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Family Health Magazine - ACTIVE LIVING

Low Back Pain
Ways to cope

diagram - normal vertebraeIf you have back pain, you know how challenging, frustrating and disabling low back pain can be. Low back pain, and the related buttock and leg pain, can exist for many reasons. Fractures, muscle strains, ligament sprains, spinal disc irritation or herniation (rupture), and spinal stenosis (narrowing of the spinal canal) are all possible causes.

Understanding the spine

The spinal column consists of 33 bones, called vertebrae, stacked on top of each other. A canal in the spinal column contains and protects the spinal cord which connects the brain to the nerves that go to our body. Spinal nerves extend from the spinal cord to all parts of the body. These nerves drive movement and co-ordination as well as give us sensory information to help us understand our world.

Between each vertebra is a cushion-like disk that helps absorb pressure, relieve compression and assist movement of the spinal column.

The lumbar spine (lower back) and pelvis support much of the body’s weight.

Each vertebra in the spine has parts that stick out called boney processes. Many ligaments and muscles attach to these. Some muscles move the body, allowing bending or twisting. Other muscles provide support, much like a corset or muscular weight belt around the spine. Supportive muscles of the shoulder, buttocks (hips) and torso (abdomen and spine muscles) form a corset around the torso of the body and are often referred to as the ‘core’ muscles.

Leg pain (sciatica) ranges from a mild tingling sensation to sharp or severe pain or numbness in part or all of the leg. Symptoms vary depending on the cause. The sciatic nerve can be mechanically or chemically irritated. The sciatic nerve contains many of the motor and sensory nerves of the back, buttocks, pelvic floor and legs. (Motor nerves connect to muscles, while sensory nerves relay sensation.)

Many factors can contribute to low back pain initially starting, continuing or recurring. They include:

  • injury due to trauma or lifting
  • genetics (yes, you can blame your parents!)
  • compensatory movements – altered actions or habits developed to avoid pain or muscle loss due to lack of use, such as butt muscles which have done too much sitting!
  • doing activities that are more demanding than what your body is physically prepared for
  • introducing new activities that your body is not used to (such as shoveling snow or gardening)
  • abdominal surgery
  • asthma or respiratory distress
  • pregnancy
  • incontinence (trouble with bladder control) - the pelvic floor muscles supporting the bladder and work together with the muscles that support the spine and pelvis
  • being overweight
  • an inactive lifestyle
  • driving for long periods
  • smoking (perhaps because smoking lowers blood circulation)
  • heavy backpacks and backpacks that are not appropriately sized (especially for children and teenagers) or carried slung over one shoulder instead of over two shoulders with the hip belt secured
  • fatigue or stress (physical, mental or emotional)
  • your emotional health (yes, your muscles are influenced by your emotional state!).

diagram - transverse abdominal sectionDiagnosis

It is always wise to talk with your doctor to rule out any medical cause of back pain. If necessary, investigations can be done but these are often not diagnostic. Investigations do not always reveal why pain or symptoms are so intense or continue. A doctor can provide guidance about medications to help manage the pain. This is especially important for night pain, as a good night’s sleep is key for recovery from back pain. A physical therapist may help to determine the likely cause of low back pain and optimize your function.

There is little to no association between the extent of tissue damage and severity of pain. Although it may seem logical that severe back pain means more damage to the tissues, this is not the case. Many times the exact cause of low back pain is not known.

diagram - back muscles / abdominal musclesPain arises in the nervous system and is complicated. Persistent or chronic low back pain can lead to:

  • changes in your nerve cells
  • changes in your balance
  • movement strategies to compensate for the pain
  • muscle tension and weakness
  • fatigue
  • insomnia, and
  • mood changes like stress, anxiety, fear, and anger.

Managing low back pain

Focusing on improving function is often more effective and realistic than efforts aimed at eliminating low back pain. To improve function, focus on movement which is nature’s best remedy for low back pain. Motion is lotion! Make lifestyle changes and choose activities that allow you to move with as little pain as possible. You may need advice from trained professionals to relearn how to move and to know which activities are best for you. Make the most of your daily routines to maintain your:

  • standing balance
  • spine, pelvis, hip, shoulder and neck mobility
  • strength, and
  • co-ordination.

Several factors determine the load on your spine;

  • where your spine moves and does not move (stiff areas)
  • the mobility of your hips and pelvis
  • the coordination and strength of your muscles
  • how you stand on your feet – do you put weight through your big toe or do you put weight on the outside border of your foot?
  • while the foot bone does not connect directly to the backbone, there is a connection between how the bones in your feet support your back.

