Wednesday, 1 July 2015

Lower Back Pain

by Todd Snowdon

I have been asked numerous times over the past few years; what conditions have I dealt with the most? Not surprisingly, my reply is “lower back pain”.

It is important to note that lower back pain is a rather complex issue - some of which are briefly outlined below.

A common re-occurring theme we see in the clinic is lower back pain due to poor posture, biomechanics and lifestyle factors. Ultimately, the three are interrelated.

Thoracic kyphosis (rounding of shoulders, chin protracted forward) is an example of poor posture resulting from copius amouts of sitting at a desk. This can lead to an increase in lumbar lordosis (lower back curvature) that changes the orientation of the pelvis. This in turn places increased load through the lumbar vertebrae in a less than ideal position and thus abdominal and lower back musculature is required to create tension from a position of reduced mechanical advantage.

So, how can exercise help?

The main benefit from an exercise perspective is the ability to re-train the muscles crucial in maintaining “correct” posture. These are both the gross musculature and the stabilisers. Exercise aims to restore full range of motion whilst providing additional mechanical support to the lower back. Common exercises aim to improve flexibility, range of motion, strength, stability and neuromuscular control. One area we focus on is the contributing factors as to what may be causing the lower back pain such as weak or tight musculature. Once this has been identified, appropriate exercises to correct this imbalance or weakness can be prescribed.

There has been particular focus in the past on core and gluteal strengthening to improve LBP.  Core stability or transverse abdominus control, is very important as a delayed onset of transverse abdominus activation has been shown in the literature to be associated with lower back pain. This is because the transverse abdominus muscle and multifidus are spinal stabilizers and support the lumbar spine during lifting, bending, forward flexion; at the time where there is an increased amount of load placed through the lumbar vertebrae.  It is also an essential contributor to pelvic position and control.

With respect to LBP, emphasis should also be placed on gluteal and hamstring strengthening. Why? Think of the attachments sites and the effect this has on pelvic position. Muscle tightness or shortening of the muscle, effects the biomechanics of the lumbar spine and pelvis.  For example, a common observation we see are strong/shortened hip flexors and weak/lengthened hamstrings, this can lead to an anterior pelvic tilt which changes the position of the lumbar spine. So you can see how tight or overused muscles can pull on their anchor points for example; the pelvis, and cause lower back pain due to the change in biomechanics and forces placed through the spine.

In summary, improving gluteal control and strength in relation to pelvic position, is very important in lower back rehabilitation/prevention.