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Lower back pain can be a real challenge, particularly to those with an active lifestyle like triathletes and swimmers. It’s crucial to understand how different movement patterns, specifically flexion and extension, can impact your lower back pain. In this blog, we can simplify what that means to you and how you can use some of the principles of Robin McKenzie, a physiotherapist from New Zealand. His McKenzie Method can help you determine which movement pattern might be best for your particular episode of back pain. We’ll try to keep it simple and easy to understand.
Michael Phelps, a name synonymous with swimming excellence, was the embodiment of aquatic grace, dominating the world of swimming with his record-breaking achievements. But then in 2004, fortunately after he had just won 6-Gold Medals, 2-Bronze Medals, and set 5 Olympic or World Records, something unexpected occurred that drastically affected his career.
Michael’s story isn’t just about his accomplishments; it’s about the challenges he faced. As you may already know, his journey wasn’t all smooth sailing. During his illustrious career, he was hit by a discouraging adversary – spondylolysis, a condition that leads to lower back pain. It wasn’t just a minor discomfort; it was an obstacle that threatened to put an end to his career.
Spondylolysis is a stress fracture in the vertebrae, and for an elite swimmer like Michael, it was a daunting diagnosis. Not only did this condition hamper his performance, but it also cast a shadow on his future in the pool. It started as a mild ache but escalated to a level that limited his ability to perform at the highest level.
Spondylolysis is characterized by inability to backward bend without pain. Consider the fact that every swimming stroke causes some degree of backward bending, especially butterfly. Then, consider the fact that Michael was known for his dominance in the butterfly events. Those two pieces of information can help you see how troublesome this back injury could be to Michael.
Before we dive into the McKenzie Method, let’s clarify what flexion and extension mean in terms of lower back movements.
1. Flexion: This involves bending forward, such as when you’re hunching over or touching your toes. Think of the typical curling forward motion.
2. Extension: On the contrary, extension means arching your back backward. It’s the motion when you lean back, similar to looking up at the sky.
Robin McKenzie, a pioneer in physical therapy, developed the McKenzie Method. It’s based on the idea that certain movements can either alleviate or worsen lower back pain, depending on your specific condition. Here’s a simplified version of how you can use this method to find relief:
1. Self-assessment: Begin by paying attention to how different movements affect your back pain. When you gently move your spine, do you feel relief, or does it worsen? For most individuals, leaning backward (extension) tends to offer more relief.
2. Directional Preference: McKenzie introduced the concept of “directional preference.” This means that for some people, extension-based movements might alleviate their pain (their preferred direction), while for others, it’s flexion-based movements. You want to identify the motion that your back prefers.
3. Exercises: Once you identify your directional preference, you can perform exercises that emphasize that movement. For example, if extension provides relief, try exercises like prone press-ups, where you lie on your stomach and push your upper body up while keeping your pelvis on the ground.
4. Gradual Progression: Consistency is key. Start with gentle exercises and gradually increase the intensity as your back pain improves.
5. Consult a Professional: While self-assessment and exercises are valuable, it’s always a good idea to consult with a licensed physical therapist, who can provide personalized guidance and ensure you’re on the right track.
“I don’t want to be specific, other than to say it is my back. I’d just like to get home and see my physical therapist and my doctor.”
-Michael Phelps in The Baltimore Sun Oct 9, 2004
Here’s a simple test you can do at home to determine whether flexion or extension might be your directional preference:
1. Begin by sitting in a firm chair.
2. Gently lean forward, attempting to touch your toes. Notice how this motion affects your lower back pain. Does it provide relief or worsen the pain?
3. Now, sit up straight and gently lean backward, arching your lower back. Again, pay attention to how your back responds.
If leaning backward provides relief, you may have an extension-based directional preference. If leaning forward feels better, you might have a flexion-based preference. Remember, this is a simplified self-assessment and doesn’t replace professional advice.
Let’s break down how “flip-turns,” often used in swimming, can worsen forward-bending or flexion-related back problems compared to the way butterfly and dolphin kicking can exacerbate issues associated with backward bending or extension in the back.
1. Forward Bending Motion: A flip-turn, a critical component of swimming, involves transitioning from a streamlined, horizontal position to a curled, ball-like one while executing a somersault-like motion. This action typically includes a forward bend at the waist.
2. Flexion Stress: This forward bending or flexion can place significant stress on the lower back, particularly on the lumbar spine. Individuals with pre-existing issues related to flexion, such as herniated discs or muscle strains, may find flip-turns to be uncomfortable or even painful.
3. Repetitive Nature: Swimming involves numerous flip-turns during a training session or race, which means that those with forward bending back issues may experience repetitive stress on their already sensitive lower back.
1. Backward Bending Motion: In contrast, butterfly and dolphin kicks in swimming involve a significant backward bending or extension of the spine, particularly in the lumbar region.
2. Extension Stress: This extension motion places a different type of stress on the back. Individuals with pre-existing issues related to extension, such as spondylosis or spondylolisthesis or facet joint problems, may find these kicking motions uncomfortable or painful.
3. Repetitive Stress: Just like with flip-turns, butterfly and dolphin kicking are integral to competitive swimming. Swimmers with backward bending back problems may face repetitive stress during training and competition.
In summary, the key difference lies in the direction of the motion and the specific stresses imposed on the back. Flip-turns, with their forward bending nature, can potentially worsen problems associated with flexion, while butterfly and dolphin kicks, with their backward bending or extension, can aggravate issues related to extension in the back.
It’s crucial for swimmers, especially those with pre-existing back problems, to work closely with physical therapists or experts who can help them adapt their swimming techniques and training routines to minimize the impact on their specific back issues. Proper training and modifications can help individuals continue to enjoy the sport while safeguarding their back health.
Over time, Michael began to witness improvements. He was no longer held back by the pain, and his performance was slowly but steadily getting back on track. It wasn’t an overnight success, but Michael’s story demonstrates the power of persistence and dedication. It’s a story that reminds us that even Olympic champions face challenges and, with the right approach, overcome them. Just like Michael, you too can find your way back to the water you love, free from the limitations of back pain, and continue your swimming journey with renewed vigor and confidence.
Understanding the principles of the McKenzie Method and identifying your directional preference can be a valuable step in managing lower back pain. Whether you’re a dedicated triathlete or swimmer, the key is to listen to your body, consult a professional, and work on the preferred movement pattern to relieve your back pain. Consistency and patience are your allies on the path to recovery.
If you have questions about your back pain, contact the team at Lifestrength Physical Therapy to learn how to get back to doing what you love!
Public Disclosure of Michael Phelps’ injury:
Following the 2004 Olympics, Phelps was diagnosed with spondylolysis of the back which echoed back to his sister’s injury: “I tried not to think that my career might end prematurely, as hers did, but of course it entered my mind”
(Phelps & Cazeneuve, In: Beneath the Surface: My Story, 2012, p. 231)
One Response
Hi Scott,
Interesting read on back pain. Hope you enjoyed this summer like fall wkd! Lee and I are headed home from OC We biked every day! Take care.
Jodi and Lee