July 19, 2009
Over the years, I have worked with literally thousands of people who suffer from mechanical lower back pain. During that time, I have identified several self management tips that are worth knowing. These tips fall into the category of “management of biomechanics” during activities of daily living.
First of all, most people who suffer lower back pain experience the pain episodically. Each episode is worse, last longer and over time, starts to come on more frequently. This is typical, and is the main reason why management of lower back pain is worthwhile.
My tips are these:
- The pain is worse in the morning, and there is more risk in the morning. It is important then, to take care of the back first thing out of bed. This is true because during the night, the disc imbibes water creating increased intradiscal pressure in the disc before you get out of bed. You are indeed taller when you wake up than when you go to bed! So the first tip is to be cautious in the morning. I have advised people who have significant morning pain to actually get up in the middle of the night and walk around for several minutes as a way to mitigate the morning pain.
- Walking is great medicine. The literature points out that maintaining your activity is of no harm, and I believe necessary to overcome episodic back pain. Sub maximal exercise gets your blood circulating, relaxes your muscles and generally promotes good health. The weight bearing also compresses the disc and squeezes some of the water out, meaning less pressure on the nerves. So a good walk every day is helpful.
- Biomechanics is key. Be thoughtful about what you do. Face the things you do, keep lifting to a minimum, but when you do lift, keep the object as close to your center of gravity (around your belly button) as possible.
- Avoid prolonged sitting. And when you do sit, a firm chair with back support and arm rests is ideal. Try to use lumbar support when you sit. For instance, when getting on an airplane, put one of those little pillows behind your back.
- Use prolonged ice daily. I mean ice plus water in a plastic bag right on the skin for at least 30 minutes. The cold penetrates at about one cm every 10 minutes. It takes a half hour to numb the muscles and dull the pain. Be careful not to use gel ice packs because they tend to be too cold (if your freezer is below freezing) and not stay cold for long enough.
- Finally, get fit. Fit people have a much lower incidence of lower back pain than the population at large. This is more of a long term strategy, but if you are stronger, your muscles do a lot to support you. Along with this of course goes flexibility and core stability. Develop your core and don’t forget your back side when you do so. Core exercises include hamstring exercises, and back muscle exercises as well.
Back pain tends to be episodic, the episodes tend to be more frequent over time, they tend to last longer each time and also to be more severe each time. Reversing these trends is the goal of managing your back pain. Follow my advice and you will be able to do so!
Filed under: abdominal exercise
,acute back pain
,facet joint pain
,low back pain
,lower back pain
,lower cross syndrome
,nerve root compression
,pain in the butt
,physical therapy for back pain
,return to function
,SI joint belt
,SI joint Sacro-iliac joint
,SI joint stabilization
| by Neil Chasan, PT, MMT @ 11:23 am | |
December 4, 2008
“Why should I do core exercise?” is the most common question I field for people suffering lower back pain.
First, the anatomy – segmental instability occurs because a motion segment (vertebra – disc – vertebra) allows a component motion of sheer which is not anatomic. In other words the vertebra above should never sheer against the vertebra below. This abnormal motion would occur when a disc has lost its volume and therefore its height. we see this as a narrowing of the disc space on x-ray. Once sheer is allowed, it is safe to assume that the static stability of the spine is lost.
In this image you can see the loss of disc height.
Muscularly, there is an opportunity to stabilize the spine dynamically using the muscles that surround the core. In front and on the sides are the Rectus Abdominus, the Internal and External Oblique muscles and the Transverse Abdominus as well. In addition there is the strong lateral stabilizer – the Quadratus Llumborum and the posterior structures including the deep paraspinal muscles Multifidus and Rotatores and others. Further, there is the large back muscle Latisimus Dorsi that inserts into the thoraco-lumbar dorsal fascia and the Gluteal muscles that also do so and provide additional tension to the structures. Finally, there is the diaphragm above and the pelvic floor below that both play a significant role in providing true core stability.
Key core exercises tackle all these muscles. Front, back, sides, top and bottom. The secret is that it is not possible to compress water, and so by having a dynamic compression of the contents of the core, stability is created whereby the segmental instability described above is restricted from movement by the compression of the abdominal contents. Make sense?
There are other considerations such as muscle tightness and joint restriction above and blow the spine that contributes to the load at the unstable segment, perhaps perpetuating the instability and the consequence of that instability
on the pain one experiences. For example, the Hamstrings insert on the Ischeal Tuberosity and it is easy to imagine how the tight hamstrings would limit the ability of the pelvis to tilt forward during forward bending, which means that as one bends forward, the unstable segment in the spine would carry the load INSTEAD of the hamstrings. And because it is moving under load more than it should, and because the motion takes it past normal ranges due to sheering, an unstable segment is more likely to become even more unstable causing yet more pain and dysfunction as time passes.
What this means is that core stability needs to be a priority, but normalizing hip and thoracic spine mobility also need to be addressed for the core exercises to matter and for their effect to last.