How common is back pain? 2/3
Today’s newsletter is part 2 of our 3 part series on BACK PAIN. Part 1 we looked at the causes of back pain and the key things to be aware of to prevent developing an injury or chronic pain. If you missed part 1 CLICK HERE to read what you missed.
And the reason we are providing this detailed series is due to the amount of people dealing with pain and resorting to strategies that either do not work, and in some cases make the pain much worse! And if you don’t believe me these were just some of the stats we shared last time.
In 2009 1 in 7 Australians (13.6%) reported having serious back problems—that’s 3 million people!
Over 2 in 5 people with back problems (44%) have difficulty in tasks and activities associated with mobility, communication or self-care
1st according to the Global Burden of Disease estimates, low back pain is ranked 1st in Australasia (including Australia and New Zealand), compared to 6th in the world
In part 2 we look at how to improve mobility of the joints contributing to your pain and also how to improve your stabilizer function. (Note that I did not say we were going to do anything about the back itself, more on this later).
Mobility and Stability are the most critical parts to getting rid of pain and setting the foundations for learning how to move correctly and eventually strengthen. This MUST be the first thing to do in the early stages of rehabilitation. Get these wrong, or neglect to do either which many do, and you risk going backwards into more pain later on and suffering for years with a condition that just gets worse. This is a MUST read for anyone going through a back injury right now or has had back problems in the past, as many of the key things you need to do will be covered in this article.
Using Exercises To Beat Back Pain?
Okay so we know what causes back pain as we covered that last time. Remember there was really 3 big things.
- Sitting too much, and poorly
- Poor posture
- Poor movement (in particular with bending)
We also know that treating your symptoms using anti inflammatory pills or getting a massage without addressing the cause is not going to do anything either.
Let’s say you have put a place to reduce your amount of time sitting, changed your workstation at the office, started becoming more aware of better posture and how to bend correctly. Is this enough to get rid of your pain or prevent another painful episode happening again? NO. You have made significant inroads but there is a lot more you will need to do in order to have long term success. And this is where you will have to use exercise strategies to do this. But where do you start?
Many people will be told various things such as:
” You need to strengthen your core, go to a Pilates class or start doing heaps of abdominal exercises, this will fix you”
” Start swimming I hear it is great for your back”
” You need to start stretching, take up Yoga I hear it is great for this”
There is problems with all three of these solutions. Don’t get me wrong they could be used as part of the program but on their own they will do very little in addressing the real problem which I will explain.
Strong Abdominals Will Not Prevent Back Pain
Yes you read that right. Opposed to what you have been told this is a real myth. The abdominal muscles, in particular the stabilizer muscles play a big role in preventing back pain, but training them on their own in isolation using planks, crunches and various other exercises, without the integration of the prime mover muscles is a waste of time. Actually in some cases the over dominating abdominal muscles are the problem that is causing the back pain. I see this a lot with boxers who do so much bad ab work such as the exercise below that leads to bulging discs.
The Core is a complex integration of small stabilizer muscles (the inner unit) working together with large prime moving muscles (the outer unit) to produce movement. These inner unit muscles attach to the body at the spine only, meaning that when they activate they generate little or no movement. They basically have no influence over how you move, they can only stabilize you in preparation for movement. They are very important and we will use exercises to retrain them, but you must understand they need to know how to work with the rest of the team to have any affect on your condition.
The outer unit controls the range of motion, generates movement and provides some good stiffness on a much bigger scale. However these muscles do a very poor job of stabilizing the pelvis and spine. Poor training technique and abuse of bad exercises however teaches them to do the role of the inner unit creating BAD STIFFNESS and setting you up for problems. The key here is one cannot work without the other. The stabilizer muscles are not designed or know how to produce movement. And the large global muscles are not designed to create stability. To teach your body how to do both you need to follow a process that is easy for the brain to learn and coordinate which is what we will discuss soon.
What About Yoga & Swimming?
Both Yoga and swimming are great exercise methods and can provide enormous health benefits to your body. However in terms of a back rehabilitation or prevention program they are not the best choice for they lack one very important function.
