Twist and Ouch

By GRETCHEN REYNOLDS
Not long after a typically underwhelming showing by the British contingent at the Wimbledon championships in July, the British Journal of Sports Medicine published the results of a study that suggested to beleaguered English tennis fans that things are only going to get worse. In the study, researchers from the Royal National Orthopaedic Hospital scanned the spines of 33 elite adolescent tennis players, male and female, who trained at the National Tennis Centre, the club of choice for Britain’s most promising young prospects. None of the players had reported back pain. But their backs, it turned out, were a mess.
Twenty-eight of the teenagers — 85 percent — were found to have serious spinal abnormalities, ranging from cysts to fractures. Twenty-three had early-stage joint disease and 13 had herniated discs or desiccated, shriveled discs, common in septuagenarians but much less prevalent in teenagers. These kids, the cream of the next generation of British tennis, had backs 60 years older than they were.
“Tennis requires more frequent, repetitive and rapid rotation from the lumbar spine than other sports,” the authors wrote. Playing it is particularly detrimental “during the growth spurt.” High-level tennis, in other words, can be brutal on the young.
But as many of us know from debilitating firsthand experience, back problems don’t afflict just teenage tennis players. According to various studies, at least a third of all competitive football players will hurt their lower backs during play, as will a third of gymnasts and 25 percent of serious rowers. About 40 percent of divers will develop a spinal stress fracture, and many cyclists will experience constant, grinding back pain while riding. In one study, six out of seven rhythmic gymnasts — those madly grinning ribbon twirlers — reported severe lower back problems. The harshest sport, however, seems to be golf. Ninety percent of injuries to professional golfers involve the lower back and the neck, and almost 80 percent of professionals will miss at least one tournament because of back pain.
If you’re a runner, do a backbend of thanksgiving: runners statistically have a lower risk than most athletes of developing back problems. But for everyone else, the news is . . . painful. So what, if anything, can you do to preserve and protect your spine?
To build a better back, most experts agree, you need a solid core. “The core” is one of those areas of the body that coaches and athletes refer to constantly but few people can accurately locate. “It’s not just the abdominal area, as many people think,” says Vijay Vad, a sports medicine specialist at the Hospital for Special Surgery in New York City and a back-care adviser to the PGA Tour and the professional men’s tennis circuit. “To really include all of the elements that move and stabilize the spine, you have to go from your knees to your nipples. That’s the core.”
The muscles, ligaments and tendons that make up the elaborate core muscle system provide rigging for the spine. The rectus, transverse and oblique abdominals, for instance — the big muscles at the front and sides of the spine — are particularly important in stabilizing the back. So are the less familiar intertransversi, interspinalis and multifidus muscles, which link to the larger abdominal group but which rarely figure in magazine articles about washboard abs. Each of these muscles must be strong and supple if the spine is to remain stable.
Endurance is important, too. It’s perhaps the most crucial element of core health, since it keeps the stabilizing muscles and connective tissues going through a long workout or game. “You have to have enough muscular endurance to be able to maintain spinal stability throughout the entire length of an activity,” says Michael Higgins, the director of athletic-training education at Towson University in Maryland and the author of several prominent academic articles about back injuries in athletes. “Without endurance, what you often see is that near the end of a game, the muscles can’t quite control the movement of the spine adequately anymore.” Whether you’re playing four quarters of football, three sets of tennis, 18 holes of golf or riding 100 miles on a bike, if your core can’t keep up, your back is sure to let you know about it.
Many lower back problems are caused by the very athleticism that modern sports demand. “The forces involved in sports nowadays are enormous,” Higgins says. “What you see in some of these sports are very powerful athletes creating high levels of extension and compression of the spine.”
Consider the forces applied to the lower back during certain activities: The torque created by a proper golf swing can produce almost 1,700 pounds of pressure on the lower spine. Rowers can put about 1,300 pounds of pressure on their backs at the catch of their stroke. And the “peak compressive load,” as the scientific parlance goes, created by a football lineman slamming into his opponent can be close to 2,000 pounds.
Often, the muscles that produce such power are accompanied by a relative weakness and inflexibility — ever see a lineman touch his toes? — in muscle groups not being used. Sprinters, for instance, tend to have mountainous quadriceps but weaker, tighter hamstrings. The hamstrings, which, like the quads, are tied into the lumbar spine system, can’t balance the force being produced by stronger muscles. As a result, the spine loses stability.
