Geez My Back Hurts (again)
Low back pain can be very frustrating. Make sure you rule out any medical condition that may be underlying these symptoms. The next issue is to get a proper mechanical evaluation. Sounds practical but a lot of us are not getting the proper evaluation. So the help offered becomes anecdotal and lucky at best. Does this treatment or that treatment work best? What should I do to get better? Nothing seems to work, Egads!
Evaluate the problem
We often start with some type of complaint. In this case–my low back is hurting. If it is a chronic problem make sure you have looked at more than just mechanical problems. As said before, get clearance from your medical practitioner at some point. Also life style plays an enormous role here. Do not under value things like proper sleep and nutrition. Much more could be said on this but it will have to wait till later.
Here I am thinking about movement of the body through space. Specifically we pay attention to the pain most of the time (and sometime all the time). We need to also look at what movements and/or postures worsen and lessen the symptoms. This question of what (movements) make it worse and better are critical to evaluating and then re-evaluating this type of condition.
Simple categories can give practically anyone some guidelines to finding ways to change this condition. One of the most popular underlying reasons for Low Back Pain is related to flexion problems of the spine. I will try to keep it fairly simple here or make it as easy for myself to explain one of the popular scenarios we see today.
Flexion problems mean forward bending and sitting that causes an increase in the low back symptoms. In this post, that means that the opposite direction of extension or straightening of the spine does not cause pain and/or alleviates it. So one will usually notice that they are worse during or after sitting or when they lean forward to write/shave/clip toe nails, etc. Often they are better if they walk around or lie down flat. There are many variations to this problem and a good evaluation will figure it all out.
A good test that I include in my evaluation is a standing flexion and extension test (among many others). For this example, let’s say that in standing, you try to bend forward keeping your knees straight. Notice how far you bend before you first feel an aggravation of your symptoms. Note the distance down the leg you are able to reach and remember it. Repeat it a few times just to see if movement and symptoms improve, worsen or stay the same.
Again to keep it simple, let’s say that when you bent forward you were limited to reaching 4 inches below your knees before you said, “Ouch” (meaning it worsened your symptoms and you didn’t want to reach any farther). Now you have a movement paired with your symptoms. This is very important. This will become your simple re-test when you decide on a treatment.
A proper evaluation will include more movements to better determine what to do and what to not do. Again the evaluation is critical and the first step.
Now if you find yourself seeking treatment before you have done a proper evaluation, you will do yourself a disservice. Do not ask what exercise should I be doing until you have enough information related to movement. Exercise is not magic. It is movement based to help alleviate the stresses and strains of both pre-existing and current problems.
It is interesting to note that many pre-existing conditions (i.e. in this case a movement dysfunction) can go undetected for years without seemingly causing any problems. Once you have symptoms, especially chronic ones, you need to deal with many of these pre-existing conditions and patterns. That’s why it is so important to have a regular program of practice where you are always working with yourself and making discoveries and changes along this route of your movement in life. Otherwise we get caught at these stressful times of our lives without the proper tools or even the time to work on these multi-layered problems and movement dysfunctions.
So if in this case let us say we have someone who is flexion intolerant. This means as said above, that bending forward activities or postures aggravate their symptoms. So one approach would be to do backward bending activities. This makes a lot of sense. This simple advise would also include to stop doing or curtail/lessen the flexion activities and postures. Also one would find it very difficult to stop sitting all together. Then another strategy would be to do things that neutralized the effects of the flexion pattern many times throughout the day. One can use a combination of many of these strategies. They don’t all have to be used all the time. Many of us find a limited amount of time and focus for these practices. So be practical. Some days rotate in the things you were not able to get to on the previous day. Always do something everyday. Just modify it. Your retesting will show you if you are doing enough, too much or something needs to change.
Now in this case the evaluation showed some adjacent areas of mechanical dysfunction in the chest or thoracic spine. Also there were movement dysfunctions in the frontal plane (side to side movements vs the sagittal plane–forward/backward movement as described previously) of the hips and lumbar through thoracic spine.
An interesting note is that sometimes you do not want to start movement exercises in the place of the reported symptoms. It could be that a person is too irritable. It could be that greater movement dysfunctions exist in adjacent areas. It could be that through experience in certain cases one has found it better to start in these non-traditional areas. For a variety of reasons, we will be starting at increasing mobility of the adjacent areas (i.e. the thoracic/chest spine) and increasing the stability in the local and symptomatic area (i.e. the lumbar to hip area).
We will work at the start in the sagittal/front to back plane.
Here in the below video we start with prone lying on the belly/chest area first. In asana work this position is called Makarasana (crocodile pose). It is an excellent rest/restore and recovery position. The position in this case eases the symptoms and the diaphragmatic breath is just an excellent support for healing.
Next when one props up on the elbows, there is a further exaggeration of the backward bending nature of the spine. Remember that this position of backward bending does not aggravate the symptoms. But look in the video and note that the person finds it a bit uncomfortable. We do not eliminate the posture but just modify it with supportive pillows based on his symptoms. We always have to be ready to listen and modify based on movement and symptoms.
Next we work in the frontal and transverse (rotational) plane (exercises shown in side lying). Quickly we will using all the planes as it will be part of the demands of some of the movement re-education patterns/exercises.
Here in the below video is an interesting way that seems to be very helpful for a variety of mobility problems in the thoracic area. I have used this position for neck, shoulder and back symptomatic problems as they relate to movement dysfunctions of this chest/thoracic area.
As you watch the example of the below video keep in mind some of the above information. It is only one approach. There are many ways to start. My point here is that they should be based on an appropriate evaluation and constant retesting.
Sagittal Plane and Frontal/Transverse Plane Movement Training Video
The next two video are dealing with hip flexion (forward movement) and hip abduction (outward movement). Here the emphasis is on creating activation of the leg in the direction of limitation while the spine remains extended and stable. Quite a bit of stabilization training of the trunk, pelvis and lower extremity are emphasized in these next two videos.
Hip Flexion with 40 inch Band Video
Hip Abduction with 40 inch Band Video
The “ouch” of the pain usually cannot exist when you improve dysfunctional movement patterns. Remember one of the keys is to identify what movements and postures have set us up for these problems. Have a way of noting a movement or movements that correlate with worsening and improving your symptoms. Then use these as a way of retesting as you explore better ways of moving through life.
Moving in these ways described above is a good start. Let it be only a start. Start identifying lifestyle issues that mirror the same problems. All of this takes us on a journey deeper within ourselves. You can stop at any time or continue. A continued journey becomes an expanded practice. Discoveries that lead us to ourselves at deeper levels become an awakening of the richness of our true lives.
Good luck in wherever you practice leads you.