Approximately 90% of low back pain is non-specific, meaning it has no identifiable cause using radiology and other tests. I believe there is always a cause, usually rooted in how you move, your lifestyle and past injuries (not necessarily of your back!).
Here at Physio Therapy Yoga, in North Sydney, we use a specific analysis to find the cause of your back pain and treat it. Finding the cause helps you prevent and reduce reoccurrences.
Do you get low back pain? Does it recur? You are not alone.
Studies of low back pain show that a loss of core muscle control and strength is associated with pain. When in pain, the body starts to move in less than ideal ways and can add to the pain.
Your nervous system may become “hypersensitive”. Long after the tissues have healed, the brain can still register pain because the nerve pathways for that area to the brain have become sensitised.
Mindful movement, strengthening and mobilisation are physical ways to treat pain, as well as focusing the mind on breathing or meditation can also help.
Muscular control of your body is a dance of flexibility, strength, awareness and skill.
To prevent strains and injury, the body needs to have the coordination to do the activities you do. It needs to balance stability and flexibility.
Each client has a body with a unique history of lifestyle and injury. Here at Physiotherapy Yoga in North Sydney, we use our observational and diagnostic skills to assess where and how your mobility (flexibility and strength) needs to be balanced for optimal movement.
What is core stability?
“Core Stability” is a widely misused term.
The concept of core stability probably originated in Australia in the 1990‘s with the famous work of Dr Paul Hodges. Dr. Hodges showed that the transversus abdominis (deep abdominal muscles) and multifidis (deep back muscles) turn on before, or within 50 milliseconds of, the shoulder muscle when subjects raised their arm up. The body did some preparation with activating these muscles before raising the arm. In low back pain subjects, Dr. Hodges showed that this motor control planning was delayed in the Transversus Abdominis (TA) and Multifidis muscles.
The exercise industry at large made some significant conclusions from this research. The idea that slow or weak transversus abdominis muscles are responsible for lower back pain has had millions of people training up their “TA”’s. Despite beliefs that core stabilisation exercises will “ wake up” this protective mechanism, studies have shown that TA training exercises do not in fact lead to abdominal muscles switching on “faster” in preparation for movement.
“Core stability” has been widely touted as a preventative/cure for chronic low back pain. Recent evidence from high quality randomised controlled trials have not shown core stability programs to be superior to other therapies such as general exercise. It may be that these exercises need to be preformed mindfully in the context of the movement you want to do, not as separate exercises like plank and sit ups.
Clinical evidence does show that spinal stabilisation exercises for patients with low back pain may help to decrease pain and disability and also reduce the recurrence of pain.
How can Spinal Stabilisation exercises work?
Individually tailored, stability programs can work for many people the following ways:
- Changing fear patterns, building trust and security in movement
- Building independence. Clients can reduce pain and improve their quality of life without reliance on passive treatment by therapists
- Breaking habits of ways of moving. Creating new patterns of movement provide a sense of ease and reduce stiffness
- Experiencing pain-free movement can “ break” the pattern of pain.
- Improved blood circulation reduces muscle spasm and improves muscular tone.
Why “core stability” exercises sometimes don’t work
There is evidence that lower back pain may sometimes be associated with increased co-contraction or hyperactivity of “core” trunk muscles, with an inability to relax muscles.
This is the experience of A-J Peterson, Principal Physio here at Physio Therapy Yoga that many people with long standing pain do not know how to switch off tense muscles.
A-J commonly sees people who have exercised and strengthened with minimal relief, some even getting worse. What is needed is to learn how to switch off certain muscles between workouts. The strengthening can happen concurrently.
Neuromuscular retraining involves relaxing particular muscles first, then strengthening particular muscles. These muscles are specific to each individual.
