As an osteopath the most common condition by far that I see is lower back pain. Lower back pain is one of the worlds leading causes for disability and will occur in 85-90% of the adult population. (Bono, 2004) One of the ways to manage and to effectively treat lower back pain is through exercises that are aimed to train the body to promote the optimum physical health (Abenhaim et al, 2000). Exercise programs for lower back pain especially for chronic pain (when you have had it for more than 12 weeks) mainly focus around exercise to strengthen and stabilise the core. The effectiveness of an exercise programme for lower back pain seems to increase the longer you have the pain and it is effective in reducing pain levels as well as increasing the function of the lower back (Hayden et al 2005). However for the most effective results it should be combined with manual therapy.
Stability and lower back pain
Core stability is one of the main elements to rehabilitation for lower back pain, in order not to keep repeating myself look at my blog post I have already written on the importance of core strength.
The stability of the lumbar spine according to Panjabi 1992 suggests there are 3 different elements neuromuscular control, ligamentous control and muscular control. There are normally two categories of instability gross and functional instability. Gross instability is often structural and will be found on imaging often involving the vertebrae or the spinal discs themselves. Functional instability is often when the balance of the stability is out of the neutral position this can be due to numerous different reasons. It has been proven that lower back pain can cause atrophy (decrease in muscle) and affects the ability of the muscle to relax and contract which can lead to muscular spasm which are very common with back pain (Kraback & Kennedy 2008)
Muscular control of the lower back:
Co-ordination of all the different muscles in the lower back are essential to the stability and the movement available at the lumbar spine. The main muscles that often are identified with significant importance in research are the transverse abdominals, multifidus which are both been deep muscles of the spine and the thoraco-lumbar facia. The deeper muscles of the spine are slow-twitch and they are normally very small short muscles that control the fine movements of each individual vertebrae and respond to changes in the posture and the forces through the spine. (Akuthota el al 2008) Multifidus is considered the primary stabiliser of the lower back as it controls the movement at each spinal level (Van Dieene et al 2003).
The thoraco-lumbar fascia is not a muscle but is seen more as a back belt that attached to all the different layers of the spine including the process at back of the vertebrae called the spinous process. The spinous process can be visible in some people; it’s the little bumps you can see of the spine when a relatively slight person bends forwards. It also controls the intra-abdominal pressure, which is another importance factor to the stability of the spine. Often if you have back pain your pain can be increased through coughing, sneezing or straining on the loo this is to do with the changes in the intra-abdominal pressure. If we go back to the analogy thoraco-lumbar fascia being a back belt an increase in the pressure would be like tightening your belt around your lower back. A lack of muscular control to the lower back can but more pressure and load on to the disc, which can lead to degeneration or prolapse/slippage.
Ligamentous control of the lower back:
The ligamentous control of the lower back often is one of the important elements that limit the movement in your back when you are in pain. You have two sets of supporting ligaments in your spine your posterior longitudinal ligaments and your anterior longitudinal ligaments, that just means ligaments at the front and back of your spine. The anterior structures attach to the vertebrae and discs between your joints and prevent you from extending your back too much. While the posterior ligaments work to prevent you from extending your back too much. The anterior ligaments are a lot stronger and thicker than the posterior. Johnson 2012
Exercises for lower back pain:
Here are my favourite and most commonly prescribed exercises for lower back pain.
Lie flat on back and bring you knees up to your chest and give them a hug and hold it for 10 seconds and then repeat 5.
Quadratus Lumborum stretch:
Do this exercise with one foot in front of the other and then bring your arm over your head to the side and hold for 10 seconds. Start with 3 then you can build it up to 5. Repeat on both sides.
Place your ankle over your knee and then push down your knee. You should feel the stretch in your buttocks, hold for 10 seconds and repeat 5 times. You can do this on both sides of your leg.
Lie down flat on your back with your knees bent, you can support your head with a small pillow. Keep your knees together and roll them to one side while trying to keep your shoulders flat. Hold this for 30 seconds and repeat 5 times on both sides.
Lie down flat on your back with your knees bent, you can support your head with a small pillow.Try flatter your lower back to the floor by contracting your abdominals while your tilt your pelvis towards your heels you should feel a gentle arch in your back. Hold this for 30 secs and relax back and repeat 5 times.
Lie down flat on your back with your knees bent, you can support your head with a small pillow. Slowly lift your pelvis off the floor so that you knees are in line with your shoulder, hold this for 30 seconds and relax down to the floor. Repeat 5 times.
Abenhaim, L, Rossignol, M, Vlat, JP, Nordin, M., Avouacm B, Blotman, F., Charlot, J., Dresier, RL, Legrand, E., Rozenburg, S., Vautravers, P.(2000) The role of activity in the therapeutic management of back pain.The report of the International Paris task Force on lower back Pain. Spine.
Johnson, Joshua, “Functional Rehabilitation of Low Back Pain With Core Stabilizations Exercises: Suggestions for Exercises and Progressions in Athletes” (2012). All Graduate Plan B and other Reports. Paper 159.