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1st Jul

2010

Essential Exercises For People With Low Back Pain

Although low back pain affects up to 80% of the population at some time, and most often repeatedly, rehabilitation exercise and physical therapy has been shown to be greatly underutilized.

There is today overwhelming evidence in the literature, that such treatment is effective in reducing pain and improving function in the majority of people with chronic and recurrent low back pain and sciatica.

Today we also have good research data which tell us what happens to specific trunk and back muscles with low back pain, and how specific exercise can rebuild such weakened muscles.

RAPID MUSCLE WASTING SEEN

Research studies have shown that dramatic muscle atrophy, or muscle wasting, occurs within 24 hours of developing acute low back pain. The atrophy is selective, and affects primarily the deep back muscles close to the spine, called the multifidus. These are the primary muscles which provide stability to the spine, and support key joint structures and the discs.

It is believed that this rapid muscle atrophy occurs as a result of a reflex mechanism, where these muscles are inhibited, or “turned off” by the nervous system, a common mechanism after injury throughout the body. It has also been shown that, even after the pain has resolved, this neuromuscular inhibition most often continues, leaving a person more susceptible to experiencing acute pain again in the future.

Together with this muscle wasting, the makeup of the muscles also changes quickly, to contain more fat in the place of muscle fibers. This has also been shown to happen after surgery, next to the spinal level where the operation was performed.

Therefore, it is of greatest importance to activate, and strengthen these deep back stabilizers after we have had a bout of acute low back pain, to get over the episode quicker, and to protect the spine for the future.

REHABILITATION EXERCISE SHOWN TO REVERSE THE ATROPHY

Several studies have shown evidence through MRI scans and diagnostic ultrasound, that specific rehabilitation exercise can activate, and hypertrophy, or increase the size of, the multifidus and other related muscle groups. The key at first is coordination, to learn to “turn on” these inhibited muscles, and thereafter to increase their endurance and strength.

Traditional health club exercise may train primarily longer and more superficial muscles, and thereby even make the condition worse, since joint stability is lacking. Even Pilates type exercise, or other popular “core muscle” exercise may be ineffective, as they may overemphasize abdominal muscles, at the expense of the deep back muscles.

DEEP ABDOMINAL MUSCLES ASSIST IN STABILITY

The transversus abdominis is the deepest stomach muscle, which spans across the lower trunk from side to side. It, and some of the oblique abdominals which cross diagonally from side to side, attach to a large fibrous band across the lower back, called the thoracolumbar fascia. By contracting these deeper stomach muscles, the fascial band in the back tightens, adding support to the back.

When we teach patients how to contract these deep stomach muscles, we also teach them to simultaneously activate the multifidi in the back, to best protect and stabilize the back.

OTHER “SECONDARY” BACK STABILIZERS

We can also improve low back stability by including specific shoulder and hip muscles. In the shoulder, a large muscle called the latissimus dorsi spans the entire back and attaches to the thoracolumbar fascia and the pelvis.

In the hip, the gluteus maximus, the largest buttock muscle, also has attachments to the thoracolumbar fascia, and thereby aids in back stability as well.

During normal movements and walking, these muscles work diagonally from the shoulder to the opposite hip. We can use this pattern of muscle contraction with rehabilitaiton exercise, while simultaneously working the deep back and deep stomach muscles, for optimal muscle stability across the back.

COORDINATION ESSENTIAL

In order to get good results with rehabilitation exercise, it is essential to learn to contract muscles correctly, and to move with good coordination. Exercises also must not increase the low back pain, since this tends to cause more inhibition of deep muscles, or cause protective muscle guarding.

It is also important to gradually progress the difficulty and intensity of exercise, both statically (without spine motion), and dynamically (with spine motion).

PULLEY EXERCISE EFFECTIVE

A pulley apparatus which is attached to weights can be extremely effective in isolating and rehabilitating muscles, including in the back and trunk. It can also be effectively progressed in small weight increments, as the condition improves.

Such an apparatus can easily be set up at home, or adjustable cable machines with small weight increments are now available in greater numbers in health clubs.

Low back training can benefit people of all ages. Exercises should be tailored to each individual, based on his or her specific condition-diagnosis, age, general health, overall conditioning level, and goals.

Enjoy the rest of the summer!

Best wishes,

Gunnar

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