作者：Dave Lasnier
原文連結：https://jennirawlingsblog.com/blog/everything-i-thought-i-knew-about-low-back-pain-was-wrong
Jenni對Dave戴夫這篇文章做的簡介：
我非常高興能分享 Dave Lasnier 為我的部落格撰寫的文章，他是一位我非常欣賞的私人教練！ 我認為他這篇關於下背痛、動作和運動的個人故事，對我們的瑜伽社群來說，是一個有幫助且有趣的故事，當他同意為我們寫下他的經歷時，我感到非常興奮！
對我來說，Dave 的故事很重要，因為這是身體對持續性疼痛狀況時，在“訓練、暴露（expose）”和“避免、保護 (protection)”中，找到適當平衡的一個例子。
“「訓練、暴露」與「避免、保護」”的辯論，是當今康復和運動領域的熱門話題，有些人認為，通過避免負重來保護疼痛區域，對恢復至關重要，而另一些人則認為透過讓疼痛區域訓練，暴露在負重的狀態下，讓它適應並提高其能力是恢復的關鍵。
我也認為Dave 的故事很有價值，因為它允許讓我們的信念和偏見受到挑戰，而這通常會導致非常積極轉變的範例。 非常感謝你花時間把你的故事寫下來，這樣我們就能從閱讀中受益，Dave！
—Jenni
Introduction from Jenni:
I’m more than excited to share this fantastic piece that I asked Dave Lasnier, a personal trainer whose work I admire a lot, to write for my blog! I thought his personal story about debilitating low back pain, movement, and exercise would be a helpful and inherently interesting one for our yoga community to learn from, and I was thrilled when he agreed to write about his experience for us!
To me, Dave’s story is important because it’s an example of finding that right balance between “exposing” and “protecting” the body in response to a persistent pain condition. The “expose vs. protect” debate is a hot topic in the rehab and movement worlds these days, with some people arguing that protecting the painful area by avoiding loading it is crucial for recovery, while others argue that exposing the painful area to load so that it adapts and increases its capacity is key for recovery.
I also think Dave’s story is valuable because it’s an example of how allowing our beliefs and biases to be challenged can often lead to very positive paradigm shifts. Thank you so much for taking the time to put your story down on paper so we can benefit from reading it, Dave!
––Jenni
如今，下背痛非常普遍。 世界衛生組織指出，工業化國家 60% 至 70% 的人口在他們一生中的某個時刻，都曾經歷過下背痛。 這很瘋狂！ 在我生命的前 30 年裡，我的下背從未出現任何問題。實際上，在我年輕的時候，脊椎按摩師告訴我，我的背部似乎比我父親的強壯得多，我父親在我成長過程中也有相當多的背部問題。 但有一天，事情發生了變化......
在大學時，我學習了肌肉動力學（運動科學），因為我對健康、健身和運動表現充滿熱情，並希望將其作為職業。 上大學對我來說有點掙扎，我很容易對課堂失去興趣，因為我經常覺得課程沒有涵蓋我真正感興趣的話題。然而，我畢業後，開始閱讀和學習的時間，比大學時要多得多！ 我終於可以深入研究我真正感興趣的話題了，下背痛就是其中之一。 不是因為我當時下背有任何問題，而是因為我知道它影響了很多人。
Stuart McGill 博士是下背痛領域的領先研究人員之一，在我職業生涯的早期，就引起了我的注意。 我開始閱讀他的書，研究他的方法，並應用他所教授的概念。 如果你不熟悉他的下背研究工作，Stuart大部分工作圍繞著使用“中立脊柱”的方法來移動、鍛煉和舉重。 我認為我那時候，是在做正確的事情，我開始將他的想法應用於我自己的訓練和我的客戶。 我一直在完善我的腹部支撐技術(bracing)，以在舉重時保持脊柱和核心的固定，並進行各種核心練習，挑戰核心和脊柱處於中立位置。
以下是我經常做的兩個中立脊柱練習的例子：
Low back pain is so common these days. The World Health Organization states that between 60 and 70% of the population in industrialized countries will suffer from back pain at one point or another in their life. That is crazy! For the first 30 years of my life, I never had any issues with my low back. I was actually told by a chiropractor as a young adult that my back seemed much stronger than my dad’s, who had his fair share of back problems when I was growing up. But one day, things changed....
In college, I studied kinesiology (exercise science) because I was passionate about health, fitness, and performance and wanted to make it a career. Going through college was a little bit of a struggle for me. I easily lost interest in class as I often felt like we weren’t covering the topics I was actually interested in. After I graduated, however, I started reading and studying significantly more than I did while in college! I could finally dive into the topics that I was really interested in. Low back pain was one of them. Not because I had any problems with it at the time, but because I knew it was affecting so many people.