Something similar occurs in golfers, especially the good ones. “If you’re a bad golfer, like me, and you use your shoulders to power the swing, instead of your back, you probably won’t hurt yourself,” says Christopher Bono, an assistant professor of orthopedic surgery at Harvard Medical School and the chief of spine services at Brigham and Women’s Hospital in Boston. “If, though, you’ve got a good swing, you’re probably going to hurt your back.”
Just ask Arron Oberholser, the PGA Tour golfer who has ranked as high as 22nd in the world but who has also, at the advanced age of 32, endured multiple ruptured discs in his lower spine.
“I thought a couple of times that my career might be over,” he says. “There seems to be something about the repetitive golf swing that primes you for this injury.”
Power and consistency, in other words, can be your back’s undoing. “Strength, by itself, is not the answer,” Higgins says. As the authors of the British study pointed out, those young tennis players were strong. But they were strong only in terms of their tennis muscles, particularly those in the shoulders. Compared with their counterparts in other national junior programs, British players rarely visit the weight room. They typically don’t stretch or cross-train. Instead they hit and hit and hit, repetitively, propulsively, their strokes becoming faster and sharper, even as their backs insidiously break down.
Having a strong back, you will be happy to hear, means not doing sit-ups. Ever. “Sit-ups are not healthy for the back,” Higgins says. “They can severely compress the lumbar spine.”
Abdominal crunches, on the other hand, in which you raise your head and trunk slightly from the ground without pulling yourself upright, improve back health significantly. “Crunches build core endurance and strength without stressing the spine,” Higgins says.
A complete back-health exercise regimen must include more than crunches, of course (see sidebar, right). “You need to activate and strengthen all of the muscles that circle the spine like a belt,” Higgins says. You can do this by slightly contracting your abdominal muscles during workouts. Don’t suck in your gut; that narrows the band of support around the spine. “You only need to contract the abdominal muscles by about
10 percent to get the spinal benefits of the abdominal bracing,” Higgins says.
Don’t forget flexibility, either. In 2004, Vad and other researchers led a study of 42 professional golfers and found that those with the smallest range of motion in their lead hip and lower back had the highest frequency of back pain. “If you have a loss of flexibility in the hips, the back will take up the slack and absorb more of the pressures of the swing than it should,” Vad says. “Yoga, Pilates, dance — they’re all good for core flexibility.”
If your back aches for more than a few weeks, or if the pain is acute or radiating, visit a doctor. “Most back injuries will clear up on their own within six to eight weeks, if you rest adequately,” Vad says. “Surgery is very rarely necessary, maybe in 3 to 5 percent of cases.”
Finally, don’t despair if your back hurts. For many athletes, pain has been a necessary prelude to wisdom. “Before my back injuries, I really thought this golf thing was so easy,” Oberholser says, almost wistfully. “I thought, ‘I can do this into my 50s, no problem.’ ” Now, after reinjuring his back yet again last spring, he’s in the midst of an elaborate overhaul of his swing mechanics, his strength training, his posture — in short, his entire game. “I’m being a lot more careful than I used to be,” he says. “I’m doing the exercises, following the advice. I’m really optimistic about next season, but cautious, too. I’ve learned that you have to take care of your back, because, otherwise, boy, it’ll take you down with you if it goes out.”
SUPPORT THAT LAZY SPINE
The best exercises for strengthening your back
Entire books have been devoted to workout routines for the back. But you can save yourself some trouble by focusing on these three exercises, which work most of the large muscles in the body’s core. Do them four times a week, breathing slowly and steadily throughout.
CURL UP
Lie on your back with your knees bent. Slide your hands under your lower back to provide support; you don’t want your spine flat against the floor. Straighten one leg. Then, while keeping your neck and lower spine straight and unmoving, lift your shoulders and chest off the floor. Hold the position for about eight seconds. Repeat 10 times, then switch legs and do another 10.
SIDE BRIDGE
Lie on your side, with your legs bent at the knee and your upper hand across your chest. Bend your lower arm so that your elbow is pointing away from your chest. Slowly raise your shoulders, keeping your spine straight, and hold for 8 to 10 seconds. Repeat on the other side. After a few weeks, do the exercise with your legs straight.
BIRD DOG
Start on all fours, then slowly lift your right arm and left leg until each is parallel to the ground. Hold for eight seconds. Repeat with the opposite arm and leg. Do 10 reps on each side. Keep your spine straight, hips level and abdominal muscles slightly contracted. And don’t forget to breathe. — G.R.