH
"For people with arthritis in the back, flattening out the back can do a lot to relieve pain," says Dr. Micheli. Lying on the floor, with hands to your side and legs stretched straight before you, slowly lift the left leg. Keeping the pelvis tilted and the small of your back pressed to the floor, gently wrap your hands around the left knee and pull it toward the chest. Hold for 15 to 20 seconds. Release the knee, slowly lower the leg and repeat the stretch on the right side.

LOWER BACK BICYCLE
"I'd call this one of the best exercises going to strengthen the lower back," says Dr. Micheli. Lying on the floor, with hands placed under the head and legs stretched straight out, bend the left knee and bring it slowly towards the chest. Hold it for a second, lower it to the floor, and lift and press the right knee to the chest at the same. Alternate knee lifts as though riding a bike, keeping the legs six inches off the ground when lowered to the floor. Do three sets of 12 to15 repetitions.

BASIC CRUNCHES
"Abdominal muscles are worked best when done slowly and with great control," says Dr. Micheli. Also, "Never do sit-ups with straight legs. It puts too much strain on your discs." Lying on the floor, with hands placed under the head, bend both knees and hook your toes under a sofa or heavy chair for support. Keeping abs tight and flat, slowly lift the upper torso toward the knees, coming up as far as you can go. Lower the body slowly to the floor and repeat 12 times. Gradually move up from one to three sets.

Trigger points are also called muscle spasms. Technically they are areas of hyper-irritability in a muscle that may refer pain &/or numbness to another area. In other words, a trigger point is a "knot" in the muscle fibers which prevents the muscle fibers from lengthening to their longest length.

Since muscles generally insert at a joint, when the shortened fibers are pulling on the insertion they are causing tension, limiting range of motion, and weakening the entire muscle because these fibers are basically out of commission.

Trigger Points and Stretching

A muscle originates on a bone, crosses over a joint, and inserts onto a bone that will move when the muscle contracts. This is the way the body moves, and it functions perfectly until a trigger point forms in the muscle. As the muscle shortens it is pulling on the insertion point and when you try to move in the opposite direction you feel stiff, inflexible. You may decide to stretch, however, people sometimes complain about feeling worse after stretching than they did before doing the stretch. To stretch a muscle, while it still has an active trigger point, could cause tiny tears to occur in the fibers, and could cause even more pain.

Consider this analogy. If you tied a rope onto a strong tree and then went straight across and tied the other end of the rope onto a flexible tree, the smaller tree would continue to stand straight. If you then tugged on the rope the flexible tree would bend. However, if you tied a knot, or two, or three, into the rope, the flexible tree would be leaning over. If you then pushed the bent tree so it was again standing up straight, you would only cause the knot in the rope to tighten, and you would be overstretching the fibers on either side of the knot. This is exactly what happens when you try to stretch a muscle that is shortened by knots in the fibers, without first releasing the trigger points.

Five Tips to Effectively Treat Trigger Points

As mentioned, the trigger points caused knots to form in the muscle and the shortening of the fibers put a strain on the insertion point on the other side of the joint. You can reverse this situation by doing the following steps:

1. Treat. Hold the pressure on each trigger point. In order to effectively stretch a muscle you need to first press on each trigger point, holding the pressure for 30-60 seconds.
2. Understand the Muscle Movement. Look at the muscle that you will be treating. To best treat and stretch a trigger point, you need to know what movement the muscle makes. For example, the muscles in the back of your neck will pull your head back so you can look up at the ceiling, and the muscle on your shoulder blade raises your arm. To stretch, you need to go in exactly the opposite direction as the movement of the muscle.
3. Stretch. Move so the muscle needs to stretch. For example, the trapezius muscle will raise your shoulder, so to stretch it you want to move your head away from your shoulder. You can accomplish this by dropping your head in the opposite direction while pulling your shoulder down toward the floor.
4. Press and Stretch for Optimal Benefit. To optimize the treatment, whenever possible, continue the pressure on the deactivated trigger point and then move your body so the muscle is forced to lengthen.
5. Slowly Move the Joint in a Smooth Circle. Slowly rotate your shoulder in a circle, move your leg so your hip joint loosens, curl and open your fingers fully, circle your neck, and arch your back like a cat. Finally, stop pressing on the trigger points but continue the slow, relaxed movement of your joints.

