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What sport against low back pain?

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1 Sport is back pain factor
11The Sport promotes the occurrence of disc lesions
 
111 Sports Complex actions are harmful
The disc lesions occur preferentially associate when bending, tilting and rotating the torso. The effect of the first two components of nuclear pressure and tension ring is well known, they would be responsible for the sudden appearance of hernias on healthy disk. Given the oblique orientation of annular fibers, rotation sends a real "screwing" disc which reduces the intersomatic space and greatly increases the pressure within the nucleus. In addition, this shear high amplitude is the cause of cracks or tangential peripheral annular radial. They would make the bed of the disk failure and could pave the passage of the nucleus on the path of disc herniation.
112 Sport fulfills his misdeeds cunningly
Only the periphery of the disc is innervated. At inadequate sport, the most central rings tear without causing pain. In the suites, it is sometimes a harmless act of everyday life that causes the nucleus in sensitive ring area. This movement abusively door lesion responsibility then that is the sport that has initiated and exacerbated most of the crack in the annulus.
113 The rapid actions are toxic
The disc operation not tolerate haste. To distribute balanced tension and to better distribute the nucleus, the disc must be put into "preload". If the disc structure fits poorly with the speed of the gesture, the nervous system can be taken as failing. It must coordinate all muscle contractions involved in the movement. The higher the speed, the greater perfection is difficult to obtain. Under these conditions, joint movements are smooth and less traumatic risk increases.
 
114 The uncoordinated movements are dangerous sports
The "lack of foresight" or "deceived automatic" increases the threat of trauma. When the motor programming is upset, joint movements are disorganized. The likelihood of disc lesion increases dramatically. Thus, the disciplines "closed", in which the gesture is still scheduled, are less aggressive for the column that activities "open" where movement changes abruptly because of a malicious adversary.
115 Lower back pain, herniated disc and sport: opinions are divided
Within the general population, 20 to 30% of people have back pain when they are asked. Fifty percent of tennis players experience pain in the column. Furthermore, 80 to 85% of the sedentary "have a bad back" or "have had back pain in the past." However, only 70% of judo and rowing practitioners have suffered their vertebrae. These seemingly aggressive disciplines seem to preserve in part the column.
In children and adolescents, the assiduous practice of football appear to aggravate lower back pain since 6% of young footballers have primary backache against 30% of practitioners in the secondary. In adults, Burton showed that recreational sports featured as many back pain than sedentary while Granhed highlighted that the former athletes had less back pain.
Auvinet recalls that half the professional riders suffer their spine. The proportion rises to 60% for top athletes specialists jumps. A volleyball player has two herniated a disc protrusion or MRI. However, the extent of injury is more correlated with the age of the subjects that years of practice. In this article Bartolozzi, the "passing time" seems inexorably more dangerous for the column that sport. A study by Mundt has not demonstrated that sport favored the occurrence of disc herniation.
2 Sport is good for the back!
21 Physical activity reduces chronic back pain
 
211 Sport can relieve some lesions of the column
2111 The "disc failure" is less painful through sport.
In case of disk failure, the annulus is cracked. The nucleus diffuses through these lacerations and no longer able to exercise pressure against ensuring the maintenance of the interbody space. The disc dehydrates and collapses. The annulus crashed on the outskirts sometimes constituting a genuine disc protrusion.
Physical activity may be beneficial to mechanize this aging structure. The pressure variations caused by walking or jogging are the cause of a pumping phenomenon favoring disc rehydration. The disc loads when well controlled gymnastic movements contribute to the maintenance of histological and biochemical annular qualities. Jogging could be considered a great "morning stiffness".
2112 The "disturbance intervertebral" sometimes regress through exercise
When minor inconvenience intervertebral segmental muscle contractures locally disrupt the spinal kinetics. This dysfunction persists and sometimes extends to the floors of "compensation" after the initial injury has healed. The gradual recovery of the sporting gesture often helps restore and maintain a harmonious segmental motion. It is in this context that the well-designed physical activity appears to be essential to prevent recurrence after spinal manipulation.
