Remedial Exercise for Lower Back Pain

Chronic Low Back (CLB) pain?

Let’s understand the core muscles and how to exercise them for maintenance and stability of the low back.

Out of all the injuries or chronic pain issues, CLB ranks within the top 3 of what I treat in my practice. Why? Past sports or car injuries, occupations with high physical demand, and improper lifting. From my perspective though, the #1 reason is POOR POSTURE- leading to weak and imbalanced core muscles. Core strengthening is all the buzz these days for many reasons but mostly because we just don’t engage core muscles frequently the way humans used to. We sit for long periods! Our bodies were not designed for so much sitting. Also, from a fitness industry standpoint, there has been a lot of techniques to ‘isolate’ a particular muscle group. Usually this is through weight machines, but what you gain in safety by using machines, you lose in core intelligence. Muscles do not work in isolation- we are not composed of parts! Luckily many ‘old school’ work out routines or exercise types are becoming trendy which are to gain back core intelliegence (eg. Crossfit, yoga, boxing, martial arts etc.).

When talking about core I am referring to the following shaded areas:

First let’s discuss the anatomy of the lower back. Low back usually refers to the lumbar spine, last 5 vertebrae of the spinal column. I also like to include the sacrum just below and the two joints it forms with the hip bones as this a major source of pain in people’s low back.

The musculature is as follows:

Superficially speaking and the ones I treat the most as they are palpable are erector spinae (3 of them), Quadratus lumborum, thoracolumbar fascia, gluteus medius. However when it comes to lower back muscles and what can refer pain in and around the area, it could be any one of the muscles of the mid to low back, glut area (hips) or anterior hip and hip flexors. The next 3 diagrams illustrate all these areas that are concerned with lower back as they either directly or indirectly affect that region and can cause pain.

Three types of back muscles that help the spine/core function are extensors, flexors and obliques.

•The extensor muscles are attached to the posterior (back) of the spine and enable standing and lifting objects. These muscles include the large paired muscles in the lower back (erector spinae), which help hold up the spine, and gluteal muscles.

•The flexor muscles are attached to the anterior (front) of the spine (which includes the abdominal muscles) and enable flexing, bending forward, lifting and arching the lower back.

The oblique muscles are attached to the sides of the spine and help rotate the spine and maintain proper posture.

Another key structure in low back pain is the hamstring muscles, the large muscles in the back of the thighs. Patients with tight hamstrings tend to develop low back pain, and those with lower back pain tend to develop tight hamstrings.

Back Muscles and Lower Back Pain

When the facet joints or certain other structures in the spine become injured or inflamed, the large back muscles can spasm and cause low back pain and marked limitation in motion. Why does this happen? For the same reasons mentioned above but also overuse, overlifting and bad posture!

Physiology of Lower Back pain

When the facet joints or certain other structures in the spine become injured or inflamed, the large back muscles can spasm and cause low back pain and marked limitation in motion. An episode of lower back pain that lasts for more than two weeks can lead to muscle weakness (since using the muscles hurts, the tendency is to avoid using them). This process leads to disuse atrophy (muscle wasting), and subsequent weakening, which in turn causes more back pain because the muscles of the back are less able to help hold up the spine.

The theory also is that tight hamstrings limit motion in the pelvis, so the motion gets transferred to the bottom lumbar motion segments and increases the stress in the low back. Rehabilitation focuses on strengthening the muscles and stretching the hamstring muscles.

Relationship among Muscles, Posture and Low Back Pain

Muscle strength and flexibility are essential to maintaining the neutral spine position. Weak abdominal muscles cause hip flexor muscles to tighten causing an increase in the curve of the low back. An unhealthy posture results when the curve is overextended called lordosis or swayback. Proper posture corrects muscle imbalances that can lead to low back pain by evenly distributing weight throughout the spine.

Lower Back Pain Exercises

Back muscles—like any other muscle in the body—require adequate exercise to maintain strength and tone. While muscles like the gluteals are used any time we walk or climb a step, deep back muscles and abdominal muscles are usually left inactive and unconditioned. Unless muscles are specifically exercised, back muscles and abdominal muscles tend to weaken with age, gravitational pull and being in a seated posture for long periods of the day (such as sitting at a computer or driving).

Chronic stress can also lead to muscle weakness and back pain. Stress causes back muscles to tighten in a fight or flight response, depriving muscles of energy needed to support the spine.

So finding a balance between strengthening the weakened structures and stretching the tight is necessary for maintaining good low back health.

For an in depth list and diagrams of these exercises, please email me at ficko@sympatico.ca and I will send you a copy!