“THEY DO NOT TEACH YOU HOW TO MOVE CORRECTLY”
Yoga if used wisely can assist greatly in providing some necessary mobility and flexibility which we are about to discuss. However the problem I have encountered with many yoga devotees is not that they lack mobility or flexibiliy, it is that they have too much! They have learned how to improve their range so much that they now force their joints into hyperextension and excessive compression. I cannot tell you how many people I have met from Yoga with severe neck and spinal problems from lack of stability and some much needed stiffness. Traditional treatments like massage, acupuncture, basically any loosening technique will often make their symptoms worse! This person needs to stiffen up. Too much flexibility is as bad as not enough.
Swimming is often linked with back pain, most notably for a disc bulge as the prone position in the water is very much like the McKenzie stretch and helps to settle the disc very quickly. This is also why many say it works so well for it can settle pain very fast. Unfortunately swimming does not strengthen or stabilize the body in a standing position at all. The body will still have faulty stabilization and movement strategies it will use that will create pain again, for it knows no other way. If you do not identify what these are and change them you will be in a revolving door of pain.
Step 1 – MOBILIZE FIRST
Remember earlier when I said we will need to address the joints contributing to your pain and will have nothing to do with the back itself. Wherever you have pain you need to look at the joints above and below, in addition to how you move if you want to identify where the problems are coming from. And with lower back pain 9 times out of 10 you will find there is a hip mobility and thoracic mobility problem. Both the hips and the thoracic spine are designed to move freely and create many of the rotational and athletic movements we need. But as we discussed in part 1 these two areas easily become stiff and rigid from sitting too much and poorly along with poor training techniques and poor posture.
The lumbar spine needs to be held in neutral as much as possible. It needs a good degree of stiffness to prevent excessive bending and flexing. But as the hip and thoracic area become too stiff and lose their ability to move with full range of motion, they force the lumbar spine to flex and bend and basically lose it’s stability creating problems in the spine.
So there is now 3 things happening.
- The hips have become tight
- The thoracic spine has become stiff and rigid
- The lower back stabilizers are now disabled
There will also be many other things to still consider which we will cover shortly, but my point here is to grasp the concept of what order things usually happen. 99% of the time it is a tight muscle that will INHIBIT an opposing muscle making it lazy and weak. In this case it could be the hips inhibiting the inner unit abdominal muscles.
Using an inner unit strength or stability exercise without addressing and shutting down the tight hip muscles first is a waste of time. The hip muscles will just steal the message from the brain to stabilize as they are in a dysfunction of hypertonicity and create a faulty movement.
Muscles are split into 2 categories of Tonic and Phasic muscles.
The tonic system muscles are prone to tightness or shortness, and the phasic system muscles are prone to weakness or inhibition. This is why we identify any flexibility and mobility problem first and apply stretches and mobility drills to begin correcting this.
STEP 2 – IMPROVE STABILITY
Now that you have identified your mobility and flexibility imbalances, and begun to implement drills and stretches to correct them, it is time to go about improving your stability at the joints that need it. Some people stop the rehab at this point as the mobility and flexibility improvements is enough to remove the pain, but this is where they set themselves up for failure, as the body is not strong or stable enough to hold those new positions. Also as we discussed earlier with hypermobile people they actually need this stage more than ever!
We will need to start with more isolated exercises to begin with, but very quickly begin to integrated into more full body positions and applying reflex skills and complex tasks in order to do this effectively.
There is a lot of confusion with stability and it is more than just trying to balance on a wobble board. I like to break this down into two parts.
- Firstly I like to identify the current level of inner unit function to assess the stability of the trunk and pelvis. Most problems start at the pelvis so it makes sense for us to look their first.
- Secondly I assess stability of the body in dynamic movements requiring skills in all planes of movement requiring stabilization of multiple joints and precise timing and firing of muscles. And this is where the real progress is made. True stability is all about TIMING! Being able to react with perfect reflexes to be able to maintain joint alignment ready for efficient and smooth movement. And it not just limited to the legs or the trunk. All joints require stability! This is why they only set the foundations, it is the more dynamic exercises using multiple joints and the combination of inner and outer unit muscles that will make the difference. This is also why planks and crunches do not work for again there is no reflex timing. You will need to work on the mobility, flexibility and stability drills for a few weeks before beginning to implement some of the more advanced skills. We don’t want to rush this stage, but we don’t want to get stuck here either. We have to get you learning standing up movements as soon as possible for this is where the danger lies and the key to getting to rid of it for good. We just have to follow the process known as the SUCCESS FORMULA.