multifidus

5 reasons why you get back pain.

image There are many reasons why we get back pain. In fact the points raised above are merely what occurs when the musculo-skeletal system is out of alignment, I repeat, what occurs when the musculo-skeletal system is out of alignment. What does that mean? Well if you work on balancing structures then all of the above points can be managed and in many cases eradicated. When we breathe, sit, think and complete exercise inefficiently we start to compensate with a variety of muscles. So getting movement and structure analysed can help to determine mobility and motor control issues that need to be addressed.

If you are ever diagnosed with any of the factors above and are told that you should avoid exercise then ignore that specialists advice. One of the most important things in anything spine related that you can do is to exercise but you need to exercise correctly, understand what has caused these conditions and use a variety of therapy and exercise to rectify the faults. Here is a brief summmary of the points suggested above.

1. Sacro-iliac joint dysfunction- is one of the most common forms of back pain and one of the most commonly mis-diagnosed conditions, often mistaken for a disc herniation. Females are often more exposed to SIJ dysfunction and can often be resolved with mobilisation and exercise to support the extra width of the pelvic basin.

2. Facet (zygapophysial) Joint- is the main articulation of the vertebra and can often become dysfunctional due to the position of the spine as most of these conditions can. Mobilisation and improving recruitment of spinal muscles can help to improve the movement of the facet joints.

3. Disc Herniation- a common problem in those over 30 mostly in the lumbar spine (can occur in cervical/neck too) with pain often felt either locally or referring commonly along the distribution of the sciatic nerve into the back, glute, legs and feet. The nucleus of the disc, the hardened jelly like material between the disc can rupture causing compression of the spinal nerves and pain ensues. Flatter back people are more predisposed to herniations but rotational and lateral movements also contribute to herniations. Strengthening of the core muscles, particularly the multifidus muscles can help alleviate and remove pain. Sometimes restoring the natural lumbo-pelvic rythm can be effective in this condition too.

4. Stenosis- the hole created by the lateral structures of the spine, is the space where the spinal nerves exit. Often when there is instability, osteophytes, small growths of bone can occur to stabilise segments of the spine. A side flexion of the trunk can close down the space of the nerves exiting that vertebral segment too. This can cause irritation of that particular nerve. Once again understanding what structures are over and underworking can provide relief to this problem.

5. Spondylolisthesis- is a fracture of the pars articularis a part of the vertebra which causes a rotation (if one sided) and forward slippage of the vetebral body, which can create torsion of the disc, also placing pressure on the spinal cord itself. Some people are born with this fracture but rotational sports such as golf contribute to this condition. Rotation and flexion at high speeds can create the sheer responsible for this fracture but can easily be avoided with the right stretch, mobilisation and exercise program,.

There are many other causes of back pain all of which can be rectified or avoided with the right program. One thing to take away from this blog is that if you are experiencing pain then you need to change what you are doing. Don't worry pain is a communication from your body to change but find someone who can deal with structural issues decribed above. You may often find that the solution is with doing less but more intelligently.

1. Bogduk, N. Clinical Anatomy of the Lumbar Spine. Churchill Livingstone. 2003

2. Porterfield, J.A., DeRosa, C. Mechanical Lower Back Pain. W.B. Saunders Company 1991.

Is your functional training making you dysfunctional?

Buzz words of the last decade in the health and fitness industry were terms such as functional, core, ground reaction, Paleo, intermittent fasting etc etc. It is an easy approach for people to throw around these types of phrases, impressing clients without having a true understanding of what they really mean. Like many it took me some time to realise that to get people strong you need a combination of good therapy, improved movement patterns and ultimately lifting well.  The emphasis on functional training has contributed to increased facilitation patterns which contribute to musculo-skeletal issues, much in the same way that the circuit training phase of the 90’s did. Now there are increased loads and patterns of dysfunction by methodologies such as Boot Camps, Cross Fit, TRX classes, Endurance events and the like and more than ever, I (and my peers) am seeing the incidence of overuse injuries created by inhibition and facilitation from poorly constructed exercise programming.

Let’s take this guy below. His exercise using the TRX must be functional , it must be making him strong right? Well no and here’s why? This gym dude like millions of others makes the mistake of utilising balance with strength as an exercise. The net effect of this type of exercise is facilitation when there is instability without the ability to stabilise.

trxjpg

You can clearly note here a rounding of the upper back   and cranial extension caused by inability to stabilise using the cervical flexors, mid and lower trapezius.

Facilitated                                                                          Inhibited

Upper traps/Scalenes                                                     Cervical flexors

Levator Scapula                                                              Middle and lower trapezius

Pec minor and probably major in this case                    Latissimus dorsi

Sternocleidomastoid                                                      Subscapularis and other structures

The cervical extensors, upper traps and pec minor amongst other structures have the ability to disrupt breathing patterns, gait and decrease strength in patterns such as the squat and dead lift. Those who teach these type of exercises should be skilled in spotting movement dysfunction, inhibition and facilitation and understand strategies of how to correct these issues or at least understand that if you keep exercising in this way you will lead to breakdown of key stabilising structures.

Is it a ‘core’ problem?

The core is really the interaction of all the muscles in the body but specific attention has been paid areas such as the ‘inner unit’ which comprises of the Tranversus Abdominus (TrA), multifidus, diaphragm and pelvic floor and the outer unit which comprises of the abdominals and internal and external obliques which interlink with many larger muscles.  In reality these muscles work in tandem with other muscles to create structural balance.  Many people think that to train their core they have to blitz their abdominals, obliques and back muscles with intensity which creates dysfunction.

This is where common misconceptions occur. The core more often than not, needs to be recruited appropriately and that should occur with proper movement development and determining what other structures beyond the core (such as previous injuries) are prevalent. Many of these problems can occur as a result of many factors. Children who don’t develop crawling patterns, who are either rushed into walking or put into baby crawlers can be at risk in later life of poor breathing patterns and core dysfunction. The seated position is not great for the spine and muscles can develop inhibition as other muscles get overworked and the nervous system will always take the least path of resistance when it comes to movement and muscle activation. Additionally the seated position also helps to create inverted breathing patterns, which disrupts the stabilising capacity of core muscles.

Many people make the mistake of activating the TrA in all the time (or drawing the belly in), even when walking. This is a disaster as it creates facilitation of the accessory muscles of breathing, creating a forward head posture, rounded back and weak links in the chain from head to the toe. In fact in some schools of thought letting your belly out and pushing outwards  also increases abdominal pressure and stabilising mechanisms that are just as good if not better for ‘core’ recruitment. Sometimes we are so fixated about our weight that we constantly walk around with our belly drawn in…let it hang out I say.

References:

  1. DNS technique according to Kolar. Training Manual Rehabilitation School of Prague
  2. Hodges, P. W. Is there a role for Transversus Abdominis in Lumbo-Pelvic  Stability? Manual Therapy (1999) 4(2), 74±86
  3. Kolá, P. Importance of Developmental Kinesiology for Manual Medicine.1996
  4. Weinstock, D. Neuro Kinetic Therapy. North Atlantic Books 2010