There have been
estimations stating that 80% of Americans will
experience back pain some time in their life1(Web MD, Mayo Clinic). Choosing an
appropriate therapeutic, corrective exercise to address back
pain can be quite the conundrum. One of the many goals in
addressing back pain with movement is not only to modulate the
pain, but to keep the pain at bay during functional
activities. Of the many therapeutic exercises available to
address back pain, preserving functionality can be a
challenge. Correction during specific and isolated movements is
more easily achieved than it is maintained during an actual
functional performance.
As therapeutic relief and
maintaining correct movement are central goals in movement
based therapy, an ideal exercise for a back program would be
that which both relieves pain and prevents further injury by
fortifying functional spine mechanics. Kettlebells have recently
garnished considerable attention in the world of Physical
Rehabilitation. Despite the kettlebell being nothing more than a cast
iron wrecking ball with a handle on top, there have been studies
exploring kettlebell exercise for lower extremity sports
rehabilitation2, musculoskeletal health3, and
cardiovascular exercise response4, 5.
Kettlebells offer a wide
array of advantages as a therapeutic exercise. Outlined in my
previous article, “Kettlebell Therapy: Restoring Movement with
Natural Physics”,
I discussed several advantages from the perspective of physics and
movement science. Applying these advantages specifically for the
concern of back pain, I suggest three specific attributes which are
of essential benefit to a therapeutic back program.
A therapeutic back
program should be corrective, dynamic, and functional:
Corrective:
Ballistic kettlebell exercises (ie. the kettlebell swing) offer the
benefit of working with natural physics which demand correct spine
mechanics to be maintained throughout exercise. When properly
taught, ballistic kettlebell exercise is self limiting when it comes
to compensatory strategies; if correct mechanics are not used,
fatigue typically sets in and exercise is terminated. Sometimes, the
kettlebell is simply dropped because substitute muscle movements
(such as deltoid based shoulder flexion) are too weak to truly swing
a kettlebell in comparison to the unified functional body. The
progression of learning the kettlebell swing consistently reinforces
proper spine mechanics during lifting and body movement which
prevents aggravation due to improper body mechanics.
Dynamic: In the many
cases of back pain which respond positively to exercise, the concern
of pain is not necessarily present when the body stays still. There
is a considerable majority of back pain elicited and alleviated
during movement (ie. McKenzie Method® - Mechanical
Diagnosis and Therapy®). In this light, it is important to address
this particular dimension of therapeutic exercise; if pain comes or
goes with movement, then the therapy should incorporate dynamic
exercises versus relatively static exercise of which the body
already perceives as an innocuous and acceptable state.
Functional:
Everything works like a kettlebell. In terms of the physical forces
applied to and experienced by our body during functional movement,
gravity bound free-body-objects all act like a kettlebell (an object
with a handle on the top where the hand holds the object against
gravity). Exercise not done in similar physics to the activity
anticipated does not always reap the benefit of improved function
and pain relief. It is ultimately the best scenario if one can
strengthen in the physical parameters most similar to the desired
activity during function.
Recently, a study
published by the Journal of Strength and Conditioning presented an
interesting reverse shearing component seen during the kettlebell
swing. The study noted a “posterior shear of
the L4 vertebra on L5, which is opposite in polarity to a traditional
lift” of which they stated “provides an insight into why many
individuals credit kettlebell swings with restoring and enhancing
back health and function6”.
The insight from my Bioengineering background would suggest that the
ballistic nature of the kettlebell swings allows for a more natural
co-activation of spinal musculature in kinetic chains which allow the
body the work together more effectively than the linear physics as
seen in traditional lifting exercises. While both exercises are
functional, dynamic, and even offer corrective benefits; the distinct
elemental difference in physics between the two proves a fundamental
advantage to the kettlebell.
A suggested progression
to the kettlebell swing begins with the Functional Wall Squat to
screen and correct proper squatting and thus swinging mechanics.
Once the progression is
in full swing (sorry for the pun)…
Move onto one handed
swings to gain counter-rotational stabilization training. This
ultimately yields high carryover potential to functional activities
as most functional activities are asymmetric in nature. After a bout
of ballistic kettlebell exercise(s), it is wise to stretch the hip
flexors, the hamstrings, and to initiate a short preventive bout of
prone press ups in the unlikely event that spinal flexion occurred
during exercise.
While prescribing a
progression of one handed kettlebell swings may seem like an over
simplification of a program for back pain, I humbly refer you to a
former patient who has experienced the therapeutic effects of
Kettlebell Therapy™ and was kind enough to make a video
testimonial. For this particular patient, I exclusively prescribed
kettlebell exercises to aide in his recovery.
In closing, I leave you
with the encouragement to experience kettlebells for yourself and
perhaps claim them as good practice for an ironclad spine.
2.
Brumitt et al. Incorporating kettlebells into a lower extremity
sports rehabilitation program. N Am J Sports Phys Ther. 2010
Dec;5(4):257-65.
3.
Jay et al. Kettlebell training for musculoskeletal and cardiovascular
health: a randomized controlled trial. Scand J Work Environ Health.
2011 May;37(3):196-203. doi: 10.5271/sjweh.3136. Epub 2010 Nov 25.
4.
Fung B, Shore S. Aerobic and Anaerobic Work During Kettlebell
Exercise: A Pilot Study. Medicine and Science in Sports and Exercise,
Volume 42:5 Supplement: S588-S589. June 2010.
5.
Farrar RE et al. Oxygen cost of kettlebell swings. J Strength Cond
Res. 2010 Apr;24(4):1034-6.
6.
McGill et al. Kettlebell Swing, Snatch, and Bottoms-Up Carry: Back
and Hip Muscle Activation, Motion, and Low Back Loads. Journal of
Strength & Conditioning Research:
