Don’t forget your back!

As we discussed last week, most of us spend a large majority of the day hunched forward either driving, working at a computer, preparing meals, writing, folding laundry, etc. This constant forward flexed posture is a set up for neck, back and even shoulder pain. In addition, the majority of exercises we incorporate into our daily routines do not directly focus on our back and neck musculature.
The back muscles can be divided into three different layers: the superficial, intermediate and deep muscles.
The superficial layer of back muscles is composed of the muscles that we can see. Many of the more common shoulder exercises target these muscle groups. In general, these muscle groups function to move the scapula or shoulder bone of the back. The muscles in the superficial layer include:
– Trapezius (traps)
– Latissimus dorsi (lats)
– Rhomboids (major and minor)
– Levator scapulae
– Splenius capitis and semispinalis capitis (neck extensor muscles)
Some common exercises which target this layer include:
– Pull ups
– Dead lifts – with weights or a barbell
– Chin ups
– Overhead pullovers with weights
– Roll outs with the stability ball
– Shrugs
– Weighted rows
The next group of muscles in the back is known as the intermediate layer of the back. This group is composed of the serratus posterior superior and the serratus posterior inferior. These muscles are primarily involved with moving the the upper ribs upwards and the lower ribs downwards during breathing. In addition, they assist with extension and rotation of the back as well as stabilization of the trunk (thorax). This layer is a little more challenging to target given that these muscles primarily function as breathing muscles. However, exercises which extend the back such as superman back extensions may be able to activate these muscles.
The final group of muscles in the back are known as the deep layer. This layer is composed of three different groups of muscles
– Spinotransversalis (splenius capitus and splenus cerivcis)
– Erector Spinae (Iliocostalis, longissimus, and spinalis muscles)
– Transversospinalis (Semispinalis, multifidus, rotators)
In general, all the deep muscles of the back function to move and stabilize the spine. Movements include back rotation, extension, and lateral bending. These muscles are the most overlooked with regard to exercises. Just as time is dedicated to other muscle groups of the body such as the biceps, triceps, shoulders and chest, so to, should time be dedicated to these muscle groups as well.
Some exercises which specifically target these muscle groups include the
– Back extensions or hyper-extensions (Superman)
– Back extensions with simultaneous single arm and leg raises
– Single leg or arm raises on all hands and knees
– Dead lifts
– Back extensions while on a stability ball
The back muscles are a very frequent source of pain and suffering. Often times back pain can be a result of decreased flexibility, muscle imbalances, chronic systemic inflammation, leg length discrepancies, viral illnesses, disc herniation, as well as arthritis. Of course, there are other causes as well, which can range from benign etiologies to life threatening. The majority of back pain though, thankfully is benign.
For most causes of pain, movement rather than rest is the best medicine because movement increases blood flow which flushes out cytokines (substances) which can further drive inflammation. Often times back pain is referred and is actually a result of a problem somewhat removed from the actual site of pain. Usually most acute back pain is self-limited, especially if you continue to move through your pain. With my patients, I often find that immobility and overprotection of the painful area are often the leading contributors to the development of chronic pain.
In addition to movement which includes both stretching and strengthening the painful area, heat, ice, anti-inflammatory medication and TENS units may be beneficial. There is evidence to support the use of certain supplements such as Omega 3 fatty acids, turmeric or curcumin, magnesium, and vitamin D3. While there are various dosing recommendations for each of these supplements it is important that they are tailored to meet your individual needs and that you inform your health care provider what other medications and supplements you are taking to make sure the dosage is correct.
Some topical preparations such as ben gay, ice hot, capsaicin cream, and Bio Freeze may be beneficial as well in alleviating pain. Focusing on proper posture, proper ergonomics at work, while driving and during your daily activities will also help to improve your pain. The back and neck musculature play a very important role in posture, stability, prevention of chronic pain and must be exercised to prevent muscular imbalance.
Disclaimer. The information provided here is not intended to substitute for medical care and should not be used for treatment or diagnosis. If you have, or suspect you have a problem concerning your health please consult with a licensed healthcare professional.

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