The more often you limber up your joints, the more flexible you will feel. Always go only to the point of "this feels great," never trying to overstretch or make a movement that is beyond your comfort level. Stretching feels great when you have untied the knots that have held you bound!

Like the proverbial albatross, it feels like a weight around your neck that spreads in bands of steady pain enveloping your whole head. Sometimes the ache and pressure confines itself to one particular spot-the forehead, back of the head or neck, the temples.

"The terms 'muscle contraction' and 'tension headaches' have been used interchangeably for several years," notes renowned headache expert Dr. Seymour Diamond, Chicago-based founder and director of the Diamond Headache Clinic Research and Educational Foundation, editor of Headache and Pain magazine and author of Diagnosing and Managing Headaches, a clinician's resource book.

"Tension-type headaches are recurrent episodes of headache that can last minutes or days. Physiologically they express themselves as reflex dilatation of the external cranial vessels and contraction of the skeletal muscles of the neck, head and face. Pain severity

tends to be mild to moderate in severity and bilateral in location."

Women generally suffer more from tension-type headaches than men, with episodes typically beginning between the ages of 20 and 40 years old.

According to Dr. Diamond, the tension-type headache, which can migrate to the shoulders, is a manifestation of the body's response to stress, anxiety, depression, emotional conflicts, fatigue and repressed hostility.

Some researchers think there may be a brain-chemical component that might work in combination with tightened muscles to produce the tension-type headache-although no one knows which comes first, chemical interaction or muscle contraction.

Tension headaches appear to show some familial association-if you have them chances are your siblings do too, although the reason for the connection remains unresolved.

You can experience tension-type headaches in two ways-episodically or chronically-the latter occurring at least 15 days a month for six months.

The occasional tension-type headache often responds well to over-the-counter pain killers-sometimes, however, a prescription is in order and will usually do the trick.

Applying a heating pad or ice pack to your shoulder and neck muscles can be helpful and it makes sense to consistently practice relaxation therapies such as meditation or undergo massage to relieve some of the triggers generating muscle contraction.

According to Dr. Diamond, chronic tension-type headaches frequently reflect an underlying psychological conflict such as anxiety or depression that may arise from life stresses, occupation, habits, personality traits, marital, social or sexual problems and the ways in which we choose to cope with stress.

Chronic tension-type headaches associated with underlying depression can occur in conjunction with other physical symptoms such as sleep disturbance, weight loss, fatigue, palpations, decreased sexual drive, and shortness of breath.

"Patients may also experience emotional and psychic complaints-guilt, hopelessness, unworthiness, fear of physical disease or death, poor concentration, low ambition, loss of interest, poor memory, etc.," adds Dr. Diamond.

Chronic tension-type headaches may have their origins in a specific event or occurrence-the death of a loved one, an accident or illness or divorce.

And all this time you thought it was just a pain in the neck!

Adopting a healthy way of life-regular aerobic activity in combination with good eating and sleeping habits along with consistent efforts at stress management, improved posture and increasing relaxation time may also prove effective in relieving and preventing tension-type headaches.

Haven't got time for the pain?

Dr. Diamond suggests the following to relieve episodic tension-type headache pain:

* Aspirin
* Acetaminophen
* Ibuprofen
* Naproxen sodium
* Ketoprofen
* Caffeine in combination with Ibuprofen-the amount of caffeine is equivalent to two large cups of coffee

"Biofeedback has also demonstrated efficacy in the treatment of chronic, tension-type headaches," says Dr. Diamond. "Tricyclic antidepressants and psychological counseling may be indicated in those patients with severe depression."

Relief Map:

Results of an Australian double cross-over study conducted by researcher Charlie Xue, PhD at RMIT University in Bundoora, Victoria, Australia, suggest that electroacupuncture applied to distal (locations away from the center of the body) acupoints may be an effective way to treat tension headaches.

Forty people, mostly women, average age 42, sharing similar baseline statistics were divided into two groups one receiving real electroacupuncture applied to distal areas on upper and lower limbs; the other undergoing a form of simulated treatment.

"Our study demonstrated that EA was effective for patients with TTH measured by pain intensity, frequency etc.," says Dr. Xue.

