Lower back pain is a widespread condition that affects up to 23% of the worldwide adult population with a recurrence rate as high as 80%. Despite the high prevalence, the majority of us suffering from lower back pain can improve, manage, and even be pain-free to have a better quality of life.
It is difficult to know where to start, but that’s where we come in - a good physiotherapist can guide you through the process of recovery. Here are the three steps we take here at Breathe Physio and Pilates.
Step 1. Pain Reduction
Step 2. Activation
Step 3. Movement
Pain Reduction
Pain is almost always the main complaint in any injury followed by stiffness, swelling, and on rare occasions, pins and needles or numbness. Pain can be debilitating to the point that it affects our quality of life and limits our participation in social and recreational activities. Thus, it is important to reduce pain first to allow further progression which we will talk about later on.
There are four key parts to pain reduction.
understanding diagnosis
stretches / Mobility exercises
hands-on treatment
movement strategies.
Understanding diagnosis and learning your spine’s behaviour gives us the upper hand at recovery and minimising potential aggravating factors. There are many different diagnoses of back pain. One of the most common back pain originates from the intervertebral disc, also known as discogenic pain. The pain aggravates with specific movements such as bending, twisting, prolonged slouching, lifting heavy objects from the ground and even coughing or sneezing. Biomechanically, when the spine deviates into flexion, there is increased compression at the front section of the intervertebral discs and potential shear force occurring at the lumbar spine level. However, be mindful that not all low back pain is discogenic. It’s important to obtain a proper diagnosis for your back injury first in order to receive the most appropriate and effective treatment.
Here we demonstrate some stretches and mobility exercises that are both safe to perform and can help to settle the disc pain.
Having the mobility to perform quality movement further assists with our spinal hygiene and prevents symptom exacerbation. There are times where additional manual therapy is beneficial to help with this process. Hands-on treatment such as joint mobilisation, deep tissue release, dry needling and stretches helps with pain and joint stiffness in the early stages of recovery.
Based on the pain behaviour of the discogenic back , there are strategies you can implement when performing lifting, carrying and bending tasks in your daily life. It is advisable to avoid slouching when sitting, aim to use your legs more during lifting to retain a neutral spine and even brace your tummy when coughing or sneezing to prevent sudden changes in intra-abdominal pressure.
Activation
“The fundamental tenet of human motion is that a proximal joint must be stiffened and stabilized before a distal joint can produce force, torque and movement.” (Dr Stuart McGill)
If we were to strip away our muscles, the spine will buckle just under 10 kg of force! This shows you how important muscle activation really is to even keep ourselves upright and walking! Muscle activation surrounding our spinal column creates what we called “hoop stress”, a type of internal pressure formed within the abdominal cavity. It is with this hoop stress which allows us to have the stability to perform functional tasks.
In discogenic lower back pain, there is evidence of pain inhibition and fat infiltration in the stabilising muscles. For example, multifidus muscle originates from the sacrum and goes all the way to the cervical spine (neck). This group of muscles actually spans across multi-levels of our spine enabling us to have segmental control by acting into extension. However, it is well documented that pain inhibition and fat infiltration have led to a significant reduction in the cross-sectional area of this muscle where this atrophy is more prevalent in chronic lower back pain. What does this mean for us? Without adequate activation, we are risking potential re-aggravation of injury which further hinders our ability to build back up our physical capacity and quality movement.
The following three exercises are great stabilisation exercises in the early stage of rehabilitation, they work to challenge the muscles while sparing the spine of high load.
1. Ab Curl: Rectus abdominus activation tensioning the lateral hoop while maintaining neutral spine
2. Side plank: Lateral hoop (external/internal obliques, transversus abdominus), gluteus medius/ minimus and quadratus lumborum activation
3. Bird-dog: Anti-rotational exercise to keep the spine stiff in neutral whilst moving your opposite limbs.
“To learn a new skill requires 30,000 repetitions. If you do 100 reps a day, it will take almost a year to establish a new movement pattern.” (Winnie Lu, Director, Breathe Physio and Pilates)
Movement
Performing quality movement on a daily basis is non-negotiable when it comes to spinal hygiene. Once the pain is reduced and muscle activation is consistent, we encourage everybody to maintain a neutral spine when performing functional movement such as a squat or hip hinge and use abdominal co-contraction and bracing.
These 3 steps (pain reduction, activation and movement) will equip you to achieve a pain-free, healthier spine and lifestyle. However, individuals and their lower back pain may present differently and this blog only presents one of many scenarios you could have. You should always consult a physiotherapist for your condition.
References:
Vincent E. Casiano; Gurpreet Sarwan; Alexander M. Dydyk; Matthew Varacallo., 2023, Back Pain, https://www.ncbi.nlm.nih.gov/books/NBK538173/
Julie Hides; Craig Gilmore; Warren Stanton Emma Bohlscheid, 2006, Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects, https://www.sciencedirect.com/science/article/abs/pii/S1356689X06001317
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