Dear Dr. Geoff- My low back is “killing me”!
Dear Dr. Geoff,
I have suffered from chronic, recurrent lower back pain for over 10 years. I have seen physical therapists, massage therapists, chiropractors and acupuncturists. I receive short term relief, but my pain always returns.
I have read your articles on the kinetic chain and am wondering if this approach would provide a lasting solution to my pain.
Suffering in Seattle
Dear suffering in Seattle,
Thank you for your e-mail. Your scenario is all too common. Many practitioners address pieces of the kinetic chain, providing short term relief, but the condition persists. The reason is as follows:
The human movement system is made up of three interrelated components:
1. Nervous system
2. Muscular system
3. Skeletal system
Together, these systems function to coordinate movements of the kinetic chain.
The nervous system is responsible for force-couple relationships (synergistic movements between muscle groups).
The muscular system is the connection of soft tissues (i.e. muscles, tendons, fascia) and functions efficiently when length-tension relationships between the muscles are optimal.
The skeletal system is comprised of joints. It is the interconnection of bones from the feet up to the skull.
If one of the systems is not working properly, then dysfunction results. This dysfunction is generally due to altered:
1. Length-tension relationships
2. Force-couple relationships
5. Movement patterns
The end result is tissue fatigue and ultimately pain and injury.
If you have recurring injuries or experience only temporary relief from therapy (i.e. physical therapy, massage, chiropractic etc.), then the problem may lie elsewhere in the Kinetic Chain.
Evaluating the integrity of the Kinetic chain as well as knowledge of these interrelationships, can help explain why a painful condition may not be responding to therapy and identify where the source of pain (not just the symptoms) is coming from.
A quick and easy way to identify dysfunction in the Human Movement System is by assessing your overhead squat. The overhead squat looks at movement at the following Kinetic chain checkpoints:
1. Foot and ankle
3. Lumbo-pelvic-hip complex
4. Shoulder/cervical spine
The Overhead Squat:
Stand facing a full-length mirror with your feet shoulder-width apart and pointed straight ahead and your arms raised overhead. Squat three times. Hold the pose at the lowest point in your third squat and take note of your body position at the checkpoints. Perform the movement again and have someone watch from the side and behind.
Considerations with low back pain:
The low back (lumbo-pelvic-hip complex) has 29-35 muscles that attach to and influence it. It is associated with both the upper and lower extremities and as such can influence or be influenced by structures above and below.
By evaluation the entire kinetic chain, we can determine where the dysfunction lies and where to focus therapy and rehabilitation.
There are 4 main lumbo-pelvic-hip complex movement compensations seen in the overhead squat assessment:
- Excessive forward lean
- Low back arches
- Low back rounds
- Asymmetrical weight shift
Each of these compensations occurs as a result of certain muscles being overactive and others being underactive.
By understanding the functional anatomy, we can identify these muscles by observing the dysfunctional movement and then performing isolated range of motion assessment and muscles testing.
These patterns can also be identified using a single leg squat assessment and during a dynamic movement assessment, e.g. walking on a treadmill.
Because muscles are related to joints, motion palpation to assess joint movement is also essential and will need to be addressed.
A kinetic Chain Approach to Low Back Pain:
Once we have identified the involved muscles and joints (i.e. through the overhead squat assessment, range of motion and muscle testing and palpation), treatment can consist of manual therapies to correct muscle imbalance and joint dysfunction (e.g. trigger point therapy and mobilization/manipulation) and then progress to corrective exercise, including:
1. Inhibiting tight muscles by using foam rollers (self myofascial release)
2. Lengthening tight muscles through static stretching
3. Activating weak muscles through isolated strengthening
4. Integrating functional movements to coordinate and retrain optimal kinetic chain function
Geoff Lecovin, MS, DC, ND, L.Ac., CSCS, CISSN
Dr. Lecovin is a chiropractor, naturopathic physician and acupuncturist. He graduated from Los Angeles College of Chiropractic in 1990, earned a Masters in Nutrition from the University of Bridgeport in 1992, and then went on to complete the naturopathic and acupuncture programs at Bastyr University in 1994. He holds additional certifications in exercise from the National Strength and Conditioning Association, National Academy of Sports Medicine and International Society of Sports Nutrition.
Dr. Lecovin specializes in treating musculoskeletal pain and sports injuries by integrating trigger point acupuncture, soft tissue release, joint manipulation, corrective exercise and nutrition. In addition, he combines exercise and nutrition for weight loss, weight gain and performance enhancement.
His clinic, located in Bellevue, WA, offers naturopathic medicine, chiropractic, acupuncture, massage and infrared sauna therapy.
He can be reached at Evergreen Integrative Medicine at (425) 646-4747 and his website address is: www.old.drgeofflecovin.com www.eimed.com