Doc’s Talk 07-01-2012

Dr. Scaff talked about low back pain.

Low back pain is probably one of the commonest musculoskeletal ailments that afflict mankind.  We have more of it than the quadrupeds (horses, dogs, etc.) because of our unique spine and upright posture.

We are the only truly upright animal, and in order to balance ourselves we developed a doubly curved spine, which consists of the cervical vertebrae (neck), the thoracic vertebrae (torso), and the lumbosacral vertebrae (low back).  Right at the bottom of the spine, between the 5th lumbar vertebrae and the 1st sacral vertebrae, which is fused, is the remnant of what some people think used to be a tail; it bends at about a 15-degree angle.  All the vertebrae sit on top of each other, down to the last one, and in order to maintain your posture there is a little bit of a bend throughout the spine. 

Separating each of these vertebrae is a disk; it looks like a garden hose made of very fibrous material filled with a pulp, which looks like Jello, only thicker.

Disk Disease
With the wear and tear of age and other things, the fibrous tissue of the disks tends to break down; the disc extrudes itself and starts pressing on the nerves that come out at various points along the spine.  You can rupture a disk at any level.  In auto accidents people rupture disks in the neck or in the back and they end up with all sorts of disk disease.

In addition to Cervical Discogenic disease, the commonest diseases of low back pain are Lumbosacral Discogenic Disease, Sacroiliac disease, or Lumbago.  Anything that increases the lordotic angle of the spine makes disk disease worse, for example, a big stomach.  As your stomach sticks out, your butt goes back to maintain center of gravity, and the lordotic angle changes.  Pregnancy, a high body mass index, and lack of exercise also contribute to increases in the lordotic angle.  As the muscles get weaker they provide less support.

Help From the Abdominal Muscles
People forget that the front of the back is the back of the front, meaning the abdominal muscles.  When the abdominal muscles are in shape they help tilt the pelvic floor forward and decrease the lordotic angle.  It has been shown that rest and exercising the back muscles is effective for easing back pain about 80-90 percent of the time.  Thus, you don’t necessarily have to go in for surgery, or see a physiatrist or an orthopedic surgeon immediately.  What you need to do is build up the belly muscles.

Abdominal Exercises
To build the abdominal muscles the Honolulu Marathon Clinic uses modified Williams’ Exercises, the best one being the tummy crunches:

– Lie flat on your back, put your arms on your chest, bend your knees with your feet flat on the ground, then do roll-ups, also known as tummy crunches.  You do not have to do a complete sit-up, which puts extra strain on the back.  Roll up so that your shoulder blades come off the ground.  This is what tightens the lower abdominal muscles.

Other exercises include:
– For flexibility, lie on your back and do 10 repetitions of pulling one knee up to your chest, and then repeat with the other knee.  Then do 10 repetitions while pulling both knees.  Have someone help you if necessary.

– To do abdominal scissor exercises keep your legs straight out and lift them straight up one at a time for 6 to 8 repetitions each leg.

Does running make low back pain worse?
There has never been a study that shows that people who run have a higher incidence of back injuries than the sedentary population; in fact, runners have less.  This means if you develop a back problem while running, it probably would have occurred earlier if you had not been exercising and running.  So exercise, running, and walking are good for low back pain.

How many of us are going to have low back pain in our lifetime?
Most of us.  Low back pain the commonest ailment that there is and it has to do with our upright posture.  If you ever read Chapter 13, “Man the Distance Animal”, of Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., on the evolution of man and how he adopted the upright posture, you begin to see all the incredible changes that were made to allow him to descend from the trees into the savannahs and the desert, …but back pain was one of the accompanying problems.

For more information on low back pain and helpful exercises, read Chapter 20 “Low-Back Pain and Running” in Your First Marathon – The Last Word In Long Distance Running, by Jack H. Scaff Jr., M.D., F.A.C.S.M., available for purchase at the Honolulu Marathon Clinic on Sundays and online at:


For some good reading on nutrition, Dr. Scaff recommends everyone check out the daily postings on Dr. Alan Titchenal’s “Got Nutrients?” web site:

Here is a recent posting:

June 25, 2012
Although the best option is to meet nutrient needs with a balanced variety of wholesome foods, there are stages of life when the proper use of dietary supplements can be important for optimal health. However, excessive use of dietary supplements has the potential to damage health.

Consumer Link
Supplements can aid diet, but be aware of their risks

Research Link
Evid Rep Technol Assess (Full Rep). 2006 May;(139):1-117.