PT Classroom - Swinging Away Back Pain ׀ by Ben Fung, PT, DPT

There have been estimations stating that 80% of Americans will experience back pain some time in their life (Web MD, Mayo Clinic) (1). 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 rehabilitation (2), musculoskeletal health (3), and cardiovascular exercise response (4, 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:

1. 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.

2. 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.

3. 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.

For more on the Functional Wall Squat, please see my post, “Breaking Down The Functional Wall Squat.”

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.

Last revised: Aapril 1, 2012
by Ben Fung, PT, DPT

References
1) Web MD. http://www.webmd.com/back-pain/default.htm
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:
January 2012 - Volume 26 - Issue 1 - pp 16-27 doi: 10.1519/JSC.0b013e31823a4063