"Chronic TTH patients should consider EA as an option. Initially they should consider having EA twice per week for four weeks, then consider the treatment again depending on the recurring and severity of the symptoms. Note that our study demonstrated that there was significant difference between baseline and end of three months follow-up for both groups."

Everyone admires straight broad shoulders. They lend symmetry and elegance and help define the universally sought-after, classic, V-shaped physique.

Chances are that your longing for an elegant shoulder line is marred by your current habitual position-stop and take a little quick inventory-how many of you are slumped over a keyboard or stretched across a desk?

Chronic bad posture-desk-bound people working in front of a computer screen or teachers forced to stand in front of a black board all day long are especially vulnerable-can seriously undermine your workout routine and may result in you developing a particularly insidious condition called upper-cross syndrome.

Upper-cross syndrome is highly visible and generally easy to spot in everyone except ourselves-the elderly routinely suffer from it-but then so do swimmers, cyclists and weight lifters. The signs are obvious-misalignment, your head is a step in front of the rest of your body, round shoulders and an obvious curve in the neck and upper-back.

"Simply put, upper-cross syndrome is the weakening and lengthening of the posterior upper back and neck muscles and the coincident tightening and shortening of the opposing anterior pectoral (chest) and neck muscles. The correction of this problem involves the strengthening of the weakened posterior musculature and stretching of the tight anterior musculature," says Oakville-based personal trainer Kevin Ferrell, national champion bodybuilder in the super heavyweight category and a member of Team Canada slated to compete in the World Championship in the Czech Republic this fall.

A good stretching program is essential to prevent and correct upper-cross syndrome, notes Ferrell. The pectoral muscles and anterior shoulder muscles must be stretched often, especially following training involving those muscle groups.

"Stretches must be held for at least 15-20 seconds to be effective and should be performed after muscles are warm (i.e. following warm-up sets and especially post workout). The goal is to gradually deepen the stretch over time to prevent tightening and to lengthen the muscles. An example of a popular stretch is the 'doorway stretch', which can, as the name suggests, be easily performed in a doorway by placing the arm against the door frame and leaning into the doorway to stretch the pectoral and anterior deltoid areas."

Ferrell suggests routinely, "at least once per hour," pulling the shoulders and neck back, hold and squeeze the upper back muscles, a practice that, in addition to maintaining proper posture, helps stretch tightened anterior muscles while activating posterior muscles.

"In the gym, trainers should focus on exercising and strengthening the numerous upper-back muscles to maintain balance with the pectorals and anterior deltoids. It is common for many trainers to focus on 'showy' body parts that can be seen from the front (in the mirror) and neglect the back muscles. Lots of bench pressing and shoulder pressing with less attention paid to the back and posterior deltoids will create a strength imbalance and can lead to upper-cross syndrome."

He recommends various forms of rowing, using cables, machines, dumbbells and barbells to focus on the upper and mid-back musculature.

"When employing exercises to correct upper-cross syndrome, specific attention should be paid to maximizing the contraction of the posterior muscles at the midpoint of the movement," he advises.

According to Ferrell, when it comes to training the shoulder complex, people tend to make common mistakes:

* Using too much weight.
* Improper exercise form (often from using too much weight.)
* Overtraining.
* Failing to focus on all areas of the shoulder equally.

Internationally celebrated Australian bodybuilder Bev Francis, multiple world power lifting champion, international track and field star and the first woman to bench press 300 pounds, says that most people make the mistake of, "working too hard on presses."

Francis, who operates Bev Francis Powerhouse Gym in Syosset, New York recommends doing variations on the lateral raise, which she describes as the most important exercise for shoulders, but cautions against involving the traps to assist in performance.

"In other words, the shoulders themselves should not lift during these movements, only the upper arm should rotate through the shoulder joint. This is difficult to learn at first. The rear delt needs a lot of work also. Front delt is usually the least problem, especially if the athlete does bench pressing. My favorite shoulder exercise is a one-arm dumbbell lateral raise, performed while holding a stable object with the other hand, keeping the body aligned, and leaning towards the working side. This position makes it easier to delete trap involvement. Shoulders should be trained every three to four days!"

