This Might Be The Reason Behind Your Back Pain!

Lower back injuries are a frustrating reality for some people, and far more common than you may realise. It has been estimated that 70-85% of adults experience back pain in their lifetime at some point. If you are suffering active and painful lower back symptoms it means there are muscles performing inadequately or improperly.

One of the most common causes of lower back pain is bad body posture in general or improper body posture whilst active, especially when lifting heavy loads. If back pain is an issue which keeps cropping up, the symptoms should present in a way that’s consistent with previous injuries.

Most back issues can be categorized into two distinct groups: flexion-based or extension-based dysfunction. Flexion based injuries are extremely prevalent without the office culture of sitting at a desk or computer screen, slouching, overall poor posture, and remaining sedentary for long periods of time. Muscles often become tight and shortened when kept in a flexed position, such as when sitting, and this causes an anterior pelvic tilt, where your hips become rotated forward. The muscles which usually work at rotating your hips backwards, your glutes, hamstrings, abdominals and obliques, become weak, stretched or inactive. Similarly, the muscles which are responsible for rotating your hips forward, the hip flexors and quads, become tight and overactive, which exerts an unequal pull on the hips, forcing them out of alignment. Muscle over activity usually occurs as a compensation for other weak muscles. The resulting imbalance often leads to pain and injury. The glutes for example, play an important role in stabilizing the hip and core, when they become weak, the muscles of the lower back must compensate and take over a role they weren’t meant for.

Control of back pain and prevention of it’s reoccurrence can be assisted by enhancing muscle control of the spinal segment, in order to improve stabilization which will protect the joints from painful strains and injury. The muscles of the lower back provide protection to the spine, help prevent unwanted joint displacement, aid in stress absorption and protect cartilage from degeneration. The abdominal muscles are often ascribed an important but underrated role in the treatment of back pain. A range of studies indicates that the deepest abdominal muscle, transversus abdominis (TA) plays an important role in the control of movement in the lumbar spine region. The TA muscle contributes stability by regulating intra-abdominal pressure and by transmitting force to the lumbar spine. It contracts with all trunk movements, regardless of direction and is recruited before all other abdominal muscles, especially during sudden movements. It has been found that better use of TA can lead to paid reduction for people suffering chronic lower back pain. This is due to the fact that back pain sufferers often have a delayed onset of their TA muscle, due to insufficient motor control. When TA contraction occurs after a movement is made, the lumbar spine is not stabilized properly and the risk of injury and pain is greatly increased.

One of the best mechanisms for increasing joint stability and decreasing pain is through the simultaneous contraction of transverse abdominis and multifidus (MF), a muscle which provides more than 60 percent of the stability in the lumbar spine region. An inactive and weak multifidus has been found in those who have experienced acute back pain. In chronic back pain suffers the muscle fibres of multifidus are sparse and weak, which means they fatigue faster and there is a higher risk of injury.
Early recruitment of TA and MF before a movement, ensures the joints of the spine are protect and supported, even during gentle low level contractions.

The length of the multifidus muscle fibres is virtually unchanged through a range of trunk postures, indicating that isometric exercise, such as a simultaneous contraction of TA and MF while maintaining the spine in a static neutral position could be the most beneficial for retraining these deep muscles into stability. This contraction of TA and MF can be achieved by gently drawing in the abdominal wall (particularly in the lower ab area), as if you are trying to pull your navel towards your spine. It is important to continue breathing normally throughout and that the rib cage, shoulders and pelvis remain in a constant position to minimise the contribution from other muscles. Co-activation of deep muscles is a gentle action, meaning other muscles of the body should remain relaxed during this localised exercise. One of the easiest positions to be in to achieve the contraction is a 4-point kneel or prone position, as this inhibits the use of global muscles and helps isolate the correct deep muscles.

In order to gain maximum benefit, the isometric co-contraction needs to be repeated as many times as possible throughout the day. First work on increasing the holding time of the contraction, as well as the number of repetitions. The goal should be to achieve 10 x 10 second holds in succession without fatigue. At a later stage this can be combined with dynamic exercise for other parts of the body, starting with low loads and minimal body weight and moving to more functional body positions with increasing external loads and at increasing extremes of spinal range. The aim of this is to be able to sustain a co-contraction of the deep muscles during every single dynamic functional movement of the trunk. The time taken to achieve this is variable and dependent on the level of dysfunction, so patience and perseverance are key. Just remember that the benefits of a pain and injury free life are worth it. Studies have shown that on completion of a treatment period using this co-contraction, there was a significant reduction in pain intensity and increases in functional mobility.

Proper stretching of the muscles helps to maintain a normal range of motion as well as providing relief for muscles in spasm. The main focus should be on stretching the hip flexors and quads, moving slowly and only to the point of mild tension rather than pain.
Similarly, it is necessary to work on strengthening the glutes, hamstrings and abdominals.

By learning and adopting the right body posture and ergonomic skills, the everyday load on the spine can be decreased, which in turn decreases the intensity of pain and disability, improves spine function, results in fewer recurrent pain episodes and therefore a decreasing number of days spent incapacitated due to lower back pain.