212 How does the sport to reduce back pain?
2121 Strengthening the muscles shows essential.
Abdominal protect the column and contribute to its operation. Two biomechanical concepts attempt to justify their effectiveness: "composite beam" and "abdominal caisson".
Between the torso and pelvis, the skeleton is connected only by a thin bone structure: the spine! To solidify the building abdominal muscle cylinder is proving decisive. In contracting, the muscle mass harden in solidarity and the upper and lower parts of the body. This unshakeable tower is made ??up of both bone and muscle. We speak of "composite beam". Strengthening exercises should be varied, urging the transverse and oblique including the tilt and rotation movements.
Abdominal also show effective because, by contracting, they increase the pressure in the stomach. Like a balloon that inflates the abdomen stretches in all directions. Through this mechanism, the abdominal muscles redresseraient column and would loose the vertebrae. We speak of "box" effect. Here are two processes that have abdominal star in preventing "back pain." However, they are not the only ones to be particularly useful.
The "paravertebral" also participate in the "composite beam" and "abdominal caisson". In addition, they support the spine and ensure its recovery. Their power ensures a smoother joint movement during these risky actions but essential to everyday life or sports.
Upper and lower limb muscles are asked to maintain a heavy object and raise after squatting. They are essential to ensure the safety position column!
Rehabilitation of low back pain should no longer be content to work the abs ... and a little paraspinal analytically. It must move towards a more comprehensive taking into locomotor neighboring charge of maintenance sport.
2122 flexibilities are effective
Stretching made ??during sports practices involved in the prevention of back pain. When thehamstrings are more flexible, more easily toggle the basin when anteflexion and disc compression decreases. During bending forward or sides, steep paraspinal compress the spine and discs, resist and disturb the gesture.
All muscles inserted on the basin are involved in the posture and movements of the column. Even the shoulder girdle muscles, especially in the swimmer, affect the overall spinal posture. As part of easing as in the strengthening, it is not only the muscles around the spine that need to be worked.
2123 Good coordination is useful in reducing vertebral suffering.
The sport requires constant monitoring of the dynamics or spinal posture. The column and pelvis are placed close to the body's center of gravity, they link arms and legs. Greater motor skills always involves improving the coordination of the spine. Of course, this postural control can be conscious. This is the case in weightlifting or bodybuilding. These disciplines really learn the art of the uprising! Karate and martial arts emphasize the control of the position of the pelvis and center of gravity. The body is well balanced, perfectly stable on his feet. Unconsciously, any physical activity increases the address of the muscles of the spine. Bow to hit a ball, tennis, seeking coordination systems. Even running requires constant dynamic stabilization of the spine upright.
2124 The endurance helps reduce back pain.
If your muscles are training to work throughout physical activity, they retain their mechanical function longer. In everyday life, they support longer vertebral joints. They allow to take easily a sitting or standing for long periods.
213 Sport has demonstrated its effectiveness in reducing chronic back pain!
Felez showed that 80% of chronic low back pain beginner karate see their pain disappear! These results are comparable to the best intensive rehabilitation protocols, so this discipline is compared to a true "back school". Of course, karate is not the only sport that have proved useful. Other activities worth mentioning because they unfairly bad reputation.
Jogging protects spinal pain despite the impact of the foot on hard ground. At a specific time, 5-8% of runners backache against 20 to 30% of individuals in the general population. In the past, 35% of joggers said they had been victims of these problems against 80% sedentary. By analyzing the situation more accurately, this finding makes sense. The race strengthens and improves the coordination of the stabilizing muscles of the column by imposing its dynamic support throughout the event. Moreover, Wilke showed that the average pressure in the discs during the race was less than that observed in the standing position and regardless of the quality of shoes! While receiving each stride increases the disc compression, the pulse expands the disk. The result is a real pump that feeds the disc and maintains its mechanical properties.
Weightlifting and its cousin, the weight, reduce the risk of suffering back. Even many years after stopping training, Granhed showed that veteran practitioners had less back pain than sedentary. Under these conditions, it's a safe bet that the continued efficiency psychomotor. These athletes have learned the technique of lifting and continue to use them to spare their vertebrae. During the period of activity, improvement in muscle strength largely justifies the beneficial action. Power abdominal ensures effect "box" and "composite beam". Strong muscles along the column allows good posture control and a smoother recovery. Most often, the machines used in the weight room are said to "guided load"; the body is stabilized and the proposed act is well suited to the functioning of the joints.
