Lumbar pain is common for most adults
Last week, I touched on the Primary Medical Exercise Training Condition of the upper back and cervical spine region.
Most often the pain and discomfort experienced in this area is related to a combination of weak posterior and tight anterior muscles of the back and shoulders, causing imbalance and resulting in stress and tension.
Irritating at best and debilitating at worst, the management of this condition is relatively simple with specific exercises designed to promote muscle balance along with postural awareness and education.
Moving down the spine to the lower back, it is extremely common for most (if not all) adults to experience lumbar pain at some point in their life.
For some, the pain is temporary and related to an identifiable “trigger.” Events like sleeping in a strange bed, sitting on a long flight, overdoing it in the garden or snow shovelling. For others, the pain can be chronic and something that needs to be managed long-term.
When a client comes to see me for exercise and identifies that they have “back pain,” I screen them to determine if they are appropriate candidates for exercise, or if they would be better suited for a physiotherapy or clinical setting.
We begin with an interview to determine if any “red flags” are present that would require medical clearance before proceeding.
Reds flags include: The presence of severe pain; Moderate pain that lasts more than six weeks; Lower extremity numbness or weakness; Foot drop, other lower extremity dysfunctions and/or loss of control of the bowels or bladder.
These are all signs pointing to a more serious health condition requiring medical attention, not exercise.
The majority of my clients do not have red flags and have more benign lower back discomfort that comes and goes and that they’ve learned to live with. Very often, they will have degenerative joint disease (DJD) that includes osteoarthritis and protruding or bulging discs. Their problems are exacerbated by poor muscle strength and lack of endurance. Combined with lots of sitting, inactivity and lack of postural awareness the predictable outcome is a “backache.”
The good news is that most back pain can be resolved within weeks using conservative measures that include exercise as part of the long term solution.
When exercising to manage back pain, there are two main outcomes to work toward; to decrease pain and to increase function. A healthy back program should, therefore, include strength and endurance exercises for the legs, strength and stability exercises for the trunk and a program that enhances cardiovascular fitness. Additionally, I would strongly recommend flexibility training for the hamstrings and hip flexors if the assessment has shown them to be tight.
Along with strength, flexibility and aerobic exercise, an effective back health program should also include these three things; Daily sitting time should be minimized, forward bending and twisting should be avoided and the idea of “spinal neutral” must be understood and applied.
When we think of “good posture,” we are really thinking of a spine that is held in a “neutral” position. There are three natural curves in the spine called the cervical, thoracic and lumbar, made up of 33 vertebrae (the bones in your back that are separated by soft, fluid filled discs) and neutral means that each of these curves is present with no flattening or arching.
When the spine is held in this position, the least amount of energy is required to maintain good posture, resulting in less stress placed upon the body’s tissues.
The point then of strengthening the muscles that support the spine is to help promote this position in all activities; standing, sitting, lying and especially when doing physical work or exercising.
If you are trying to manage low back pain, start by getting out of your chair more often, stand up straight, add a daily walk to your life and then find a qualified professional for an assessment and to teach you how to safely build the muscles that will keep your back in the safest possible position as often as possible.