Sim­ple tech­niques of­ten over­looked in bat­tling lower back pain

The Weekend Australian - Travel - - Health - CHRIS TZAR

AROUND 70 per cent of us will ex­pe­ri­ence re­cur­rent or chronic low back pain within our life­time, with about 80 per cent of th­ese cases iden­ti­fied as func­tional — that is, due to poor strength and range of mo­tion of spe­cific mus­cle groups. The ris­ing preva­lence of obe­sity is also con­tribut­ing to the in­creas­ing rates of chronic back pain com­plaints in the work­force.

Whilst there are var­i­ous treat­ment op­tions, strong de­bate has emerged against many treat­ments ear­lier con­sid­ered ef­fec­tive. A large-scale trial com­par­ing the ef­fec­tive­ness of surgery ver­sus non-oper­a­tive treat­ment for lum­bar disc her­ni­a­tion over a two-year pe­riod re­vealed no sig­nif­i­cant dif­fer­ences in out­comes be­tween ei­ther group ( Jour­nal of Amer­i­can Med­i­cal As­so­ci­a­tion 2006;296(20):2441-2450). While out­comes for both groups sig­nif­i­cantly im­proved and there were no ad­verse ef­fects as­so­ci­ated with ei­ther treat­ment, the non-oper­a­tive treat­ment in­cor­po­rat­ing ed­u­ca­tion, coun­selling, ac­tive ther­apy and anti-in­flam­ma­tory med­i­ca­tion is con­sid­er­ably less in­va­sive.

More re­cently, a re­view


in Neu­rol­ogy (2007;68(10):723-729) con­cluded that epidu­ral steroid in­jec­tions pro­vided lim­ited short-term re­lief (last­ing two to six weeks) but no long-term re­lief for radic­u­lar pain (lower back pain that ra­di­ates down the lower leg — also known as sci­atic pain). Ques­tions have been raised re­gard­ing the cost-ben­e­fit of such com­monly ap­plied treat­ments.

De­spite ex­ist­ing ev­i­dence for the treat­ment of low back pain, ac­tive based ther­apy or ex­er­cise ther­apy re­mains the most un­der­utilised op­tion. One area of ac­tive ther­apy treat­ment fo­cuses on strength­en­ing the core sta­bilis­ers of the lower back re­gion. This not only helps to pre­vent spinal in­jury but as­sists in the man­age­ment of chronic back con­di­tions.

The core, the lum­bar spine, the trunk — all are com­mon terms used to de­scribe the area be­tween the ribs and the hips. Com­pris­ing five ver­te­brae and lay­ers of in­ter­con­nected mus­cle, the trunk forms the cen­tre of grav­ity of the body and has far more mo­bil­ity than the rest of the spine and up­per body. It can flex (bend for­ward), ex­tend (bend back­ward), lat­er­ally flex (lean to side), and ro­tate (as when twist­ing to look be­hind over your shoul­der). We are of­ten re­quired to per­form th­ese move­ments si­mul­ta­ne­ously in daily tasks.

When you reach to pick up an ob­ject be­side your feet, for ex­am­ple, your lum­bar spine both flexes and ro­tates (bends and twists). This mo­bil­ity makes the trunk (or lum­bar spine) vul­ner­a­ble to in­jury. And it is not just the weight of the ob­ject lifted that places stress on the spine, but also your up­per body — which equates to about half your to­tal body­weight.

The greater the mo­bil­ity of a joint, the more sta­bil­ity and sup­port it re­quires from sur­round­ing struc­tures. In the case of the trunk, th­ese struc­tures are a group of mus­cles known as core sta­bilis­ers. Core sta­bilis­ers work to hold the spine in the cor­rect po­si­tion via small con­trac­tions known as static (or ‘‘ iso­met­ric’’) move­ments. Healthy func­tion­ing core sta­bilis­ers are ac­tively re­cruited dur­ing light or vig­or­ous ac­tiv­i­ties, whereas poorly func­tion­ing core sta­bilis­ers dis­play de­layed re­cruit­ment pat­terns, pro­vid­ing lim­ited sup­port for the lum­bar spine and pos­ing it at risk of in­jury.

The fol­low­ing ex­er­cise is one of the most ba­sic of an ac­tive ther­apy in­ter­ven­tion, but will help de­velop co­or­di­na­tion and en­durance of th­ese mus­cles — and in­crease their ef­fec­tive­ness. Start by ly­ing on your back with knees bent. Your lum­bar spine should be nei­ther arched up nor flat­tened against the floor, but aligned nor­mally with a small gap be­tween the floor and your back. This is known as the ‘‘ neu­tral’’ lum­bar po­si­tion.

Breathe in deeply stom­ach mus­cles.

Breathe out and, as you do so, draw your lower ab­domen in­wards as if your navel is mov­ing to­wards your spine — a move­ment that you would per­form if you were zip­ping up a tight pair of pants.

Hold the con­trac­tion for 10 sec­onds whilst




your re­main­ing re­laxed, al­low­ing your­self to breathe nor­mally as you hold the ten­sion in your lower stom­ach area. Re­peat 5-10 times. Do not tilt your pelvis or flat­ten your lower back, as this means you have lost the ‘‘ neu­tral’’ po­si­tion you are try­ing to learn to sta­bilise. Nor should you hold your breath, as this means you are not re­laxed. Vari­a­tions: Learn­ing th­ese tech­niques may re­quire from one ses­sion to one month. Once you have mas­tered ab­dom­i­nal hol­low­ing ly­ing on your back, prac­tise it ly­ing on your front, kneel­ing on all fours, sit­ting and stand­ing. In each po­si­tion, en­sure your lum­bar spine is neu­tral be­fore you per­form the hol­low­ing move­ment.If you cur­rently suf­fer from back pain, con­sult your lo­cal ex­er­cise phys­i­ol­o­gist or phys­io­ther­a­pist be­fore com­menc­ing an ex­er­cise pro­gram. Chris Tzar is an ex­er­cise phys­i­ol­o­gist and di­rec­tor of the Lifestyle Clinic, Fac­ulty of Medicine, Univer­sity of NSW

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