Deep Abdominal Exercise - Turning Them On!

  • Lie down with knees bent and feet shoulder-width apart. Place your fingers as shown in the illustration. These are the muscles that you want to turn on.
  • Feel your deep abdominal muscles tense when you activate them. (Hold for 10 seconds. Relax. Repeat 5 times.)
  • To turn on or activate your deep abdominal muscles imagine:
    - drawing your belly button to the spine
    - drawing your hip bones together
    - exercising your pelvic floor muscles or stopping urine flow (Kegel)
    - walking into a glacier-fed river

Do not:

  • Poke your chin forward.
  • Hold your breath.
  • Expand your stomach like a balloon blowing up.
  • Suck in your stomach.
  • Arch your back.
  • Flatten your back (pelvic tilt).
  • Lift your rib cage up or out.
  • Twist the pelvis.
  • Shrug or round shoulders.

Turn on your lower abdominals frequently throughout the day. Activate these muscles, while sitting, standing, walking, lifting or doing sports. You cannot activate your deep abdominal muscles too much! Eventually, these muscles will turn on automatically, without your mental involvement.

As mentioned previously, the back muscles have different functions. The deep corset muscles support and are like a corset or muscular weight belt around your spine. This muscular system responds to small changes in your body’s position and it ‘contracts’ just before you move your arms and legs. In someone who has never had back pain, the deep muscular corset contracts automatically prior to limb movement.

However, once you have experienced back pain, regardless of what causes the pain, this complex deep muscle corset may not contract effectively or automatically prior to your legs or arms moving. The timing of muscles which support and protect the spine is delayed. You must consciously retrain and relearn how to use the deep abdominal and spinal muscles.

If this timing delay is not corrected, you are at greater risk for recurring low back pain. Even if your back pain settles, the timing of these deep muscles is not automatically restored. If you do not retrain the deep abdominal muscles, you will likely continue to have flare-ups of low back pain.

According to current research, treating low back pain includes retraining the timing and recruitment of the deep torso, pelvic and respiration muscles. A physical therapist can teach and guide you through progressive torso and buttock exercises specific to your needs. You may also have to learn to let go and let certain muscles relax!

The amount of effort required to turn on your deep muscular corset is similar to the force required to hold a pencil. However, the mental effort may be 110 per cent! Sometimes a physical therapist will use ultrasound imaging to give you feedback so you can see a visual image of your abdominal muscles. This improves activation and timing of your deep corset and pelvic floor muscles.

Preventing low back pain involves retraining the timing of the activation of these deep torso, pelvic floor and respiratory muscles, while restoring spinal, pelvic and hip mobility. Your goal is to activate your lower abdominals often during the day, such as when you are standing, sitting, walking, lifting or doing sports. You cannot activate your deep abdominal muscles too often as the goal is to have these muscles turn-on automatically, without you having to think about contracting them.

Core muscles include the deep muscle corset, pelvic floor, respiratory muscles, as well as the shoulder, abdomen, spinal and hip muscles. Essential exercises to strengthen your core focus on:

  • correct breathing
  • restoring spinal, pelvis, hip and shoulder movement
  • improving posture and spinal alignment
  • co-ordination.

Temporary use of back braces, sacro-iliac (SIJ or pelvic) belts, or taping, may help settle muscle spasm and give support while one retrains and conditions one’s core muscles.

It is important to stop compensatory movement patterns that result from low back pain. This requires awareness and focus. These patterns must be corrected to avoid building up stress on your spine. As well, to enjoy the lifestyle you choose, you will need to train and maintain your muscular coordination, endurance and strength!

Maintaining spinal mobility and fitness is a continuous commitment.

It is a daily habit. Core conditioning classes, some yoga classes, Pilates, tai chi, and aquasize are safe types of exercise that can maintain and improve your spinal health.

Understanding persistent or chronic pain is essential in managing back pain. Check out this excellent five minute explanation of pain from the University of Southern Australia:
Pain is in the Brain

on YouTube

Some people who have low back pain benefit from the following:

  • spinal mobilization or manipulation done by a physiotherapist, chiropractor or osteopath
  • acupuncture treatments
  • Gunn intramuscular stimulation treatments
  • massage
  • myofascial and soft tissue release treatments
  • breathing and pelvic floor muscle education and exercises.

With care and perseverance, low back pain can often be managed. You can do many things to improve your function and enjoy the best quality of life possible.

FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
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College of Family Physicans of Canada
Alberta College of Family Physicians
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