Here is a great Z Health email I got the other day from a local trainer
I just got done doing (KB) snatches today and the 32kg's are just flying up! Unbelievable how much more power I have now that my glutes and hammies are actually working properly. My back is feeling great and I also did arm bars and gained mobility in my shoulders and hips too.
Mobility, even in the lumbar region?
Yep, I am talking about LUMBAR FLEXION and EXTENSION. Holy crap, I just suggested that you should move your low back and for some of you (not the readers of this blog--way too bright for that) are thinking that I have lost my friggin’ mind now and confirmed that really am out on a weekend pass from the funny farm.
Here is why I believe you should move your lumbar spine.
Now, one of the rules of the Z Health system is that you never move into pain, but pain free movement is good! Maybe this means you need to move slower, cut the range of motion or in extreme cases cut the loading (work in a pool for example). Either way, the body was designed for movement.
This is the direct opposite to anything else. If you built a bridge and stuck it in a vacuum, it would last forever. Shoot someone up into space, confine them to bed rest, or severe the nerve supply to muscles and they will atrophy like crazy. Countless studies show that one of the WORST things is space flight (due to zero gravity and the unloading effects) and bed rest!
What is normal?
There is a debate about what is considered a "normal" ROM (range of motion) for the lumbar (low back) area. Zigler, J et al. (15) stated, “a normal ROM at the implanted level (for L3–L4 and L4–L5 between 6° and 20°; for L5-S1 between 5° and 20°).
Herp et al (14) compiled a nice table or range of motion in degrees in 20-30 year old from 5 different studies. Click here for the study
Denoziere, G et al. (1) stated "The rotational mobility offered by the device is limited to 12° in flexion, extension, lateral bending and is not limited in axial rotation.” This study was done to investigate the normal ROM for a computer model.
The take away is that none of them said ZERO for a
What else you got?
Zigler, J et al. (15) did just that in a prospective, randomized, multicenter (all good words for studies!) FDA (Food and Drug Administration) investigational device of a disc replacement versus fusion for the treatment of 1-level degenerative disc disease. So we have one case with some movement (artificial disc) and another case with no motion (fusion). Not the best since we have to jam this foreign object into someone’s back, but it is a start.
Keep in mind, that for this study what they define as “success”. “By the FDA definition in this study, ROM success required greater motion at 24 months than at preoperative baseline for investigational patients. Using this analysis, 89.5% of investigational patients were clinically successful." (15) We all know that it just not as simple as a ROM test 2 years later, but in the realm of this study, it is a “success”
Feipel et al. and others (2, 9-11) has shown a loss of proprioception in patients with chronic low-back pain, although not conclusive (5) I saved you a diatribe on each study, but some very fascinating stuff.
2) Mechano vs noci (what the hell is he talking about now?)
Onodera T et al (12) did a great study looking at the density and distribution of neural endings in rabbit lumbar facet joints after anterior spinal fusion and to evaluate the effects of intervertebral immobilization. The author states, “These results suggest that immobilization of the intervertebral segment causes a reduction in the number of mechanoreceptors in the facet joint capsules because of the reduction in mechanical stimulation. Moreover, in the upper adjacent facet joint there may be neural sprouting caused by nociceptive stimulation.” This is further evidence (in an animal model) that the body will remodel in a possibly negative way to immobility. Is that really that far of a reach?
Johansson, H et al (3, 4) have found a close relationship between activation of joint mechanoreceptor and stimulation of the gamma efferents (to sensitize the spindles) which results in increases in muscles "stiffness" and joint stability. Now the work of Johansson was done on knees, but the same principals probably apply.
So maybe our end result is more muscle “stiffness” but we need to TRAIN MOBILITY to get there?
Mc Lain, RF states (7) “Previous studies have suggested that protection muscular reflexes modulated by these types of mechanoreceptors are important in preventing joint instability and degeneration”
1. Denoziere G., D. N. Ku. Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc. J Biomech. 39(4):766-775, 2006.
2. Feipel V., C. Parent, P. M. Dugailly, E. Brassinne, P. Salvia, M. Rooze. Development of kinematics tests for the evaluation of lumbar proprioception and equilibration. Clin Biomech (Bristol, Avon). 18(7):612-618, 2003.
3. Johansson H., P. Sjolander, P. Sojka. Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng. 18(5):341-368, 1991.
4. Johansson H., P. Sjolander, P. Sojka. A sensory role for the cruciate ligaments. Clin Orthop Relat Res. (268)(268):161-178, 1991.
5. Koumantakis G. A., J. Winstanley, J. A. Oldham. Thoracolumbar proprioception in individuals with and without low back pain: intratester reliability, clinical applicability, and validity. J Orthop Sports Phys Ther. 32(7):327-335, 2002.
6. McLain R. F. Mechanoreceptor endings in human cervical facet joints. Spine. 19(5):495-501, 1994.
7. McLain R. F. Mechanoreceptor endings in human cervical facet joints. Iowa Orthop J. 13:149-154, 1993.
8. McLain R. F., J. G. Pickar. Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine. 23(2):168-173, 1998.
9. Newcomer K., E. R. Laskowski, B. Yu, J. C. Johnson, K. N. An. The effects of a lumbar support on repositioning error in subjects with low back pain. Arch Phys Med Rehabil. 82(7):906-910, 2001.
10. Newcomer K., E. R. Laskowski, B. Yu, D. R. Larson, K. N. An. Repositioning error in low back pain. Comparing trunk repositioning error in subjects with chronic low back pain and control subjects. Spine. 25(2):245-250, 2000.
11. Newcomer K. L., E. R. Laskowski, B. Yu, J. C. Johnson, K. N. An. Differences in repositioning error among patients with low back pain compared with control subjects. Spine. 25(19):2488-2493, 2000.
12. Onodera T., Y. Shirai, M. Miyamoto, Y. Genbun. Effects of anterior lumbar spinal fusion on the distribution of nerve endings and mechanoreceptors in the rabbit facet joint: quantitative histological analysis. J Orthop Sci. 8(4):567-576, 2003.
13. Roberts S., S. M. Eisenstein, J. Menage, E. H. Evans, I. K. Ashton. Mechanoreceptors in intervertebral discs. Morphology, distribution, and neuropeptides. Spine. 20(24):2645-2651, 1995.
14. Van Herp G., P. Rowe, P. Salter, J. P. Paul. Three-dimensional lumbar spinal kinematics: a study of range of movement in 100 healthy subjects aged 20 to 60+ years. Rheumatology (Oxford). 39(12):1337-1340, 2000.
15. Zigler J., R. Delamarter, J. M. Spivak, et al. Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine. 32(11):1155-62; discussion 1163, 2007.