So Michele's low back pain is better. Two weeks of significant discomfort has gone away. Her treatments consisted of ice, than heat once the inflammation went away, some electrical stim, and some cross friction massage to the stabilizing muscles of the spine. I used a lot of Isagenix Ageless Pain Relief cream while doing the muscle work and she loved it. Once things relaxed a bit with the musculature we were able to get some nice pelvic adjustments which took away the last bit of discomfort she was feeling at night.
So what happened? As I mentioned in the last newsletter it was an innocuous movement of straightening up from a seated position at the computer. But that's only part of what really happened, which was the stabilizing muscles of her spine didn't activate to support her back when she made that small movement. As a result, she strained her back. The discomfort she felt was largely due to the superficial musculature, or the mobilizers of the spine, splinting in an attempt to act as stabilizers.
We think of the spine, the bones, discs, and ligaments as being capable of handling the various stresses placed on it with our day to day activities when in reality these passive structures are quite weak. Research has demonstrated that discs and ligaments will fail, or become injured under only 9 kg of mechanical stress. Normal movements place the spine under 600-1,700 kg of stress. If these passive structures can only withstand 9 kg of pressure, obviously the role of the spinal stabilizers is tantamount to a healthy spine.
We have 3 layers of tissue in our trunks, each with a specific function. The deep layer is comprised of the discs, vertebrae, and ligaments. The function of this layer is to provide the nervous system with positional sense information of the various joints. It also provides the spine with a small amount of stability. The middle layer of the trunk consists of the medium size muscles responsible for stabilizing the spine and protecting the discs and ligaments from injury. The outer layer is made up of the large muscles which are responsible for motion of the spine and overall posture of the spinal column.
According to Rick Jemmett, BSC (PT), all spinal pathology leads to three inter-related problems. With either acute injury, or slow wear and tear of the aging spine, increased motion will develop at a spinal joint. This can be seen with the decrease in our disc heights as we age, or with ligamentous strain. At the same time, protective stabilizing muscles of the trunks middle layer will fail to work correctly as the nervous system develops an inability to activate or control these muscles in an optimum fashion. Outer layer muscles are than recruited to act as stabilizers at the level of the injured joint.
According to Jemmett "People with low back pain are unable to adequately activate muscles such as transversus abdominis and multifius in any movement situation, whether it is something as simple as sitting upright or as complex as a yoga posture. People with low back pain have a nervous system that continually compensates for its inability to properly activate middle layer muscles by excessively activating outer layer muscles in an attempt to protect the spine."
So does Michele (or you) really need to know this? You do if you want to get truly better. Research shows that is you don't retrain the two primary stabilizers of the low back, the transverses abdominis and multifidis, you have a 70% chance of recurring and progressively more severe episodes of low back pain. What I recommend for Michele, and for any patient with chronic or episodic low back pain are exercises based on the Australian Spinal Stabilization Method.
A study published in the journal Spine evaluated this approach to therapeutic spinal stabilization. The study showed that patients with acute, first episode low back pain corrected the nervous system error which caused their multifidus and transversus to work improperly. Even more impressive, the patients who were treated with the Australian approach were 12 times less likely to experience repeat back pain during the first year following the treatment. In short, if my wife takes the time to do her homework and re- boot her nervous system the chances of another episode are significantly less. If not, plan on another 2-8 weeks of pain and immobilization most likely to occur when she/you/me are most inconvenienced!
You can find many on-line instructions for working on these stabilizing muscles, however, they are very subtle and very difficult to do correctly. The key is in being able to activate these muscles to the exclusion of the more superficial musculature and in a proper progression of exercises and skills. Much like any physical activity, progression to more demanding skill sets is needed for long term success. If you would like to try this approach to either chronic or acute low back pain, give us a call and we will get you in and started.