The cycling must be encouraged in the low back. If the rider does not abuse the anteflexion to increase its aerodynamics, lumbar spine sits right in delordosis, the most common analgesic attitude in the individual victim of a disc failure or protrusion. Moreover, the bike position resembles that of the great apes. These sporadic bipeds have left us their musculoskeletal system, there are 3.5 million years. Since our spine and joints have tried to adapt somehow at the mercy of random mutations say. As highlighted paleontologists and Pillardeau, this process is causing a real evolutionary tinkering source of major functional shortcomings. By bicycle, the man finds a delordosis probably better matching spinal biomechanics. Above all, it revives quadrupedalism. The prior support stabilizes the bust and reduces vertebral torsional stresses. It also decreases the spinal lever and relieves paraspinal.
Even the horse proves effective. When the rider sitting in the saddle, following the paces of the horse, it strengthens and improves the coordination of the muscles in his back and abdominals. The underlying vertebral game for damping the movement provides effective pumping to inflate the nucleus. So beginners with back pain can be relieved by a progressive practice in a frame with comfortable gaits. A study shows that half of the professional riders with back pain see their pain disappear when riding. Conversely, practicing high level, hitherto preserved, is frequently low back pain when it must cease activities!
It's theleisure sport that wins the prize for efficiency. Salminen shows that a varied workout, regular and low intensity has a favorable effect on low back pain. Chiabiglio confirms that the herniated disc is rare in athletes. However, the protection decreases and the pain increases progressively as the age of onset decreases, the practical level rises and the intensity of the workout increases.
214 Physical activity retrained column
2141 The spine may falter!
In cases of chronic low back pain, disc wear is often minimal. Sometimes, there is no injury. The spine suffers because he can not bear the mechanical stresses imposed on it. It is désentraîné or "deconditioned". Joint function may be compared to the cardiovascular system. In sedentary, some jogging causes shortness troublesome symptoms suggestive of heart failure. No medical examination will not reveal any pathology! The heart is normal, the lungs are normal, you are only in poor physical condition. The lower energy solicitation is a source of discomfort! The spine reacts similarly. If the muscles are not in shape, they suffer during exercise, they hurt guide joints. A vicious circle may soon be established, "I hurt for the movements, I reduce my activity, I désentraîne, I still suffer more when I move my spine."
This situation is common after spinal trauma. The disc lesion heals, thanks to an often excessive rest. The frequently inadequate rehabilitation, learning to protect the vertebrae. Sometimes the therapist will work the right muscles and not retrained column. At the end, it persists as the "spinal deconditioning." The problem reveals dramatic during work accidents occurring in handlers. Many months after the initial accident, they are unable to resume their place in the business!
2142 The "retraining the spine" has amply demonstrated its effectiveness!
The first studies on spinal reconditioning are born in the 80s in the US. Probably more for economic reasons than humanitarian, private insurance companies want workers with disabilities find back the development of working life. Tom Mayer was one of the most ardent promoters of "functional restoration methods spine." He published in "spine" and can retain its provocative slogan "Use-it or loose it". The formula is particularly explicit: He must use his column to not lose its function, it is necessary to work to strengthen the muscles, it is essential to mobilize the disks for not stiffen!
1243 The "deconditioning spine" is a scientific reality
Many French rehabilitation centers have taken the concept of repackaging spinal "made in USA". It concerns CLBP off work for several months, unable to resume their work and for whom retraining proves hazardous. The medical assessments, including additional examinations do not reveal anatomic lesions that may be subject to special treatment. Only a few "ordinary wear" can be found, the source of some pain or minor troubles.
