This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2022. For the original video go to https://www.youtube.com/watch?v=rPFpg4Cdv1E&t=266s
Bob: Today, we're going to talk about low back pain. You know, there's really a lot of information out there. So we're trying to narrow it down to what we think you really need to know. So we think you need to know, are you a flexor, extender, shaker, or compressor? You might also be a combination of these.
Brad: Right, right.
Bob: So we're going to go over how you can determine what you are. This will help determine what exercises you should do. And it will also tell you what things you should avoid. Because they both could be harmful to you.
Brad: Before we go further I think it's important to note that we're getting a lot of this information based on Stuart McGill.
Bob: Stuart McGill and Robin McKenzie, a little smattering from each other
Brad: Yeah they kind of piggyback off each other a little bit. They all work together with time.
Bob: So the quick story: I, my wife, and I got a California king-size mattress from SleepOvation, and you know how they come, they come in a box and the box weighed over like north of 110 pounds. So pretty heavy.
Brad: You have to be careful Bob.
Bob: Right, so it's delivered to my door. I struggled to get it inside. I'm like, I’m not going to have my wife help me with this. She's going to hurt her back.
Brad: Right? Yeah. You're a man. All six foot six. You should be able to tackle that.
Bob: That's right. So I slid it up the stairs. Very difficult. I get to the top. I opened it up and you know how it expands. Once it expands, it's very difficult to move.
Brad: Why didn't you put it in the bedroom and expand it?
Bob: I did.
Brad: Oh, okay.
Bob: But I still had to slide it over onto the frame. So I started sliding it over on the frame. The last push, zap! I got a zinger. I mean, I couldn't even stand up straight. All I could do was lie on the bed. So I lay on the bed. And while I'm there, I'm thinking I have to host golf next weekend with 12 guys who are coming and I'm not going to be able to golf. There's no way. I couldn't even walk.
Brad: So you're thinking about how this is going to affect your life.
Bob: So I'm thinking about my life. I'm not going to be able to help my wife with chores. But you realize how it does affect your life. Tremendously. So Brad is on the other end of this.
Brad: So you're saying you were actually bent over when the event happened?
Bob: Yes. That's what caused my pain, flexion.
Brad: So flexion or bending started it and irritates it.
Bob: Right. So do you want to tell your story about being an extender?.
Brad: Well, in other words, with my back, I have spondylolisthesis, although if you have stenosis or you may be an extender without those two diagnoses. You'll know if you're an extender if bending backward irritates your pain.
Bob: We'll show this; we'll have you try that. But I mean, did you go through a period when you were dealing with this, I know you couldn't run for a while.
Brad: Running, walking, I could not walk, which is a form of extension, not excessive, but a mild extension, I couldn't walk for more than three-fourths of a mile without getting sciatica down my right leg. And that was for about a year.
Bob: Brad's a very active guy. And so this was greatly affecting him.
Brad: But I could bike! I could bend over on my bike. So that didn't bother me, but things like laying on my stomach where my back went backward, standing for any period of time, or going shopping with my wife.
Bob: Any overhead work, right?
Brad: Working overhead I’d get a backache or anything where overhead, standing for a long period of time or walking, always irritated my back and I got sciatica with it.
Bob: But did you start to realize your mortality, like I can't do these things?
Brad: Yeah, I was actually considering going to see the surgeon, but then I figured something out, luckily. We'll get to that.
Bob: We'll get to that. So let's talk about flexor first- flexor is probably the most common by far, right? Wouldn't you agree?
Brad: I think so.
Bob: So, I am a flexor and here are some of the common questions. If you answer yes. You may be a flexor. Are you generally worse when you're sitting? Like when you sit for a prolonged period and when you get up from sitting.
Brad: Yeah, but then after you get moving, it settles down.
Bob: Right, it feels better. Are you worse after prolonged bending like vacuuming or ironing or digging or gardening?
Brad: Exactly Shoveling.
Bob: Is it better with walking? Usually, it hurts at first, but once you get going, it feels better with the walking. It was funny for me, it actually felt better with running too. And I ended up being able to golf the next week because I went back to running the next day and it just seemed like it worked its way out. And generally, it's going to feel better when lying down. It might be worse at first, but once you get straightened out and things calm down, it feels better.
Brad: And oftentimes, prone on your stomach feels good in that position.
Bob: Yeah, a simple test is you could do repeated flexion. You could do it from a seated position or standing position. Or you could even hold for a prolonged period of time.
Brad: So you might be like this and if it starts to irritate it. It might irritate it right away or it takes 10 or 15, 30 seconds, all of a sudden, whoa.
Bob: You may be a flexor. Okay. If you're an extender, it could be a number of things like we talked about spondylolisthesis or arthritis or spinal stenosis. If it's spinal stenosis, usually you're over age 50.
Brad: Unless you have spondylolisthesis too, then because of the shift of the vertebrae, you may have some stenosis.
Bob: You got it younger than that, right?
Brad: Yeah. I'd have to think about it, but I was in my forties.
Bob: You got injured, and you remember the injury. So is the pain worse with the back extended for a while? So you want to show what the extension means, Brad?
Brad: This is extension. But even just standing up is extension. If you're standing and pain, pain, pain, and you sit, and immediately the pain goes away you're probably an extender.
Bob: It's also worse with walking, right?
Brad: Now it isn't, but it was at one time.
Bob: Generally, for people they call it shopping cart syndrome where they actually lean on a shopping cart and it feels a lot better. And as soon as they sit down it gets better.
Brad: It doesn't have to be a shopping cart. You could lean forward in your car.
Bob: Sure. One test you can do is you can actually lean back and to one side and you can even push down through the shoulders a little bit, just to see, add a little bit more compression to it. Now the other way. Do any of these bother you, Brad?