Dr. Stuart McGill, one of the leading researchers on low back pain, was brought to my attention early on in my career. I started reading his books, studying his methods, and applying the concepts he was teaching. If you’re not familiar with his work, most of it revolves around using a “neutral spine” approach to move, exercise, and lift weights. Thinking I was doing the right thing, I started applying his ideas to my own training and with my personal training clients. I was continually perfecting my bracing technique to keep my spine and core rigid when lifting weights, as well as performing all sorts of core exercises that would challenge the core and the spine in a neutral position.
Here are two examples of neutral spine exercises I commonly did:
疼痛的開始
一開始我的訓練很順利，我變得更強壯了，而且我沒有背痛問題。 我做的一切都是所謂“正確的”，而且效果很好…… 直到有一天它不再是了。 我無法確定我的下背部問題開始出現的確切時間，但那是在 2011 年左右。有一次我的下背部在硬舉訓練做的重量比我過去更重一些的那天，後面幾乎一個星期有很多的下背痠痛。
大約在同一時間，有幾次劇烈疼痛，發生在一些平常的動作，我“調整”我的背部動作時，一次彎腰在水槽上洗臉，另一次扭身從椅子上站起來。 每次疼痛都會在事件發生後的 24 小時內，升級到我幾乎無法正常工作的程度。 坐下，下車，彎腰，拿起雜貨袋，都會讓人覺得很痛苦。
疼痛會在接下來的一兩週內消退。 這些情節每年會發生 3-4 次。 中間的時間段沒有那麼痛苦，但大多數時候我會感到非常僵硬。 早上是最糟糕的，因為我的腰部非常僵硬，以至於連穿襪子都變得非常困難。 不用說，我的訓練進度和我努力訓練了 6-7 年的所有力量都在逐漸消退。
The Onset of Pain
My training was going well, I was getting stronger, and I wasn’t having any issues with back pain. I was doing everything “right,” and it was working…. until one day it wasn’t anymore. I can’t pinpoint the exact moment when my low back problems started, but it was around 2011. One time my low back got excessively sore for almost a week after a deadlift session where I pushed the weights a little further than I should’ve that day.
Around the same time, there were a few episodes of intense pain where I “tweaked” my back doing the most mundane things – one time bending over the sink to wash my face, and another twisting to get out of a chair. Each time, the pain would escalate within a 24-hour period after the incident to a point where I could barely function. Sitting down, getting out of a car, bending forward, and picking up grocery bags would all feel excruciating.
The pain would then subside over the following week or two. Those episodes would happen 3-4 times per year. The time periods in between weren’t as painful, but I would feel very stiff most of the time. The mornings were the worst, as my low back was so stiff that even putting my socks on became pretty challenging. Needless to say that my training progress and all the strength I had worked so hard on for 6-7 years were whittling away.
尋求解脫背痛
我決定加倍掌握有關下背痛和脊柱中立方法的知識。 我增加了我正在做的核心訓練量，並且我特別注意我在健身之外的其他姿勢。 我甚至尋求其他教練、物理治療師和脊椎按摩師，來幫助我緩解疼痛并解決我的失衡問題，但似乎沒有任何效果。
我最終在 2014 年左右，接受了 X 光檢查和核磁共振檢查，並諮詢了一位骨科醫生。我發現我的 L5 椎骨兩側都有一個過去的骨折，沒有正確癒合，稱為過去的骨折是因為它沒有被診斷出受傷的時間。 直到今天，我都不知道這是怎麼發生的。
我對嚴重跌倒或意外事故沒有任何記憶，有人告訴我這種類型的傷害是如何發生的。 醫生說，除了控制我的症狀外，當時沒有什麼可以做的。 融合手術是唯一的另一種選擇，但在我這個年齡不推薦這樣做，因為手術會嚴重喪失活動能力。
確切地知道問題是什麼讓我鬆了一口氣，但我同時也感到沮喪，我很想知道我還能做什麼。 清楚我的現況後，我開始更加在乎我正在做的鍛煉類型和我在健身房外參加的活動，但我仍然感覺沒有任何改善。
In Search of Relief
I decided to double down on the knowledge I had about low back pain and the neutral spine approach. I increased the amount of core work I was doing, and I paid special attention to the positions I was adopting outside the weight room. I even sought out fellow coaches, physical therapists, and chiropractors to help with my pain and to work on my imbalances. Nothing seemed to work.
