Kinesiology THURSDAY – Lumbar pain and BLTs

“No bending, lifting or twisting” (no BLT) is common advice given to people following low back surgery or suffering with low back pain. Bending, lifting and twisting (BLT) isn’t inherently wrong. In fact, you were designed to perform these motions. BLT isn’t bad for you. But BAD BLT is bad for you. Let’s break it down:

Region	Flexion	Extension	Side bending	Rotation
Lumbar	65˚	31˚	30˚ (R/L)	15˚
Hip	130˚	18˚	Abd=40˚ Add=18	IR=40˚ ER=50˚
Thoracic	26˚	22˚	30˚ (R/L)	47˚

ROM of lumbar spine and adjacent body regions.

Most injuries to the lumbar spine occur in a flexion/rotation moment. Lumbar strains and herniated lumbar discs fall into this category. Looking at the numbers above, it is easy to see where most of the flexion and rotation SHOULD happen when you bend, lift and twist. The hips are large contributors to flexion and rotation ROM, and the thoracic spine is a significant contributor to rotation.

So bending lifting and twisting isn’t bad for you, it’s just bad if you perform more than 65˚ of flexion and 15˚ of rotation at your lumbar spine. You have all heard the saying, “Force follows the path of least resistance.” So if you go to bend forward and your hips don’t flex enough (or if they flex too early), then your lumbar spine will pay the price. Tight hamstrings could limit hip flexion.

Here’s a quick test: Stand with your feet hip width apart and toes pointed straight ahead. Keeping your back straight and your knees unlocked, you should be able to hinge at your hips until your trunk is parallel to the floor, without contribution of lumbar flexion. That would be normal functional hamstring flexibility.

And if you go to rotate and your hips and thoracic spine are limited, then your lumbar spine will surely pay the price. 15˚ of rotation capability in each direction is not a lot of motion. Here’s a short list of what can limit thoracic and hip rotation:

Tight latissimus dorsi
Tight pectoralis major/minor
Tight hip external rotators (piriformis, posterior gluteus medius, iliopsoas, adductor magnus, lateral gastrocnemius and indirectly, vastus lateralis)

Conventional thinking says: Avoid bending, lifting and twisting if your back hurts or if you have had surgery.

Real World Thinking says: Restore normal ROM in the hips and thoracic spine to PROTECT the lumbar spine from bad BLTs. Working on the limiters of motion in these areas will protect your lumbar spine, even post-surgically. Especially post-surgically.

So now go and have a great BLT. Both kinds.