Low Back Pain
One of the main developments in treating lower back pain has been the understanding that the abdominal muscle group plays an important role in supporting the spine, and that strengthening this region is valuable in all prevention and treatment programs for lower back pain.
The paraspinal muscles, particularly multifidus, co-contract with transversus to maintain a “neutral” lumbar spine. This refers to the low back, or lumbar segment of the spine as neither extended nor flexed, with the pelvis flat and not tilted. Learning to control this “neutral” position is the focus of most care stability exercises. Research shows that poor multifidus activity is found in back pain patients. Walters suggests that we should be striving for a comprehensive program of exercises that effectively strengthens all the muscles and movements of the spine. Lower back pain has a variety of causes, and while focusing on a neutral spine is important in the early stages of rehabilitation, global musculature and functional movements must be incorporated for optimal function.
Back movement and function:
Any back movement is a combination of the basic flexion, extension and rotation. The key muscles involved in the performance of each of these movements are:
Flexion: rectus abdominis, internal and external obliques and hip flexors
Extension: erector spinae, quadrats lumborum, gluteus maximus and hamstrings
Rotation: rectus abdominis, obliques and erector spinae
The most effective lower back pain programs involve all the muscles, how they move and function and in which positions these movements occur. This comprehensive approach also takes into consideration that back injury and lower back pain can be caused by various factors, including poor posture, lifting strain, poor stability, muscle strength imbalances, small repetitive stresses and poor flexibility. The more comprehensive and varied the lower back pain program, the more likely all these factors will be accounted for.
Any rehabilitative training needs to be specific to the individual patient and progressed according to the diagnosed contributing factors. A progressive program may start with specific activiation and co-contraction training of transversus and multifidus, but should progress to exercises such as planks, bridging, trunk twists, back extension and superman type exercises to recruit more global musculature. More advanced exercises could include the wood chop, deadlifts, and squats. It is important to incorporate two pull movements for every push movement. Functional training exercises with equipment such as the multi-directional cables, TrX, and kettle bells challenge the body in ways that conventional lifting cannot. The key point of the latter exercises is that most of these require the body to move or stabilize in a rotational direction thus simulating everyday life tasks. The final point is that rehabilitative and training exercise programs need to be regular to generate the stress to create an adaptive process.
At Corona Station Physical Therapy, our team of experienced physiotherpists believe in a comprehensive rehabilitation approach to treating low back pain as well as working to prevent recurrence. For further information please contact us by phone or email and ask to speak to one of our physiotherapists.
Haladay, D., Miller, S., Challis, J. & Denegar, C. (2013). Quality of Systematic Reviews on Specific Spinal Satbilization Exercise for Chronic Low Back Pain. JOSPT, 43(4).
Walters, P. (2000). Back to Basics. Health and Fitness Journal, 4(4).