Kevin Ferrell Recommends the Following Shoulder Exercises:

Internal/External Rotation-Elbow 90 degrees (forearm parallel to floor)

This exercise is most easily performed using a cable apparatus, bands or rubber tubing:

* Internal rotation: When using cables for example, grasp the handle with the forearm parallel to the floor and elbow bent at 90 degrees.
* Start with the cable and handle out to the side of the body.
* Pull toward the middle of the body and then return to the starting position, all the while keeping the elbow in tight to the body.
* External rotation: Start with the cable crossing in front of the body, the handle at the midpoint of the body (reverse position of internal rotation).
* Rotate the handle to the outside of the body (again keeping the elbow in) before returning to the starting position.

As an alternative, this exercise can be done using light dumbbells while lying on your side on a bench.

Rotation-Elbow 90 degrees (upper arm parallel to floor):

Another good rotation exercise can be done with the upper arm out to the side of the body and parallel to the floor, elbow bent at 90 degrees and forearm perpendicular to the floor (envision a right-hand turn signal). This exercise is most easily performed using a light dumbbell or weight plate.

* Keeping the upper arm fixed in place, rotate the forearm forward in front of the body until approximately parallel with the floor or slightly past (only as far as it is comfortable).
* Reverse the rotation moving the forearm past the initial starting position to a point slightly behind the head.

Both of these exercises should be performed with strict form using a lighter weight. A repetition range of 12-15 is sufficient.

Form is critical to avoid injuring the notoriously unstable shoulder complex, especially for overhead pressing movements, which increase vulnerability.

"Slowly lowering the weight under control and avoiding any bouncing at the bottom before pressing back overhead is recommended. For those who experience shoulder pain, or to prevent eventual shoulder problems, it is a good idea to limit the range of motion when performing pressing movements. The weight need only be lowered to a point that is approximately parallel to the ears and pressed to just short of lockout to sufficiently stimulate the deltoid muscles. Lowering the weight below ear level puts unnecessary stress on the joint and locking out at the top involves the triceps more than the deltoids. Keeping the weight within the middle range of the movement maintains constant tension on the deltoid muscles and limits the stress on the joint," Ferrell cautions.

He suggests avoiding behind-the-neck presses, preferring instead the military press, dumbbell press or various machine presses and urges some focus on the frequently neglected rotator cuff muscles.

The shoulders receive indirect development from exercises targeting other muscle groups, says Ferrell.

"For example, chest exercises such as various forms of bench pressing and flye movements secondarily involve the shoulder muscles to a great degree. Back and arm exercises will also recruit the shoulder muscles. Those who train each of these other body parts on days separate from shoulder training may effectively be training the shoulders a number of times per week possibly leading to overtraining. Therefore, it is a good idea to be aware of this fact and limit the number of exercises and sets performed directly for shoulders."

It can be lonely at the top where, forgotten and overlooked, the muscles responsible for head-and-neck mobility are among the most neglected in the body.

Despite such commanding-sounding names as splenius capitus (a posterior neck muscle that enables the head to rotate and extend forward), this compact group of muscles only seems to compel attention while inflicting pain. Pain that occurs with alarming regularity as many women can attest, since they have a higher incidence of neck problems than men.
Studies indicate that inadequate muscle strength is the primary cause of neck pain, a condition that can be remedied by resistance training. Of course, athletes derive the most benefit from neck training-they also have the most to lose if they fail to exercise splenius capitus and its companion muscles.

"Any sport where the head could be jarred requires athletes to do neck exercises," says Dr. Ryan T. Tierney, director of the Graduate Athletic Training Program at Temple University in Philadelphia, Pennsylvania.

"What we're attempting to determine is if we can increase head stabilization through neck- muscle training. In every sport there are certain times when athletes may be hit in the head, or land hard, rocking their head back. There are many different mechanisms for brain injury or concussion, and we're trying to see if we increase the ability to control our head with our neck muscles, and reduce the incidence of injury."

Head speed is a measurable force in sports, the rapid movements on the playing field resulting in periods of sudden acceleration. Any impact sustained when the head is in motion warrants concern, which is why Dr. Tierney is studying ways to minimize impact.

Strong, supporting neck muscles are a stabilizing influence and the reason he recommends neck exercises for all athletes, not just those involved in contact sports.