I ended up getting an X-ray and an MRI and consulted with an orthopedic doctor around 2014. I discovered that I had an old fracture on both sides of my L5 vertebra that hadn’t healed properly because it hadn’t been diagnosed at the time of injury. To this day, I have no idea how that happened; I have no memory of a severe fall or accident, which I was told is how that type of injury happens. Doctors said there wasn’t really anything that could be done at that point, other than managing my symptoms. Fusion surgery was the only other option, which they weren’t recommending at my age, as there is a significant loss of mobility that comes with the surgery.
There was a little bit of relief in knowing exactly what the problem was, but I was also feeling discouraged wondering what else I could do. Having a better perspective on what my situation was, I started being even more careful about the type of workouts I was doing and the activities I was partaking in outside the gym, but I was still feeling no improvements.
轉捩點
2016 年，我聽到了前體操國家隊教練Christopher Sommer的播客。 在採訪中，薩默教練談到了他的訓練理念，更具體地說，是他降低受傷風險和康復的方法。 他專門研究下背部問題，以及他認為過去處理這種類型傷害的標準方法是荒謬的。 他甚至對Stuart McGill 麥吉爾博士進行了一些研究，指出了他研究的局限性。
不用說，我對他的評論和他對這個話題的強烈不同的看法感到震驚。 然而，很難不同意他所說的任何事情。 一切都是合乎邏輯的，他的解釋中也都顯得非常合理。 他的論點圍繞這樣一個事實，也就是：我們的脊椎需要在體育運動和日常生活中以各種方式移動。 出於這個原因，他相信以這種方式訓練脊柱並在各種位置挑戰它。
經過一些反思並意識到在過去的 3-4 年裡，我目前治療背痛的方法毫無進展，我覺得有必要嘗試 Sommer 薩默教練的方法。 他有一個名為 Gymnastic Bodies 的線上培訓系統，我決定註冊。 畢竟，那時我沒什麼好失去的？
這個計劃以柔軟度、自身重量的運動和全方位的運動強化練習為中心。 沒有涉及翻轉或雜技，只是在各種姿勢下加強身體的方法。 起初，我很高興嘗試一些與我習慣的完全不同的東西，並挑戰我目前的信念。 但同時，我有點猶豫要不要開始讓我的背，以這些我不曾做過且“奇怪”的方式移動—這些是我以前認為是禁區的方式。 有一點擔心我會讓事情變得更糟。 在過去的 8 年裡，我一直相信脊椎應該不惜一切代價保持中立，但這些方法顛覆我過去的認知！
以下是我使用過的脊柱全方位範圍運動練習的兩個範例：
當我以這種方式改變訓練和加強背部的方法時，事情開始發生變化。 我的背痛並沒有突然消失，但我開始注意到好轉的跡象。 比起過去在訓練後覺得背部僵硬，我的背部在這種類型的鍛煉後實際上感覺更好和更放鬆， 隔天早上背部僵硬也開始減輕。
儘管有這些令人鼓舞的跡象，但我仍然非常謹慎。 我慢慢地做且非常放鬆地進入這些我的身體不熟悉的新練習和新姿勢。 通過這次新的冒險，我一直在傾聽我的身體和腰部的聲音，尤其是。 事情持續的改善。 我對自己所取得的進步和日常生活中的自由感到非常興奮。 你不知道在努力完成這項簡單的任務幾年後，能夠在早上毫不費力地穿上襪子的感覺有多棒！ 太奇妙了！
在經歷了大約 5 年的使人衰弱的疼痛之後，現在已經連續 4 年沒有讓我的背部疼痛或因為使用這個新方法讓我背不能做事。 就在過去一年左右的時間裡，我甚至開始重新引入一些我曾經做過的更傳統的力量練習（例如，深蹲和硬舉），因為我的背部感覺好多了。 我訓練的主要重點仍然是柔軟度和全方位範圍的運動練習，我相信這對我保持健康和最佳功能的身體至關重要。
Turning Point
In 2016 I heard a podcast with coach Christopher Sommer, a former gymnastics national team coach. In the interview, Coach Sommer was talking about his training philosophy and more specifically his approach to reducing the risks of injury and rehabbing them. He delved into lower back problems specifically and how he thought the standard approach to dealing with that type of injury was nonsensical. He even took a few digs at Dr. McGill, pointing out the limitations of his research.
Needless to say, I was taken aback by his comments and the strong views he had on the topic. It was hard to disagree with anything he was saying, however; everything was logical and everything made sense in his explanations. His argument revolved around the fact that our spine is required to move in all sorts of ways in athletics, as well as in everyday life. For that reason, he believed in training the spine that way and challenging it in various positions.
