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Writer's Block Oct 18 | Rebuild Your Back

18 Oct 2008 07:53 pm

Writer’s Block Oct 18

Oct. 18, 2008

Sit-ups and the Herniated Disc

mailman

Here are a couple great questions from this week’s mailbag (edited for brevity)…

Hi Dean,

I just read your latest blog post on herniated discs … does this mean we should never bend forward?

[snip]

Also, I do 100 sit-ups a day to build core strength … am I on the right track?

Any recommendations would be appreciated.

Regards,
A Curious Reader

Dear Curious,

Those are some very good questions.

First, should we avoid bending forward?

Based on McGill’s findings, (quoted in my last article) slowly and gently bending forward should not pose much of a risk factor. He demonstrated that under moderate pressure (260 N) that even with 85,000 flexion cycles (forward bends) the disc did not herniate.

This would seem to indicate that, if you have healthy discs, normal everyday activities such as bending and stooping should not pose much of a health risk. As McGill puts it…

“It would appear that the disc must be bent to the full end range of motion in order to herniate (Adams and Hutton, 1982).” [1]

“Disc herniation is associated not only with extreme deviated posture, either fully flexed or bent, but also with repeated loading in the neighborhood of thousands of times, highlighting the role of fatigue as a mechanism of injury (Gordon et al., 1991: King, 1993).” [1]

There will always be exceptions to every rule, but I am not yet ready to accept the idea that forward bending is intrinsically harmful. I believe that the body was designed to bend in all directions and that there is no reason to fear normal everyday activities.

The real problem seems to be with prolonged sitting or forward bending, rather than the mere act of bending forward.

Now, about your second question concerning sit-ups and lower back rehabilitation, it is my opinion that:

  1. Sit-ups are not necessary (and may not be a good idea)
  2. Sit-ups are an advanced stage exercise only
  3. If you are going to do sit-ups, be sure to do them properly.

What’s Wrong With Sit-ups?

Several highly regarded rehabilitation experts, including Dr. Stuart McGill and Dr. Jolie Bookspan, take a very dim view of sit-ups. Dr. Bookspan is especially adamant on this point.

Personally, I take a more moderate stance on the subject, but you should keep in mind that I’m not an expert. I’m just a journalist and you should adjust your conclusions accordingly.

Which is a round about way of saying that I don’t totally agree or disagree with them. I still occasionally do sit-ups and don’t seem to be having any problems, as a result. On the other hand, if they are correct in their conclusions, you may want to modify your routine.

Sit-up-Cat1

One thing I will say is I don’t believe that doing sit-ups is necessary for developing lower back health. I am quite certain that it is entirely possible to completely rebuild your back and never do a single sit-up.

Sit-ups are an Advanced Stage Exercise Only

Here is where I totally agree with Bookspan and McGill.

I am quite certain that sit-ups and crunches are not a good idea during the initial stages of rehabilitation especially if you’re dealing with a herniated disc. They place too much compressive loading on the disc and this can only exacerbate the problem.

On the other hand, I don’t believe (or am not yet fully convinced) that slow, gentle partial sit-ups and crunches are harmful once you reach an advanced stage of back rehabilitation.

That is, provided they are performed in the following manner.

How to Properly Do Sit-ups.

What I consider the correct way to do a sit-up is to perform them slowly and gently and not to go to full flexion.

My preferred technique is to perform a slow partial sit-up where you keep constant tension on the abdominal muscles at all times. This allows you to feel the burn sooner and get faster results without having to do a high number of repetitions.

In other words, my technique is to:

  1. Slowly curl up one spinal segment at a time with the tummy creased.
  2. Strive to feel the tension and the burn in your tummy muscles.
  3. Do as many as you can and don’t worry about how many that is. If done correctly you should feel it in your tummy, not your hips.
  4. Only rise up as far as illustrated below. Like I said, a partial sit-up.
  5. Don’t release the tension when you lower back down.

This is a very tough way to do sit-ups, but the good news is, you don’t have to do very many.

Sit Up

How Not to Do Sit-ups

Despite my less than stellar illustration above, I don’t recommend locking your fingers behind your head. According to the experts, it causes you to place unnecessary strain on the neck and takes your focus off the abdominals.

After all, you’re not trying to pull yourself up with your arms; you’re trying to work your abs.

Instead, the above illustration is supposed to show the fingers lightly touching the side of the head. (Sorry, I’m not much of an artist.)

Alternately, some people fold their arms across their chest. Others prefer the Pilates style of reaching straight forward toward the knees. I suggest trying them all and choosing what works for you. Just don’t pull on your neck.

Secondly, it is pointless to jerk or fling yourself up like so many people do in order to do more repetitions or to get it all over with quickly.

By doing sit-ups and other abdominal exercises as slowly as possible — mentally curling one vertebra at a time — you reach and strengthen the small muscles that surround the spine.

These small muscles are what connect and support the vertebrae and are just as important to rebuilding your back as are the larger more visible abdominal muscles.

One properly done sit-up is worth 10 done incorrectly. You’ll still get six-pack abs and you’ll get them sooner with less work. So take your time.

In Conclusion

legups1

To be quite honest with you, I don’t do many sit-ups. I generally do one set of about 30 repetitions and I only do them maybe once a month. Seriously. I figure if I can’t get the job done (a full burn) in 30 repetitions, I must not be doing them right.

Keep in mind that this is only my personal maintenance routine. It’s not a recommendation or a prescription. I’m not training for sports. My only interest is in maintaining overall back and joint health. Furthermore, sit-ups are just not my go-to abdominal exercise. I much prefer more effective exercises such as hanging leg lifts.

I hope this has given you some food for thought. I’m going to go workout, now.

Later,
Dean

References:

1. McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 45) Human Kinetics (2007)

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