Bracing Muscles: Misunderstood, Even at the Highest Levels


The BRACING Series: No. 6

By Sean M. Wheeler, M.D.

Screen Shot 2017 10 04 at 10.13.39 PMIn this series, we're going deep into the theory of bracing muscles and their role in body stabilization, and in doing so we've departed from the received wisdom of the scientific community, which has a poor (though developing) understanding of back pain.  I wrote my book, UPRISE, to push this community into new paradigms of thinking so that together we can cure chronic back pain.  This blog aims to not only explain the thought shift introduced in the book but to expand upon it as the hypothesis evolves into new territory.

One example would be the idea of "Bracing Deficiency" described in articles four and five of this series, which moves beyond the central themes of Uprise to give the condition more specificity and, finally, a name.  Theories such as this one and the proprioception theory of back pain (to be discussed in this space in the coming weeks) are meant to do what theories throughout the history of science have done: lead to more research.  If no theory is introduced, then there can be no wave of research activity in its wake to prove or disprove that theory.

In the absence of a theoretical underpinning, deciphering the results of completed research can sometimes lead to suspect interpretations of the data.  Take, for example, the study released in the December 2016 issue of the scientific journal, Spine.  In it, researchers evaluated the influence of weightlessness on muscular fitness by studying six astronauts stationed for six months at the International Space Station (ISS).  The astronauts underwent three MRIs of the spine: one prior to their trip (an average of 214 days prior), followed by an "immediate" MRI within two days of their return, and a third MRI more than thirty days later (on average, 46 days).  They did strength training on the ISS using a resistance exercise device to simulate the action of squats, deadlifts, bench/shoulder presses and rowing to keep large muscle groups strong.  After their return, they were given cardio, resistive weight training, and functional exercises focused on balance, proprioception, agility, coordination, and power.

Researchers found the astronauts' deep muscles in the spine decreased in size by an average of 14% from the first MRI to the second and that after six weeks of post-trip training those muscles were still on average 5% smaller than pre-trip.  The conclusion, as reported by Gizmodo, was a show stopper: extended space travel could cause irreversible back damage.  The analysis was widely reported, no doubt leading some mothers to announce to their kids, "Well, you're not going to be an astronaut!"

This conclusion indicates that even those at the highest levels of science (NASA) don't understand how the back works.  The astronauts were able to maintain the strength of larger muscles through simulated resistance training while in space, but the smaller bracing muscles responsible for stabilizing their spines atrophied due to their state of weightlessness, in which the bracing muscles were never obliged to fire.  Upon their return, the rehabilitation of the astronauts (and this applies as well to non-astronauts who have a major surgery, pregnancy or an extended period of inactivity) should have been guided by two fundamental principles of bracing muscle theory: one, that the body will naturally compensate for weak bracing muscles in the spine by engaging the hamstrings to take over the role; and two, that bracing muscles are endurance muscles which take far longer than six weeks to return to form (six months is more like it).  The rehab needed to encourage stabilization that minimized the use of the hamstrings and needed to continue for longer.  In this case, the third MRI was done much too early to have any real diagnostic value.  Ultimately, this lack of understanding may explain why astronauts are four times more likely than the rest of us to have a lumbar disc herniation.

NASA, if you are reading this, give me a call

We have much to discuss.


Sep 28 2017