Unless you consider neoprene belts, posture trackers, and shiatsu massage pillows cutting edge, the realm of back pain prevention hasn't been a hotbed of innovation since, well, ever. Which is why the Internet lit up recently when researchers at Vanderbilt unveiled their latest tech: Smart underwear that reduces stress on the spine by giving the muscles of the lower back a biomechanical helping hand.
"Instead of the muscles and ligaments doing all the work, the device shares the load," explains lead researcher Karl Zelik. "And the cool thing about it is that you can engage it and disengage it as necessary—when you don't need it, it just feels like regular clothing."
The medical community was understandably excited. Eighty percent of Americans will experience back pain at some point in their lives, and 20 to 30 percent of us are suffering from it at any given moment. It's a leading cause of missed work days in the United States, costing the nation 10 to 20 billion dollars in lost productivity each year, and one of the top reasons people visit their doctors, resulting in an estimated annual spending of 90 billion dollars.
That's an astronomical amount to spend on a condition that has no detectible cause (like an infection or a pinched nerve) in 85 percent of cases, and clears up on its own 90 percent of the time. But if you're one of the unlucky few for whom such "nonspecific" low back pain becomes chronic, you'll likely face a slew of treatment options—including bed rest, spinal surgery, opioid painkillers, and steroid injections—that recent studies suggest can range in effectiveness from not-at-all to potentially harmful. The takeaway: If at all possible, you're better off never having to deal with back pain than trying to stop it once it attacks.
"And that's our focus," Zelik says. "We're aiming to prevent injuries and pain rather than treat them."
Designed to be worn under conventional clothing, the device consists of shorts and a vest (made of nylon, Lycra, polyester, and other lightweight materials) that are connected by two elastic bands. A double tap on the chest prior to leaning forward or lifting a heavy object engages the bands, which run parallel to the spine and flex to support the movement of the user.
When Zelik and his team tested the device by having eight subjects lean forward and lift 25 and 55-pound weights at various angles, they discovered the device reduced activity in the lower back extensor muscles by up to 45 percent. That's a good thing, according to the Vanderbilt team, as such assistance can potentially help reduce not only fatigue and strain in those muscles, but also the stress on the spine that might occur as a result of not doing so.
There's only one problem: So far, that potential is unproven. "We've demonstrated smart clothing's benefit in terms of reducing low back muscle activity during lifting and leaning," Zelik says. "But there's a lot left to explore; additional research is needed to understand the long terms effects on preventing pain or injury."
If those effects are anything like those for conventional back belts and braces—which restrict range of motion rather than support it, but nevertheless reduce lower back muscle activity, like Zelik's device—the prospects aren't good. According to the National Institute of Occupational Safety and Health, "although back belts are being bought and sold under the premise that they reduce the risk of back injury, there is insufficient scientific evidence that they actually deliver what is promised."
As far as science is concerned, there's exactly one strategy that studies consistently show to be beneficial for preventing chronic low back pain, and it just so happens to be what a growing body of evidence suggests is one of the best ways for treating chronic nonspecific low back pain once it occurs: exercise.
In a recent review of 23 studies, which included 30,850 participants in 21 randomized clinical trials, Australian researchers concluded that exercise alone can reduce the risk of developing lower back pain by 35 percent. "And in my experience, the percentage is much higher—if you match the type of exercise to a person's pain triggers," says Stuart McGill, a professor of spine biomechanics at the University of Waterloo in Canada, and the author of Back Mechanic. In short, you need to be smart about how you work out.
In practice, that generally means lifting with proper form, focusing on mobility as well as strength, and including core stability work in your training program. "I've worked with powerlifters that can lift nearly half ton off the ground, and they don't have back pain," he says. "The reason is that they've adapted their bodies to perform that kind of activity."
And therein lies a fundamental flaw with nearly every back prevention device ever invented, including Vanderbilt's Justice League-worthy smart underwear: They allow the core muscles responsible for supporting and stabilizing the spine to disengage, and in so doing, potentially allow those muscles to weaken. When that happens, stress on the spine can increase, as well as the likelihood of experiencing pain.
"The core muscles—including the back extensors—act as guy wires for the spine, and they're very well designed," McGill says. One of the keys to preventing back pain is not to shut them off, but to become more effective at turning them on and coordinating their activity patterns.
The following exercises, developed by McGill and his colleagues at the University of Waterloo, can help you do just that. "We call them the 'big three,'" says McGill, who recommends doing them every day for maximum effectiveness. "They'll help you not only increase your core stiffness [which is essential for stability], but also build impeccable motor patterns, teaching your core how to support your spine in ways that transfer to daily life."
Get down on your hands and knees with your hands directly below your shoulders and your knees directly below your hips. This is the starting position. Keeping your back flat and core braced, simultaneously extend your left leg straight behind you and your right arm straight in front of you. Hold for 10 seconds, and then return to the starting position. Repeat with your left leg and right arm. Do three sets of four to five reps, alternating arms and legs each rep.
Lie on your right side with your legs straight and feet stacked. Prop yourself up on your right elbow, positioning it directly below your right shoulder, and place your left hand on that same shoulder. This is the starting position. Raise your hips so that your body forms a straight line from your head to your heels. Hold for eight to ten seconds, and then return to the starting position. Repeat three times, switch sides, and repeat. That's one set. Do three.
Lie face-up on the floor with your left leg straight, your right leg bent, and your right foot flat on the floor. Place your hands under your lower back, palms down. This is the starting position. Slowly raise only your head and shoulders about an inch off the floor. Hold for seven to eight seconds, breathing deeply, and then return to the starting position. That's one rep. Do three sets of four reps, switching leg positions halfway through each set.
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