After some reflection and realizing I had made zero progress with my current approach to treat my back pain over the past 3-4 years, I felt compelled to try Coach Sommer’s methods. He had an online training system called Gymnastic Bodies, which I decided to sign up for. After all, what did I have to lose at that point?
The program was centered on flexibility, bodyweight movements, and full range of motion strengthening exercises. There were no flips or acrobatics involved, just ways to strengthen your body in a variety of positions. At first, I was excited to try something so completely different from what I was used to and something that challenged my current beliefs. At the same time, I was a little hesitant to start moving my back in all these “weird” ways I wasn’t used to – ways I’d previously considered off limits. There was a little bit of fear that I could make things worse. I had believed for the previous 8 years that the spine was meant to stay neutral at all costs, so this was quite the paradigm shift!
Here are two examples of spinal full range of motion exercises I worked with:
When I shifted my approach to training and strengthening my back this way is precisely when things started to change. My back pain didn’t suddenly disappear, but I was starting to notice signs of improvement. The first one was how my back actually felt better and looser after that type of workout, rather than tighter, which is what I was used to after working out. Then the morning stiffness began to lessen.
Despite these encouraging signs, I was still very cautious. I was taking things slowly and really easing my way into these new exercises and new positions my body wasn’t familiar with. Through this new adventure, I was always listening to my body and my lower back, especially. Things just kept improving and improving. I was getting very excited about the progress I was making and the freedom I now had in my everyday life. You have no idea how great it feels to be able to effortlessly put your socks on in the morning after struggling to perform that simple task for a few years! It’s amazing!
After about 5 years of debilitating pain, it’s now been 4 years straight without hurting my back or having incapacitating back pain using this new approach. Just in the past year or so, I even started re-introducing some of the more traditional strength exercises I used to do (e.g., squats and deadlifts) because my back feels that much better. The main focus of my training remains around flexibility and full range of motion exercises, which I believe are key for me to maintain a healthy and optimally functioning body.
學到的教訓
如果我現在說我的背完全沒有問題，那我就是在撒謊。 每隔一段時間，如果我在同一個姿勢停留太久，我會在早上感到有點僵硬。 但是，我可以說我的腰背問題已經減少了 90-95%。 與我以前的經歷相比，剩下的一點點是微不足道的。 它不再影響我的日常生活。 也不會限制我做什麼。
這是一段面對下背痛的旅程。 儘管處理起來既困難又無能為力，我實際上很感激它發生了。 這聽起來可能很奇怪，但當我回顧我的旅程時，沒有其他方式可以看待它，而是感激。
背痛並不有趣，但它教會了我很多。 它教會了我韌性、恢復力（Resiliency）。 一直以來，我過去都拒絕接受現狀，我始終相信可以做些什麼來變得更好。
它讓我對訓練和鍛煉有了全新的認識。 我過去堅信我以前所認為的準則教條，是進行訓練和鍛煉的最佳方式。而這次經驗打破我過去對下背痛的信念，也讓我學到新的知識。
作為教練/訓練師，我現在可以將許多新概念應用到我訓練人們的方式中。 實際上我已經透過使用這些讓自己恢復的方式和概念，成功的幫助了許多人， 如果我當初我沒有處理自己腰背痛的問題，我今天就不會成為一名出色的教練/訓練師。
最後，這教會了我謙虛，教會了我，我並不總是有答案，保持開放的心態非常重要。
Lessons Learned
I’d be lying if I were to say I have zero issues now. Every once in a while, I get a little bit of stiffness in the morning or after spending too much time in the same position. However, I can say that my low back problems have gone down 90-95%. The little bit that’s left is so minor compared to what I used to experience. It doesn’t affect my everyday life anymore. It doesn’t limit what I can do.
It’s been quite the journey dealing with low back pain. As difficult and incapacitating as it was to deal with, I’m actually grateful it happened. That might sound weird to say, but when I look at my journey, there’s no other way to look at it.
Back pain is no fun, but it’s taught me a lot. It taught me resilience. The whole time, I was refusing to accept the status quo, and I always believed there was something that could be done to get better.
It’s opened my eyes to a whole new perspective on training and working out. I had strong beliefs about what I thought was the best way to approach training and working out. Those beliefs got shattered with my experience with low back pain and the new things I learned.
As a coach/trainer, I can now apply so many new concepts to the way I train people. I have actually had a lot of success helping people feel better using many of the same concepts I used to rehabilitate myself. I wouldn’t be nearly as good of a coach/trainer today if I hadn’t had to deal with this issue.
Finally, it’s taught me humility. It’s taught me that I don’t always have the answers, and that keeping an open mind is so important.
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