Got Low Back Pain?
Nearly 80% of adults are affected by low back pain, with annual costs in the United States estimated to be greater than $26 billion.
Low back pain affects office space workers, those engaged in manual labor, athletes and even children.
Low back pain has been attributed to direct trauma, arthritis, and mechanical dysfunction.
Mechanical problems are likely the most common cause, with poor ergonomics, lack of activity, and poorly designed exercise programs being common underlying mechanisms.
Mechanical dysfunction is defined by:
1. Tight muscles
2. Weak muscles
3. Joint mobility problems
4. Improper movement/recruitment patterns mediated by the nervous system
What is the best way to manage mechanical low back pain?
Chiropractic, physical therapy, acupuncture, massage and specific exercises all can work.
The key however often lies in the assessment.
Low back pain is a general term.
In an average day I see 15-20 people with low back pain, each with a different assessment and treatment approach.
If a practitioner treats everyone with low back pain the same, some will improve, but many won’t.
For example, you may have seen a chiropractor who manipulated your spine, when the problem was actually delayed activation of the transverse abdominis (TVA) muscle; or you may have seen a physical therapist who prescribed strengthening exercises, when the problem was due to a joint fixation.
What should a mechanical low back assessment include?
1. A detailed history, including lifestyle factors and treatments tried
2. A general movement screen
3. Range of motion testing
4. Muscle and sensory testing
Any practitioner who does not look at the areas above and below the area of pain, is often missing the underlying cause.
As you can see from the diagram below, many problems can originate from the foot and ankle complex.
If the site of your pain (e.g. knee, hip, back and even shoulder) is the main focus of therapy then as soon as you walk to your car, exercise or return to your regular routine, the pain is likely to recur.
Research on low back pain has shown four primary compensation patterns that can be identified on an Over Head Squat Assessment- a tool used to identify where dysfunction originates.
1. Excessive forward lean
2. Low back arching
3. Low back rounding
4. Asymmetrical weight shift
Each of these patterns is characterized by specific muscle, joint and nervous system imbalances and as such, would need to be treated differently.
The treatment can employee the same techniques, however the areas of focus would vary.
The techniques I find most effective include:
1. Inhibiting myofascial tissues- e.g. dry needling, fascial release, massage
2. Lengthening myofascial tissues- e.g. static and active stretching
3. Isolated activation techniques- e.g. exercises to strengthen the Transverse abdominis, internal oblique, gluteus medius and multifidus muscles
4. Integrated dynamic full body exercises- e.g. squat to row. Stability ball hip extension leg curls
There are 29-35 muscles that attach to the lumbar spine or pelvis. It is a region of the body that influences and can be influenced by the structures above and below.
Because of this, there are a number of reasons why someone can develop pain and as such, the key to managing the pain is assessing the areas of dysfunction, not just the site of pain.