Testing of Lumbar Function
If the identification and resulting prevention of the incidence of low back disorders is to become a real possibility, meaningful testing of the lumbar muscles must be produced. Testing must not only include the measurement of the specific strength of these muscles but their range of motion and their “typing” with regard to muscle fiber distribution and the resulting recuperative capacity.
Very recently, an exhaustive study of low back function was conducted at The University of Gainesville, College of Medicine and College of Health and Human Performance. In this study , the development of a new testing machine which meets all of the mechanical criteria for accurate lumbar testing was described and tested. The machine eliminated pelvic involvement, stabilized the pelvis and the femurs and consistently and accurately measured the strength curve of the lumbar muscles in isolation in a range of seventy two degrees of lumbar extension.
In addition, this extensive testing project provided data which indicated that maximal power is produced in the fully flexed position and is proportionally weak in the heretofore reported extended position. The disproportionality of lumbar strength capacity as demonstrated by the test results of 25 healthy volunteer subjects reflected the poor state of condition considered normal. After a ten week strength training program conducted once per week, the subjects gained 104% at zero degrees (full extension) and gained 42% at seventy-two degrees (full flexion). This result demonstrates rather vividly the poor condition of the “normal” population’s lumbar back musculature.
Testing for Work Capacity
If the cost of caring for low back disorders is to be reduced to any substantial degree, two processes must be accomplished accurately and objectively: First, the functional capacity of the lower back muscles must be measured and secondly, occupational, recreational and social conditions must be adapted in order to reduce the possibility of superseding that functional capacity to the point of injury.
The following information has little support in the published literature. Most of this information formed the basis of a doctoral dissertation that this writer developed for a degree in exercise physiology and is the result of clinical observation and testing conducted by this writer.
If the musculature involved with lumbar support and movement are in a healthy state of condition, very little in the way of chronic or abuse injuries is likely). It would logically follow that if reliable, accurate testing of the involved muscle groups were possible and practical, work capacity could be precisely predetermined. In that area, some very simple questions must be answered with regard to the working or performance capacity of the muscles in question. First, what is the strength potential of the muscles? Second, what is the strength curve i.e. the progression and variation of available strength potential? Third, what is the fatigue and recovery effect of specific levels of exercise on the strength and strength curve?
If these three questions are pertinent and if they are accurately answered, then work hardening or preparation or prevention of low back injuries is not only possible but highly likely.
The Application of Exercise Principles for Low Back Treatment
When an individual becomes “an expert” in some particular field of endeavor, that individual, given reasonable communicative skills, should be capable of simple, understandable explanations concerning that field. It is this writer’s experience that many “experts” wear their alleged expertise like shields with which to ward off the possibility of shared understanding of their special subject as if their level of accomplishment is inversely proportional to the number of individuals who can understand their subject. Exercise is a complex and an inexact science. However, the application of exercise is almost always simple once the objective has been clearly determined.
For the purpose of identification and treatment of low back disorders, the following exercise principles must be understood and applied: Muscles produce force, nothing more and nothing less. They can maintain force for limited periods of time. The greater the force produced, the shorter the period of time that it can be sustained.
Recovery is another factor which varies on an individual basis but remains consistent for each individual once it is accurately determined. For the singular purpose of the muscular strength development, a relationship exists which is obscurely developed in the literature. This relationship is not only vital for conditioning purposes but just as important for the determination of work assignments and descriptions for those subject to increased risks of low back injury. The relationship referred to should be called the anaerobic endurance ratio but this term is not found in the literature.
Simply stated, the anaerobic endurance ratio is the relationship of the existing maximum strength level to the capacity to perform muscular work at some lower level of strength. This ratio is different for each individual but remains absolutely constant for each individual. “This relationship never changes except in the case of injury and then returns to normal when rehabilitation is complete”.
The importance of this concept is simple. Once the anaerobic endurance ratio is known in any individual case, then strength can be determined by measuring endurance and endurance determined by measuring strength. Since it has been previously determined in this presentation that it is now possible to accurately isolate and measure lumbar function, the following exercise principles can be precisely applied for the identification and treatment of low back disorders:
Measure and determine the existing strength curve and range of motion of the lumbar muscles of the back using a device which completely isolates and anchors the pelvis. Such a device exists and is currently being used in a number of clinical, university and industrial settings. This data will serve as a baseline for later comparison and analysis of treatment effect.
Compare the baseline strength curve with that of a normal range strength curve and determine if aberrations exist within the strength curve or range of motion which might predispose the individual to potential low back problems.
Prescribe a full range, balanced form of resistance training for the lumbar muscles specifically and the support and assistance muscles of the lumbar area including, the abdominal, gluteal, quadriceps and hamstring muscles.
Re-test the individual after four to six weeks and reevaluate the strength curve and recovery capacity of the individual.
As a result of step four, three courses of action may be taken:
lace the individual on a maintenance program once he has attained a normal range of lumbar function.
Continue the existing rehabilitative program if it has improved the condition.
Reevaluate the individual completely, including any medical, psychological or mechanical testing which is appropriate.
The exercise protocol must be prescribed on an individual basis but all the information upon which the prescription should be prudently developed is available when the aforementioned testing is properly performed. The determination of the strength curve, recovery capacity and anaerobic endurance ratio will establish the necessary frequency, intensity and duration of the appropriate exercise program.
The documented cost in terms of dollars, pain and social upheaval incurred as a result of low back disorders insures that any preventive measures which can substantially reduce that cost, will necessarily enhance the quality of life within that society. Certain of the established social institutions which deal rather directly with low back treatment and payment for such treatment, including medicine, education and industry, must certainly become more responsive to the progressive approaches provided in this presentation. If, as determined by the data, low back disorders are primarily mechanical in nature, it is rather apparent that preventive measures and early detection must revolve around the accurate assessment of the mechanical i.e. musculo- skeletal capacity of the low back.
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