Spinal Strengthening with Physiotherapy
Recent estimates of the global prevalence of low back pain in adults showed on average 23% get pain once a month. It has been reported chronic back pain ranges from 10 to 20% of the population and rising.
Approximately 90% of low back pain is nonspecific, defined as pain symptoms with no specific cause. It always has a cause, it takes an experienced physiotherapist to find it. Find the cause(s) of your back pain and you can prevent or reduce reoccurrences.
Do you get back pain? You are not alone…
Studies of low back pain show that a loss of muscle control and strength is associated with the presence of chronic pain, and the body starts to move in less than ideal ways to avoid pain.
The nervous system may become “hypersensitive”. Even when the tissues have healed, the brain can still register pain because the nerve pathways for that area to the brain have changed.
Mindful movement, strengthening and mobilisation treats the body holistically, body and mind.
Motor control of the body is a dance of strength, awareness and skill. To prevent strains and injury, the body needs to have the skill set to do the activities you do. It needs to balance stability and flexibility to produce steadiness in all movements.
We all place different demands on our bodies. Each client has a body with a unique history of training and injury. A trained physiotherapist uses their observational and diagnostic skills to assess where and how your mobility (flsxibility and strength) needs to be developed for optimal function.
What is core stability really?
“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 huge extrapolations 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 self efficacy. Clients can reduce pain and improve their quality of life without reliance on passive treatment by therapists
- Breaking habits of ways of moving. Moving in new patterns creates new ease and reduces stiffness
- Experiencing pain free movement in an area previously identified to have pain associated with it 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 and hyperactivity of “core” trunk muscles, with an inability to relax muscles.
This is the exeperience of A-J Peterson, Principal Physio here at Physio Therapy Yoga. After 30 years of clinical exeperience she ses peopel who have been to the gym, done pilates to help their back pain to no avail. They have failed to learn how to relax particuloar muscles.
Neuromuscular retraining to first relax particular muscles, then strengthe others, specific to each individual body is the way forward.