Understanding Low Back Pain
Understanding Low Back Pain.
By Chad S Brenzikofer
Low back pain is a worldwide epidemic affecting upwards of 80% of the adult population. Research shows that regardless of treatment intervention, first episode low back pain resolves itself in 80-90% of cases within 6 weeks. However, recurrence rates beyond 12 months are staggering at upwards of 80%. Think you are young and healthy and therefore immune to back trouble? Think again; studies show that adults aged 40-55 are most effected by low back pain.
Understanding your low back pain doesn’t have to sound as grim as the statistics above. Perhaps the most publicized of all low back pain conditions is disc herniation or prolapse. Disc herniation can be a very serious and painful event given its relationship to the nerve. It is also greatly misunderstood. Many people who have suffered non-traumatic disc herniation will explain how they simply rolled out of bed and “POP!” there goes the disc. They often think, how did “big-tough-super-athlete-me” get hurt doing something so easy? The answer is, most likely you didn’t. The event that is forever etched in your brain was simply the breaking point of the tissues that had been stressed and overloaded likely for years or even decades. Liken it to the tires on your car that slowly wear out and finally go flat.
Give vs. Restriction:
The concept of give and restriction is an easy to understand principle that allows us to better understand how parts can wear out. For example, a quad muscle that is too tight (restriction) can cause increased movement (give) in an adjacent structure.
The subject is performing the proper technique for stretching the quad. The small lumbar curvature is maintained and the pelvis is level (blue lines). The tight quad is restricting hip extension by 10-15° (Red lines). In Figure B, the hip angle has improved but only due to changes in lumbar and pelvic extension.
Perhaps even more commonly, people adapt to their “tight” hamstrings (restriction) by allowing increased flexion (give) of the lumbar spine. In this example, the hamstring is placedunder stretch to its limitation (mild stretch) while the pelvis and spine maintain proper position. In the next image, the hip angle is identical to the prior image although it provides the viewer with a perception of increased range of motion. This perceived improvement has occurred due to flexion of the entire spinal system combined with trunk and pelvic rotation, neither of which is good for your spine or hamstring.
When motor control deviations such as this exist, the treatment approach is simple… stop the give and mobilize the restriction. In low back pain sufferers, the “give” is generally the part that hurts. In non-low back pain subjects, identifying and controlling the “give” is the key to prevention. The best kind of medicine!
Core Stability vs Core Strength:
Wait, what? These aren’t the same thing? Although the mainstream fitness industry and often the medical community has made you believe these are synonymous, they are in fact quite different. Core stability refers to movements where the spine and pelvis are held motionless (or stable) while moving an extremity. Core strength, well, that’s…. the same thing! The distinguishing difference is effort or load!
Core stability refers to activities that require less than 25% (low threshold) of Maximum Voluntary Contraction (MVC). This muscle system is made up of 1-joint muscles (only crosses one joint) that are highly suited for postural control and enhancing joint stability. Core strength on the flip side requires more than 25% (high threshold) of MVC. This muscle system is ideally structured for movement. These muscles are large, 2-joint muscles that can produce tremendous force and torque, essential components needed for mobility.
These threshold and muscle system design differences are critical for 3 primary reasons. First, we know for fact that pain, inflammation and swelling changes muscle function and impacts stability oriented muscles more dramatically than strength/movement focused musculature. Second, the training or retraining of affected muscles depends heavily on targeting the right muscle and the appropriate threshold. Finally, there is countless research that clearly documents targeting and training the low threshold stability system correlates significantly with a reduction in recurrence rate and severity of low back pain episodes.
Both core stability and strength are critical to overall back well-being. Having a thorough understanding of these key principles is critical in providing a proper framework for developing an appropriate action plan for dealing with back pain or hopefully, preventing it in the first place.
-CB