"We measured head-impact speed for football, hockey and soccer," reports Dr. Tierney, "and the level of head speed was consistently higher among soccer players who were consistently doing headers. Every once and awhile, however, there would be a big hit in football or hockey and the number of Gs would spike to 150, which can be a potential concussive event. Nevertheless, head speed remained at a consistent level among soccer players, underscoring a need for neck exercises. The stronger the neck muscles, the more stable the head is for headers. And if the head is more stable, its speed is less, reducing brain movement during impact."

Non-traditional resistance training with hands supplying the resistance is a popular means of strengthening the neck, but results are better when a neck machine is utilized.

Resistance is more measurable on a machine, and technique is easier to execute. It's also very difficult to progress when using hands or band because there's no way to accurately measure the forces involved.

"It's tough to measure intensity if you're just using your hands," comments Dr. Tierney. "In any case I wouldn't use a lot of resistance for the neck. Begin at a low resistance and progress very carefully with the object of increased strength and muscle girth."

Neck and Neck:

There's no margin for error when exercising the neck, since even the mildest strain can be debilitating. Neck machines provide the control and stability necessary to ensure safe strengthening of cervical muscles. Four-way neck machines like those used by NFL teams are best, and enable the user to accurately measure progress.

Here are four commonly executed neck exercises, which should be done twice a week:

* Neck Flexion: Resistance is at the front of the head. Push forward, lowering your chin towards your chest.
* Neck Extension: Resistance is at the rear of the head. Push backward, raising your eyes to the ceiling.
* Lateral Flexion Right: Resistance is to the right of the head, which you press down against.
* Lateral Flexion Left: Same as above, only this time you're pushing down to the left.
* NFL trainers recommend 12 reps for each exercise with a total duration of 60 seconds per set.

For many of us spending several hours each day in front of a computer screen or on the phone is a necessary fact of our working life. The toll it takes on our bodies is just something we learn to cope with.

"Sitting at a desk for eight or more hours a day creates strain in the neck, shoulders, back and hips. Looking at a computer screen can cause headaches and eyestrain; mousing leads to repetitive strain injuries in the wrist, hand and shoulder," explains

Ellen Serber a yoga and Tai Chi Ch'uan instructor based in California.

Once we acknowledge the areas of concern, taking the time to stretch and move around throughout the day can lessen the aches and pains that go along with our sedentary lifestyles.

"The best solution [to avoiding stiffness] is to take frequent breaks from your desk and walk around, swinging the arms to loosen the neck and shoulders, looking into the distance to relax the eyes. You can also incorporate exercises at your desk." says Serber.

BODYWORKS:

Ellen Serber offers desk exercises for each part of your achy, stressed out body. For more exercises, see Ellen's Web site at (www.mydailyyoga.com).

Keep in mind: "In all of the following exercises, sit upright in a chair with your feet planted firmly on the floor. Press the top of your thighs down into the chair, stretch up the sides of the body, and extend the neck and the crown of the head."

How to Begin
Inhale and raise the arms above your head, stretching your arms out to the side on the way up. Interlock your fingers and then reverse your palms so they face the ceiling. Press your palms up, stretching your wrist, forearm, upper arm, and the sides of your torso. Exhale and release your hands, lowering your arms slowly to the side.

Chair Twist
Shift your left leg slightly forward. Place your right hand on the arm of the chair and your left hand on your right thigh. Inhale and extend the top of your head to the ceiling. Exhale and turn right, looking to the right. Pause, inhale, and exhale as you turn to look over your right shoulder. Inhale again and on an exhale, return back to the center. Shift your right leg slightly forward and repeat to the left side.

Release pressure on your lower back
Push the chair away from your desk and extend your hands to the desktop. Bend from your hips, stretching your torso between the chair and the desk, with your arms straight. Stay in the stretch a few breaths and inhale as you come up.

To Open the Upper Back
Put your left hand to your right shoulder and your right hand to your left shoulder, hugging your chest with the right elbow under the left. Inhale and on the exhale lift the lower arms so that the finger tips are to the ceiling. Inhale and exhale as you raise your elbows up, opening the area between your shoulder blades. Stay for a few breaths and then release and repeat with the other arm on top.

To Open the Chest
Sit forward on your chair and reach your arms behind the back. Interlock your fingers with your palms facing toward your torso. Inhale and stretch your arms back, exhale and turn your head to the right, stretching your neck and chest. Inhale, come back to center and exhale; repeat to the left. Come back to center and release your arms. Close your eyes for a moment and one by one, relax your forehead, eyes, cheeks, jaw, tongue, and throat. Relax your belly and breathe slowly and deeply.

