It is estimated that about 80 percent of the population will suffer from low back pain at some point in their lives. The condition accounts for millions of dollars in medical expenses and lost work time and is often a perpetual misery for the sufferer. Recent evidence indicates that many cases of lower back pain can be permanently treated without medical intervention or drugs using exercise and flexibility. This article aims to provide some very basic information on LBP and offer helpful tips to individuals on dealing with the condition themselves.
What is Low Back Pain (LBP)?
LBP is a complex condition ? sometimes pain onset can be traced to a mechanical defect like a ruptured disc, while in other instances there may be no apparent cause or history of injury or trauma (for example, "tweaking your back" when bending over to pick a pencil off the floor). Growing evidence from Australia now indicates that the root cause of lower back pain may be linked to muscle imbalances and instability of the low back due to poor control of the core stabilizing muscles. Traditional methods of treating LBP often fail - being either ineffective or even worsening the condition, or providing only temporary relief. Why? The answer is simple: these treatments fail to identify and treat the muscle imbalances and low back instability leading to pain, leaving the person feeling desperate ? that the only resort is surgery.
What is the "core"?
The core is a complex of 29 muscles that act to stabilize the lower back, pelvis and hip. It is where the body's center of gravity is located and where all movement begins, since it acts as the "anchor" for nearly all the muscles in the body. The most important core muscle in terms of controlling and treating low back pain is called the transversus abdominis (TVA). This is the deepest of all the abdominal muscles and when working correctly, tightens like a corset ? bracing and stabilizing the lower back.
Studies show that in subjects without pain, the bracing of the TVA works in an unconscious, reflex action to stabilize the spine BEFORE body movement begins. However in subjects with pain, the TVA fails to work in this manner and allows for excessive movement of the spine, resulting in misalignment, altered mechanics, degeneration and pain. It is suggested that after the first incident of pain, the brain "forgets" how to activate the TVA in preparation for body movement - a possible explanation why people re-injure their backs while performing light, everyday tasks.
How do I "retrain" my transversus to stabilize my low back?
A sure fire way to relearn how to activate the TVA is to find a rehabilitation specialist familiar with the Australian approach of Spinal Segmental Stabilization. Some practitioners use ultrasound equipment to "visualize" the muscles of the abdominal wall in operation ? providing the patient with visual biofeedback. Other less sophisticated methods is to use a blood pressure cuff (pressure biofeedback) to monitor the movement of the low back during training.
If neither of the above services are available, the person can "self coach" him or herself using the following tips:
1. Lay flat on your back with your feet in contact with the floor and the knees bent to about 90 degrees or less (crook lying position)
2. Use the tips of your 2nd and 3rd finger of one hand to find either of the iliac crests (the top of the "wings" of the pelvis just below the level of the belly button)
3. Once you have found the bone, press quite deeply on the inner ridge with the finger tips
4. Now the difficult part: gently contract the pelvic floor muscles (concentrate hard and visualize one of these images to help you: imagine pinching the hip bones together, stopping urine flow mid-stream or pinching the anal sphincter)
Do not try stomach hollowing/ vacuums or the traditional Pilates tip of "pulling your navel to your spine" as this tends to activate the wrong muscles.
Now use the fingers of your other hand to prod the muscles of your front abdominals, side abdominals and glutes (butt muscles). If you sense ANY hardening of these muscles, feel like you are having to hold your breath or you are breathing extremely shallow, you are most likely activating the wrong muscles. Concentrate solely on the pelvic muscles using the image techniques mentioned. You should be able to have a conversation and still feel the gentle hardening of the TVA under your fingers with the other muscles remaining "soft". Hold the contraction for "sets" of ten repetitions starting as short as 10 seconds and progressing to periods as long as a minute, making sure not to activate the other muscles.
Practice and strengthen
If you can effectively isolate the TVA, attempt to incorporate it in a large variety of functional body positions such as standing, sitting and kneeling. Also, try holding the TVA during the day while driving in your car or standing in line at the grocery store. To increase the strength of the TVA, try holding the contraction while slowly moving the arms and legs in the crook lying position (dead bug exercises). Once you can do this successfully, move on to bridging in several different positions. Bridging or "planking" as it is commonly called are excellent exercises for improving the strength of the entire core. An example of a bridge is to prop yourself up on your elbows and toes from the face down lying position, making sure to hold the TVA and keeping a perfectly straight body from head to toe. Try performing planking in the prone (face down), supine (face up) and side lying positions.
Remember to stretch
It is also important to begin a regimented stretching routine to restore muscle balance to the body. It is particularly important to stretch tight muscles that may be affecting the alignment of the pelvis such as the hip flexors (groin muscles), low back and hamstrings. Although it may be very difficult initially, try stretching in the standing position with good posture and with as little external support as possible ? this allows you to train balance (core stability) and flexibility at the same time. Stretching in the lunge position with the spine held vertical is excellent for stretching the hip flexors. Standing on one leg and gently pulling one knee towards the chest while maintaining a straight spine will stretch the low back. To stretch the hamstrings, place a rope or a dressing gown cord under the ball of one foot and hold on to the ends. While standing on one leg, gently pull up and towards you with the rope or cord to elevate the opposite leg directly in front of you. It is very important to keep the leg straight, with no knee bend and your toes vertical or slightly angled towards you. Hold each stretch to the point of mild discomfort (no pain) for 20-30 seconds and repeat 2-3 times. Try stretching daily as your balance and flexibility will simultaneously improve.
In conclusion, it is hoped that this article has provided some helpful information to individuals suffering from LBP. Exercise is not a guaranteed "cure all" for all cases of LBP, but anyone suffering from the condition should definitely try exercise as an alternative before deciding on surgery or spending large amounts of money on ineffective treatment methods.
David Petersen is an Exercise Physiologist/Certified Strength and Conditioning Specialist and the owner and founder of B.O.S.S. Fitness Inc. based in Oldsmar, Florida. More articles and information can be found at http://www.bossfitness.com
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