Chances are that if you have ended up here you have some low back discomfort.
In this blog post covers;
Basic back biomechanics
How pain can impact biomechanics
The treatment approach we find to be helpful in reducing low back pain
Basics Back Biomechanics
In order for an individual to get from point A to point B the body has to manage and distribute the forces that act upon it. In order to do this the body has to coordinate multiple different systems and subsystems in order to create fluid pain free movement. The 3 main subsystems we are focusing on are :
1. The passive (think rigid bones)
2. The active (your muscles)
3. The control (your nervous system)
Typically these systems all work together in harmony to keep you in this nice “Goldilocks Zone” where the forces that result from you moving are well managed without any single system having to carry more than their fair share (2).
But then something happens. It does not have to be any great traumatic event. It can be something as simple as bending down to tie your shoe.
So here is the scenario. You lift your leg up to tie your shoe. As you are bending down mid reach you start to lose your balance. You quickly put your foot down and snap up straight. As you do this you feel a slight twinge in your low back. You think nothing of it and bend down to tie your shoe without issue.
The next day you notice that your low back is a little achy. The perfect harmony between the 3 systems has gone awry and you are no longer able to move in the “Goldilocks Zone”
Pain and the subsystems
Let’s break down what may have happened when you snapped up quickly after attempting to tie your shoe.
As you lifted your leg you may have been in a position that placed uneven force on the spine.
When you quickly stood up you increased the force on the spine and surrounding tissues.
The spine and surrounding tissues were unable to meet the force demands resulting in pain.
When your body feels pain it has an inhibitory effect on muscle contraction force and frequency (3,4).
What this means is that when you felt that twinge your brain told the muscles around the area of pain to STOP!
Once the muscles are given the stop command the body has to compensate for the decrease in muscle activity. Most of the time our bodies can rely on other non-painful but ultimately less efficient muscles to compensate. This can result in what is known as a compensatory movement pattern. All this means is that your body is adapting to stresses in a biomechanically disadvantageous pattern.
Think of it like driving with one tire slightly deflated on your car.
Most individuals can go pain free with this movement pattern for quite some time. However, just like driving your car with one low tire, moving around with this compensatory movement pattern can cause some alignment issues. Think of it this way, before we had a nice balanced system with each sub-system sharing the load. However, when muscles are inhibited due to pain often times the passive sub-system (bones) have to carry more of the load.
Over time this lopsided distribution can lead to pain, and potentially a decrease in the stability of the back.
This is the point at which most individuals begin to experience pain that interferes with their ability to perform their daily tasks. This is usually the time when pain leads patients to seek help from a PT.
Retraining the Core using the 4 B’s
Please note that for each of our patients we do an in-depth evaluation to ensure that we are offering the right treatment and not overlooking any serious issues that warrant further medical intervention.
For most of our low back patients our focus is in restoring control of the active system i.e. your muscles. We do this by asking patients to identify and activate these 4 muscle groups in the following sequence.
1. Bowel and Bladder
Deep pelvic muscles that make up the floor
2. Belly and Breath
Transverse abdominis & diaphragm muscles that make up the ceiling and front wall
3. Back
The multifidus muscle which makes up the back wall
4. Buttocks
The gluteal muscles which help to stabilize the hip and spine
The goal of activating these muscles is to bring back conscious control of the core and identify which muscles may not be fully activating. Think of it like opening up your electrical box to see which fuses are tripped. Assuming there is no serious pathology we can train individuals to re-activate the inhibited muscles and restore the balance. The long term goal is to restore adequate core muscle activation. We do this through daily repetition. We instruct our patients to "turn on each muscle group and hold for 10 seconds". We recommend doing this multiple times a day and in different positions. The short term goal is to be able to do at least ten - 10 second holds in a row. Once and individual can demonstrate adequate core activation we guide them through higher level core exercises with the goal of reinforcing this muscle new activation pattern while improving core endurance.
In short our goal is to be able to hand the controls back to the subconscious system with the idea that the retrained core activation pattern is carried over and becomes the new normal way of moving.
Here at Spine & Sport we use a variety of techniques to help patients identify the core muscles and retrain their core. We find that for the vast majority of patients this method of retraining the core is very effective in reducing their low back pain.
If you have any questions or want to learn more give us a call at 540-868-9599 to set up a visit with one of our therapists.
References
Low Back Pain Fact Sheet | National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Accessed March 20, 2020.
Yue JJ, Torre JJ-DL. Clinical application of the Panjabi neutral zone hypothesis: the Stabilimax NZ posterior lumbar dynamic stabilization system. Neurosurg Focus. 2007;22:3.
Graven-Nielsen T, Svensson P, Arendt-Nielsen L. Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function. Electroencephalogr Clin Neurophysiol. 1997;105(2):156-164. doi:10.1016/s0924-980x(96)96554-6
Farina D, Arendt-Nielsen L, Merletti R, Graven-Nielsen T. Effect of Experimental Muscle Pain on Motor Unit Firing Rate and Conduction Velocity. J Neurophysiol. 2004;91(3):1250-1259. doi:10.1152/jn.00620.2003