LOW BACK PAIN: WHAT ARE THE BEST STRATEGIES TO TREAT AND REHAB TO BE PAIN-FREE AND STRONG

BUILDING THE FOUNDATION: THE DEEP CORE STABILIZING SYSTEM
​Annemarie Alf, PT, DPT, CSCS, SFMA

Back problems are slightly more common in adult women than men; nearly 55% of the adult population suffers from LBP.

​What are the symptoms of lower back pain?
Symptoms of lower back pain can come on suddenly or appear gradually. Sometimes, pain occurs after a specific event, such as bending to pick something up. Other times, you may not know what caused the pain.

Pain may be sharp or dull and achy, and it may radiate to your glute or down the back of your legs, which may or may not be sciatica. If you strain your back during an activity, you may hear a “pop” when it happened. Pain is often worse in certain positions (like bending over) and gets better when you lie down.
Other symptoms of lower back pain include:

• Stiffness: It may be tough to move or straighten your back. Getting up from a seated position may take a while, and you might feel like you need to walk or stretch to loosen up. You may notice decreased range of motion.
• Posture problems: Many people with back pain find it hard to stand up straight. You may stand “crooked” or bent, with your torso off to the side rather than aligned with your spine. Your lower back may look flat instead of curved.
• Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably.  Muscle spasms can cause extreme pain and make it difficult or impossible to stand, walk or move.

What causes lower back pain?
Many injuries, and conditions can cause lower back pain. They include:

• Strains and sprains: the most common cause of back pain. You can injure muscles, tendons or ligaments by not moving well or properly.
• Fractures: The bones in the spine can break during an a specific incident, or from overuse such as spondylolysis.
• Spondylolisthesis: This condition causes the vertebrae in the spine to slip forward. IT leads to low back pain and often leg pain as well.
• Disc problems: Discs basically act as cushions between the vertebrae.  Discs can bulge from their position in the spine and press on a nerve- herniated disc. With age, disks can get flatter and offer less protection, aka degenerative disc disease.
• Structural problems: A condition called spinal stenosis happens when the spinal column is too narrow for the spinal cord. Something pinching the spinal cord can cause severe sciatic nerve pain and lower back pain. Scoliosis (curvature of the spine) can lead to pain, stiffness and difficulty moving.
• Arthritis: Osteoarthritis is the most common type of arthritis to cause lower back pain. ​

BUT did you know that movement, exercise and Physical Therapy are the BEST treatments for Low Back Pain?
​Rest, meds and ice are NOT the answer.

Do you know how to breathe? Did you know it could improve your performance and decrease your pain? Learning how to activate your diaphragm and creating intra-abdominal pressure will lead to increased activation of the deep core stabilizing system.  This is key for protecting the spine and leading to improved movement patterns and therefore increased power and performance overall. 

Core stabilization is accomplished through precise coordination of these muscles to generate intra-abdominal pressure (IAP).  This is regulated by the central nervous system- our brain.  Our sagittal stabilization begins at 6 weeks of life.  Our spinal (core) stabilization is attributed to muscle complex called the Deep Stabilizing System of the Spine (DSSS). 
What is the deep spinal stabilizing system?  It is more than just the ‘deep muscles.’
Deep Spinal (core) stabilization includes: multifidi, deep neck flexors, diaphragm, abdominal wall, pelvic floor.  When these muscles are automatically activated prior to movement, a stable base is generated.  In proper stabilization, activity does not involve only one muscle but the whole chain working together. Functional stabilization is necessary for safe, purposeful movement.

How to create proper IAP: intra-abdominal pressure?
-->  It’s distribution occurs with correct activation of diaphragm. 
1. Physiological movement of the diaphragm should be part of all movement and exercise. 
2. Increases equally in all directions
--> The ideal position of the Spine, Chest, and Pelvis = stacked/ parallel Do NOT want ‘open-scissors’ of the diaphragm OR a rib- flare.
Posture and respiration form one functional unit.
Diaphragm has 3 functions:
1. Respiratory 
2. Postural/ stabilizing function
3. Coordination of both


Keys to Success: Achieving sagittal stabilization:
1. Spine axially elongated/ uprighted;
2. Chest in expiratory position (rib cage down);
3. Parallel position of diaphragm and pelvic floor;
4. Equal distribution of IAP independent on respiration;
5. Equal activation of abdominal wall

In order to improve and achieve optimal movement:  Quality> quantity.  Muscles must be trained in both their stabilization and dynamic (movement producing) functions.  Movement efficiency = optimizing the distribution of internal forces of muscles that act on each segment of the spine and/ or any other joints or segments
ANY PURPOSEFUL MOVEMENT IS PRECEDED BY THE AUTOMATIC ACTIVATION OF THE POSTURAL STABILIZERS.

“If breathing is not normalized- no other movement pattern can be” – Karel Lewitq

GOT BACK PAIN???
Want an evaluation/ assessment of your ability to create IAP and activate you diaphragm for stability prior to movement?  Email us at: INFO@olympusmovment.com to schedule an appointment.
www.olympusmovement.com

References and images:
www.rehabps.com
https://www.youtube.com/watch?v=hp-gCvW8PRY
www.athleteenhancement.com
https://my.clevelandclinic.org/health/diseases/22325-back-pain
https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain

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