The Right Chemistry: Intense back pain led me from outer space to the inside of a cell

My knowledge of anatomy is rather limited, so I wasn’t too surprised that I had never heard of the “multifidus” muscles that line the spinal column and have the task of supporting movement of the vertebrae. Neither had I heard of the “transversus abdominis” muscles in the abdomen that act as a natural corset, stabilizing the lumbar spine.

I now know that weakness of these muscles is associated with low back pain, something I learned the hard way. It was such pain that introduced me to these muscles and started me on a journey that meandered from outer space to the inside of a cell.

But let’s start at the beginning.

It was just an innocent little move. I turned to put a file down on a chair and felt a little twinge in my lower back. I didn’t think much of it, but by evening my back was getting sore and by the next day, the pain was excruciating and shooting down my right leg. Walking was almost impossible. An MRI showed a herniated disk and I was assured that with time the pain would resolve. I turned to AI to see what I could do about the hellish pain. And that is how I encountered the problems faced by astronauts who return to Earth after having spent months on the International Space Station.

When circling the globe at 28,000 kilometres per hour, the pull of gravity is balanced by centrifugal force generated by the forward velocity. As a result, astronauts experience the phenomenon of weightlessness — essentially a continuous free fall. Since muscles do not have to work against the pull of gravity, they shrink.

A study of astronauts who had spent six months on the International Space Station (ISS) revealed that the multifidus shrank by 10 per cent and the transversus abdominis by 34 per cent. That explains why many astronauts report back pain during space flight and complain of it lingering even after the mission. When astronauts feel pain, NASA scientists swing into action. Needless to say, astronauts have to be in great physical shape and follow a rigorous training regimen. However, scientists found that weightlifting and resistance training that can pump up the biceps and abdominal muscles do not strengthen the muscles that support the spine. These require what has been called “low intensity continuous activation exercise,” or LICA).

The exercise regimens that astronauts follow in space to prevent backaches have been adapted for Earthlings who suffer from the same problem. Some of these, like the “bird dog,” “side plank,” “pelvic tilt” and “dead bug” are familiar to anyone who has been directed to a physiotherapist. But it turns out that of equal importance are low effort movements that keep muscles gently active all day. Scouring the scientific literature reveals that low intensity movements throughout the day are not only important for the back, but for general health as well.

The expression “sitting is the new smoking” has been making the rounds. While a bit extreme, there actually is some substance here. It turns out that being sedentary is an independent risk factor for cardiovascular disease and diabetes. The risk is there even if one goes to the gym for an hour every day as long as the rest of the day is spent sitting. What, then, is the low intensity exercise that those of us who sit most of the day should focus on? Not that difficult. Standing up and down a few times every 15 minutes, taking a short walking break every hour, a longer one at lunchtime, standing up whenever talking on the phone and taking the stairs instead of the elevator. 

Low level muscle activity reduces post-meal blood sugar spikes, improves circulation, reduces inflammation and activates AMPK, an enzyme that senses when a cell is low on fuel and initiates an emergency response that involves sending a signal to stop energy-intensive building projects like protein synthesis and start “burning” glucose and fats for energy.

Aside from breaks from sitting, other activities that do not involve formal exercise are also important for health. These are often termed “non-exercise activity thermogenesis,” or N.E.A.T. This refers to the energy expended outside of exercise, such as walking, standing, gardening, cooking, cleaning, folding laundry and playing with the dog. One can exercise daily and still be unhealthy if N.E.A.T. is low, especially when it comes to obesity. We have long known that some people readily gain weight and others don’t. Why is that?

The clue came from a study at the Mayo Clinic in which volunteers were overfed by a thousand calories a day. Some gained significant weight while others gained very little. Those who stood more, walked more and fidgeted more, roughly for a total of two hours a day, burned up to 700 more calories. It seems that the calories one burns without trying may matter more than the ones burned on purpose. An hour at the gym does not make up for 10 hours of sitting.

Recent research indicates that our proteome, the assortment of proteins present in our body at a given time — numerous enzymes, hormones, immune factors and signaling agents — can also be influenced in a positive way by low intensity continuous exercise. Aging, for example, is associated with chronic low-grade inflammation that is reflected in specific proteins in blood plasma.

Low intensity continuous exercise has been shown to induce clinically meaningful changes in proteomics in older adults, and monitoring such changes has given rise to “proteomic clocks.” These estimate biological age by comparing an individual’s proteome with the average proteomic pattern of people at each age in a reference population such as the UK’s Biobank project, which has collected data from half a million people over decades.

A proteomic age greater than a person’s chronological age implies accelerated aging. If it is less than the chronological age, then there is slower aging. Looking at a proteomic clock can be useful when trying to determine if an “anti-aging regimen,” be it a dietary supplement,  pharmacological drug or an alteration in lifestyle, is delivering the goods.

Back to my back pain. After seven weeks, it is finally beginning to resolve. I’ve been doing the astronaut exercises religiously to try to prevent it from happening again, and I’ve just purchased a “walking pad” so I can watch TV without sitting for hours. Now I have to finish this column because it is time for me to get up and do my half-hourly knee-bends. I may even throw in a couple of “dead bugs” to strengthen my multifidus.

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Joe Schwarcz, Special to the Montreal Gazette

Joe Schwarcz is director of McGill University’s Office for Science & Society (mcgill.ca/oss). He hosts The Dr. Joe Show on CJAD Radio 800 AM every Sunday from 3 to 4 p.m.

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