To Relax the Eyes
With all the facial muscles relaxed, circle your eyes clockwise for six rotations and then counterclockwise for six rotations. Take your time. Close your eyes and breathe deeply, relaxing the temples.

Trunk stability and rotational strength are keys to efficient, injury- free performance, but the often-neglected torso falls off most people's radar.

While taut hamstrings and bulging biceps are standard equipment among fitness buffs, too frequently the structural support required to train and compete at a high level simply isn't there causing significant problems.

Resulting postural issues and back pain can impose severe limitations.

It's a familiar pattern, especially among recreational athletes who lack proper instruction.
"Most athletes just want to work hard, which is a great ethic to have, but can lead to problems if this enthusiasm is applied with exercises or loads that are counterproductive," comments Dr. Calvin Morriss, National Fitness Coach for the Rugby Football Union in Twickenham, England.

"I see athletes do a huge amount of sit-ups but generally never work any frontal plane movements of their spine (the plane where the spine is at its most vulnerable). Sit-ups do nothing to strengthen the torso. I see athletes involved in power or strength-related sports that rarely do any training that emphasizes strength of the torso muscles. I also see athletes that can handle very large loads for a couple of reps in heavy exercises, such as squats and dead lifts, but who suffer from bad posture and chronic back pain complaints. The exercises that these athletes are performing are not the problem (unless they have terrible lifting techniques), it's probably that they do little else to help correct their postural issues and lack the ability to recruit the smaller postural stabilizing muscles. These athletes need a basic torso-stability program so they can get the most out of their training."

As Morriss points out, movement results from the production of force. It follows then that the more powerful the movement, the more forceful the muscular contractions.

He describes the body as a system of linked segments, all of which must be strong in order to facilitate its most forceful output.

To have quickness, for example, athletes not only require strong legs, they also need strong torsos to handle the ground reaction forces that travel through their bodies with each stride.

"Many coaches believe that improving the strength and control of the torso will directly help sporting performance," says Morriss. "By improving torso strength, endurance and control, the minimum benefit that an athlete should receive is decreased injury-risk to the spine. Notably the spinal cord also feeds the neural drive to the muscles of the legs. It has been shown that the source of injuries such as Achilles tendon rupture might well exist as spinal control problems. Put another way, pressure exerted by intervertebral disks on the spinal cord can have consequences for pain and movement at sites other than where the pressure is being exerted. Athletes should look to improve the overall fitness of their torso to avoid any of these kinds of problems."

According to Morriss the spine handles compression well, especially when in its natural position (often called the neutral position). It's when shear and rotational forces are applied through the spine that it's most at risk.

Any exercise that involves an athlete voluntarily holding their spine in a neutral position while body weight is shifted from side-to-side, is recommended.

Twist and Shout

For good result, Morriss recommends the plate twist, barbell twist, cable twist, and cable and barbell rotations. All are easy to perform and improve both strength and flexibility:

* Plate Twist: Stand with feet shoulder width apart. Hold a barbell weight in front of your chest and begin rotating your upper body from side to side, pausing between each twist. Maintain a neutral spine and rotate in a controlled fashion, briefly holding your sideways position.
* Barbell Twist: Assume a seated position. Place a barbell across the back of your shoulders and turn at the waist, moving to the left and then the right. Turn slowly and hold. Be mindful of your posture. Lengthen your spine and lift your chin.
* Cable Twist: From a standing position, fold your arms across your chest, grasp a cable with one hand, and then shift your torso in the opposite direction. Repeat using the other hand.
* Cable and Dumbbell Rotations: In this version, one hand holds the cable, while the other lifts a dumbbell above your head. Rotate your body as you draw the cable to your chest, keeping the dumbbell in the air. Change hands and repeat.
* For more go to: www.rfu.com/pdfs/technical_journal/trunkstability.pdf.

"Make sure you obtain a good evaluation of your strengths and weaknesses in respect to torso fitness," advises Morriss. "You might be strong but lack endurance; you might have good endurance but be weak. You might have good strength in certain movements but not others, or you might have good global stability under load, but experience pain owing to a specific lack of stability. Any of these shortcomings can lead to spinal-function problems, pain or injury."