The "deconditioning spinal" is confirmed. The spine is stiff. The muscles are weak. The physical tests on computerized machine show that muscle balance is reversed. In a healthy individual, the paraspinal are 1.3 times stronger than the abdominals. This finding makes sense, muscles along the column supporting the bust and often permanently lift loads. In the CLBP deconditioned, strength reaches only 0.7 times that of the abdominals. Too preserved this patient désentraîné his muscles. It does nothing more picks or systematically bends his knees to retrieve his pen fell to the ground. Physiotherapists, indoctrinated with the dogma of the box and the composite beam, systematically strengthened their abs! This observation proves that the "spinal deconditioning" is not a vague concept of intellectual elitist but a scientific reality. It's obvious, the muscles lost strength but also flexibility and endurance! What is true for the musculature is for discs and nervous system. The column, frozen for many months in a pseudo-protective stiffness in his joints enraidi. This stiff spine no longer manages to coordinate his movements, lifting gesture was forgotten! It's time to start training!
1244 Ask the 'repackaging' program
Conventionally, hospitalization will last 3 weeks. Five to six hours are daily sports program. Patients support, not passive techniques, no massages! Physical activities are varied and complementary. They are analytical and structured as in the sessions of stretching or strength training. They are quickly gaining specificity to retrain back to lifting loads. They also take a playful aspect through the use of team sports.
The typical day begins with a work ofStamina: thirty to 45 minutes by bike to start smoothly through analgesic delordosis or some jogging for mechanization disc! Improving the ability to "endure without endure" proves essential to take 16 hours of daily living including 8 hours of handling. After this training, one hour of stretching is planned. Then, you must perform a hour of weight training. All muscle groups are involved. The muscles of the arm holding the load. Abdominal ensure the eternal purpose "box" and "composite beam". The legs and paraspinal are the main actors of the uprising. All are worked, preferably guided load machine. Particular attention is paid to systematically deficient paraspinal. The morning ends with an hourteam sport, football often. Ball games are a fun way to learn to coordinate the movements of the pelvis and spine. The friendliness of the moment, the joy of movement, help to reconcile with that body once thought forever sickly! The pain soon be forgotten.
After a break of one hour and a half lunch devoted to restart the program with an hour of weight training. At the end, the work of coordination and specific building starts; it will last one hour. To learn how to lift weights, we must go back the weight leaning forward! In the workplace, you can not keep your back straight and bend your knees ... it is normal! Often the employee lack of space to realize this movement and the contortions necessary. Above all, this theoretical gesture is an ergonomic heresy! Therefore, to pick up a parcel of 3 kg placed on the bottom shelf, our storekeeper Should squat? Why, instead of picking up three kilograms, goes back there every time, all the weight of his body! That would prove exhausting! It would be impossible to hold an entire day! This is why our organization chooses spontaneously and appropriately to address before the bust! The squatting and bearing torso straight, abs tight, blocked respiration, must be reserved at lifting heavy loads! Initially, the trainee retrained in these paraspinal isokinetic. The device rigorously hold the body and protects everything wrong move. The resistance exerted by the machine automatically adjusts to the force produced by the patient, thus avoiding any muscle or joint injury. However, it is imperative to look forward and go bust! Gradually, the patient abandons his reassuring machinery. Gradually, he realizes without maintaining strength exercises in positions theoretically increasingly binding the column. He soon to lift boxes laid on the ground, turns, twists view to store! Dérouillent the joints, muscles gradually acquire the technique and strength to ensure a smooth spinal movement. Without hypocrisy, this specific training gives the body the ability to take on his professional mission!
The day ends with a long session of therapy. Hot water, whirlpools facilitate muscle relaxation and recovery. This regeneration will prove very useful to support the next day's program ...
This type of protocol is proving very effective. After several months of work stoppage and treatment failure, the course of "physical and sports preparation" allows 80% of patients to resume their professional activity! Often some pain persist but are better tolerated and less dramatic. The patient now knows that "painful sensations" does not mean "further damage". Our handler regained confidence, alteration of vertebral structures does not prevent his spine to run! It is safe to live and work normally. It is even possible to do sports ... to conserve acquired!
1245 hard sports can be a victim of "deconditioning spinal".