Brad: No.
Bob: So your pain tends to be bad with repeated extension
Brad: Or static for a length of time. I know if I stood bent back for about three minutes, I would really want to sit down.
Bob: Does it make it worse if you put your arms overhead and lean back?
Brad: Yeah. If I do things over ahead, that's a good way for me to get a backache that will last for days.
Bob: Right. So again, the spinal stenosis, spondylolisthesis, all those things will make it worse. Are you a shaker? This is what makes a shaker. So if you can take a look we have three discs here. Now one of these discs is a bulging disc and it's weakened. It's lost some of its stiffness. The top and bottom discs have normal stiffness. Now watch when I start turning.
Brad: So we're looking at the middle disc. The blue lines are just references. So we're looking at the low back here. We're looking right about at the belt line level.
Bob: Yeah and there's too much movement at one segment. So your back is unstable. So you're going to feel that, these are the questions that you're going to ask yourself. One, does your back have a feeling like it's giving way, or does it spasm on you?
Brad: It's like you move a certain, and all of a sudden it hits you. It kind of takes your breath away, but it's short-lived oftentimes, and you can kind of work a way out.
Bob: Right, you might feel some catching or locking while you're bending or twisting your back. A sign that’s really normal is twisting in bed.
Brad: Rolling in bed, side to side and you go ouch! So you really take your time.
Bob: Yeah, exactly. That's an unstable back, or going from sitting to standing, could be another one. So, all right. The final one is compression. Again, you can have a combination of these. So with compression, you don't like it when your spine is compressed together. And that happens when you're lifting something like weightlifters. Brad's going to show a test for that right now. While you're in a chair, you can first bend forward, straight, and then bend back and see how it is. No pain.
Brad: Feels okay. Then I'm going to bend forward. I'm going to grab the chair wherever you can get ahold of it, and then I'm going to pull down and actually compress the spine in a flexed position and see how it responds. Does it feel good? Does it feel worse? Does it create pain? And if it creates pain with that, then you know, that's a compression issue in a flexed position.
Brad: Then you can try good tall posture, grab again, pull down, see how it feels, and then extend backward and then pull down and see how it feels, and then note which one irritates it and if two don't irritate it. I would say the majority of people may experience pain with flexion and compression.
Bob: Right. Right. So another way to do this really quickly is if you have a weight like this, it's an 8-pound weight, and you keep it close and you bend, there's no problem. But if you put it out in front of you, that puts a lot more stress on your back. And this is the one that actually hurt my son's back. He extended and put the arm out like that.
Brad: Now should that test be done seated or standing?
Bob: Either way.
Brad: But either way, you probably want to have a firm chair, not on a couch or something like that.
Bob: Probably standing would be best. So now once you determine what you are, let's talk about the flexor first. So, you're going to avoid bending forward, you're going to keep the back straight when you bend forward.
Brad: So, you're probably going to bend at the knees as opposed to bending at the waist, but you're going to keep the back straight one way or another.
Bob: But the way you really round out, become a C, that's where you're really troublesome.
Brad: You’ll feel it.
Bob: So, you're going to learn to keep your back straight. We're going to have a series of videos on what to do when you're a flexor or extender, I'm just going to touch upon it slightly here. If you're an extender, you obviously want to avoid extension. That’s going to fire it back up. You want to stretch your hip flexors, believe it or not because if your hip flexors are tight, they'll extend your back.
Brad: Sure.
Bob: So if you're a shaker, you really want to work on your core strength.
Brad: Right. Because it's like a back belt that's going to stabilize and keep that spine from moving around and giving you that sharp pain. So something you really have to think about is the position of your pelvis and your back and tighten things up and get to the point where you don't have to think about it. You just do it automatically.
Bob: I think a really good example, Brad, is the people that turn in bed and it hurts. I had a patient like this. It worked just beautifully. He's like, I can't get out of bed without it really hurting. So all we had him do is tighten up as abdomen and then turn out of bed and he had no pain then.
Brad: So he had his own back belt basically built in and he just used it.
Bob: So that's all you have to do is start by tightening, you can put your fingers into your sides to see if you're tightening the abdomen. And if you're a compressor, you want to make sure your back is in neutral. It's not flexed. It's not extended. And you want to be in neutral and you want to tighten your abdomen too.
Brad: You probably want to avoid lifting heavy things.
Bob: Yes.
Brad: Even light things until things get better.
Bob: Yes. You know, unfortunately, some young guys often hurt their back because they use too much weight and they actually damage the end plates on the vertebrae. That's getting a little tech technical, but you know, that's what happens.
Brad: You know; I've got my niece. She's about 35, an aggressive worker-outer. She's into CrossFit. I'll get in trouble here. That is an aggressive group. She's 35 and she just had back surgery.
Bob: Oh, she did.
Brad: Yeah. And it sounds like the surgery went well, but you know, I could talk to her until I'm blue in the face and say don't do this and that but.
Bob: The thing is, with CrossFit, if you have a good instructor, they're going to teach you the right way to do things.
Brad: And they're good at max everything out, because that's the mindset.
Bob: Yeah, I know.
Brad: I know, because I'm one of those people. I think I'd be in Crossfit if I was 25. For sure.
Bob: So I like CrossFit though. I mean, I think it does some good things, but yeah, they go a little crazy.
Brad: Pretty damn crazy.
Bob: All right. Those are it. Those are the four things and we will have some future videos. We'll talk about if you're a flexor, and what you should do in great detail.
Brad: Sure. You betcha.
Bob: All right. Brad and I can fix just about anything.
Brad: Except for..
Bob: A broken heart.
Brad: And we're, well, we'll work on that.
Bob: Thanks for watching.
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