Simple techniques often overlooked in battling lower back pain
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