At the practitioner good level, it is a "relative detraining." He feels pain during activity because his spine is not prepared to accept the constraints of his discipline. The tennis multiplying the lateral inflections and torso rotations eventually suffer from its records. The footballer finished his match with a bar in the kidneys. It can also be a "deconditioning": too much abdominal exercise, not enough to strengthen the paraspinal and an obvious lack of easing. In these conditions, sport flies to the rescue of the sport! A specific activity must always benefit from"Generalized physical preparation." It could be called "general fitness". Its mission is to give to each athlete, athletic body able to tolerate the biomechanical requirements of the chosen practice!
1246 sport supplants the rest, medication and rehabilitation!
The programs of "spinal reconditioning" blatantly demonstrate the benefits of physical activity on spinal pain. Karate has also proved useful with comparable results. Bentsen offers postmenopausal women fitness program indoors and at home. There has been a reduction in the duration of work stoppages and lower consumption of drugs. Women adhere well to the Protocol and appreciates the empowerment home source of adherence. Tortensen highlights a rehabilitation program or specific exercises are more effective than a home practice without supervision. Finally, in 1997, Tulder published a meta-analysis that assesses the results of 39 scientific studies comparing different treatment of chronic low back pain. It confirms that physical activity is proving the most effective support! It shows slightly more beneficial than traditional rehabilitation and much more useful than the usual medication.
3 In practice, what sports against back pain?
 
31 Prudence and moderation
Sport can cause disc and vertebral alterations. Officials injuries most often occur during periods of growth. They are bone kind. They prove amply favored by intensive activity and premature specialization. For the spine and well-being of children, such practices are ways to avoid. In adults, the risk of herniation or disc failure seems higher in case of excessive training. Conversely, recreational sport seems to protect these lesions. Improving physical fitness provides good prevention in everyday life and compensates for the increased risk inherent in certain disciplines. Activities should be varied and moderate. It is good to combine the playful practices more analytical preparatory exercises such as weight training and stretching. In addition, the work of the muscular and cardiovascular endurance should not be forgotten. The dangerousness of intensive sports, conflicting results about spontaneous leisure practices and effectiveness of reconditioning protocols invites us to propose progressive and individualized programs. Far from abandoning the low back pain to repetitive physical therapy or athletic unbridled practice, the therapist should guide the patient to structured sporting activity, motivating and enjoyable.
32 Enthusiasm and motivation
321 initial Medical Assessment and progressiveness.
Physical activity to propose to chronic low back pain should attempt to integrate cardiovascular and metabolic preventive practices. Anyway, the program beneficial for the back must seek and maintain heart and muscle endurance. Under these conditions, a complete physical examination and often a stress test is necessary to ensure efficient reconditioning safely. If rehabilitation can initiate the restoration movement of the spine, it is also a time for learning the analytical and comprehensive work of the spine. In this context, the following protocol may be proposed. Our patient begins with a rehabilitation session per week for 2 weeks, it simultaneously increased physical activity in everyday life. He spends 2 weekly sessions during the 15 days. In his physiotherapist, it adds to the analytical work, a more comprehensive solicitation cardiovascular component: bike, stepper or ellipteur and why not rower. A 1 month of support, it performs 3 sessions per week involving articular and cardiovascular work.
322 Individualization, regularity and diversity
According to evolution, the doctor offers his patient to empower gradually. Personalized sports program based on symptoms, functional abilities and tastes take over rehabilitation. It may have 3 weekly sessions of 30 minutes to over an hour, every week, every week. It is essential that each drive begins with a "warm-up". It takes at least 10 minutes. The amplitude and movement speed increase gradually, cardiovascular intensity increases gradually to a level that "talk but not sing." This work continues 15 to 30 minutes and ends with a cool-decreasing difficulty of 5 to 10 minutes. All these cardiovascular sessions seeking the disc structure and spinal guys especially when they are practiced on éllipteur or rower. However, often a more complementary analytical work is beneficial. The efficiency of workover expense of diversity and synergy of sports.
323 Strengthening and flexibility
Strength training is beneficial. By increasing the strength of all muscle groups, support column improves. We must not neglect the paraspinal. Work should begin in static. In the absence of proven injury, over the following drives, it is logical to introduce more specific dynamic contractions of everyday life. It is good to restore anteflexion bust followed by a recovery with harmonious roll at low speed. It is useful to add stretching view of yoga. Please note, despite the good reputation of these activities, they sometimes impose supra-physiological range of motion as may be aggressive for the spine. Moderation is still required. Themaintenance gymnastics and some group classes combine strength training and stretching. The cocktail can be effective in the fight against back pain
324 muscle and heart Endurance
It is good to endurance sports including work building muscle. Swimming can be beneficial but is not the only discipline to offer. Must swim back to the abdominal muscles and belly to strengthen the paraspinal! Horizontality and weightlessness reduce herniated constraints and provide a link to the movement without pain. These settings limit the specificity of this practice. To readjust to everyday without hypocrisies and professional constraints, other activities are essential. Thecardio room or home can increase gradually spinal stress. Both the bike household intervertebral discs, as the rower is seeking the column. We must begin this right back simulator. Gradually, it becomes possible to look forward to revive a movement that surrounding the uprising. Cycling is a good activity. Theoretically the back does not suffer. The paraspinal soft stretch and strengthen. Legs and heart acquire stamina. However, any default setting can turn a nice walk in torment. It is advisable not to lean forward and change position frequently. We must keep hands well to stabilize the torso. If necessary, you can drop a little saddle, to avoid tipping the pelvis with each pedal stroke. Finally, painful period, the room or road bike are preferable to jolts and the imbalance of the ATV. Despite its poor picture,jogging can be a favorable discipline spine. Jogging strengthens and coordinates the muscles supporting the spine. The pace reception / pulse causes articular pumping which rehydrates the discs. So remote painful episodes, it's good to go running.
325 Coordination and games
Most recreational activities such as ball games or rackets are possible. They improve the dynamic coordination of the column. However, it is better not abuse it. For those with bad backs, one session per week should be sufficient. It is imperative to involve endurance activities and more analytical practices such as weight training and stretching. Even top athletes perform a "general physical preparation"!
Bibliography
AUVINET B. Riding academic, adaptation of the rider, professional riders: pains and spinal injuries Sports Med 1978, 52, 25- 349, 28-252..
BARTOLOZZI C. The incidence of disk exchange in volleyball players. The magnetic resonance Findings. Radiol. Med. Torino. 1991 December 82 (6): 757-60.
BENTSEN H, The effect of dynamic strength back exercise and / or a home training program in 57-year-old women with chronic low back pain: results of a prospective randomized study with a 3-year follow-up period.
Spine 22: 1494-1500
BURTON AK, KM TILLOTSON, Does leisure sports activity influences lumbar mobility or risk of low back disorder, J Spinal Dis 1991; 4: 329-36.
FELEZ A, Low back pain and martial arts. Karate back school? Spine and Sport. Masson Ed. Paris. 1995.p 298-302.
Granhed, B MORELLI, Low back pain Among wrestlers and weight lifters retired. Am J Sports Med 1988; 16: 530-64.
MAYER TG, Functional restoration for spinal disorders. The Sports Medicine approach. Philadelphia: Lea and Fediber, 1988; 36-51, 218 240.
MUNDT D. An epidemiological study of sports ad weight lifting can have facors for herniated lumbar and cervical discs.Am. J. Sports Med. Nov. Dec. 1993. (6): 845-60.
PILLARDEAU P. Pathology and Human evolution or Lucy syndrome. DERMS editor. 2003.
SALMINEN J. Leisure time physical activity in the young. Correlation with low back pain, spinal mobility and muscle strength in trinck 15 years old school children. Int J Sports. Med. 1993.
Torstensen T, Efficiency and costs of medical exercise therapy, conventional physiotherapy and self exercise in patients with chronic low back pain: a. Pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up Spine 1998 23: 2616-2624
Van Tulder, Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the MOST common interventions.Spine 1997 22: 2128-2156
VANVELCENAHER J, VANHEE JL, functional restoration program of the spine in the context of chronic low back pain: a new therapeutic approach Review of orthopedic medicine, No. 31, September 1995, 5-16...
WILKE HJ, News measuring intradiscal pressure in the activities of daily life. Der Unfallchirurg 1999 Helf 271.

Doctor Stéphane CASCUA. - 14 mars 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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