Exercise and Low Back Pain
Jessica Seaton, D.C.
11022 Santa Monica Blvd.
Suite 440
Los Angeles
CA 90025
(310) 470-0282
E-mail: jseaton@aol.com
News item: In 1994, in a major departure from traditional practice, federal health officials [Agency for Health Care Policy and Research] said that expensive tests and therapies typically used to diagnose and treat lower back pain are largely useless. Instead they recommended over-the-counter pain medications, chiropractic manipulation and low-stress exercise, such as swimming or walking.
Roughly 85% of the general population experiences back pain at some point. Swimmer’s are not necessarily part of the general population, as we spend part of the time in water. However, some swimmers injure their backs while doing dry land activities, and occasionally particular swimming-related activities will lead to back pain. Anyone who has endured serious back pain, has most likely heard all their friends’ and neighbors’ back pain stories—what worked for them and what didn’t. The low back is mechanically one of the most complex areas of the human body. So, one person’s back pain may be due to different structures being injured than another person’s. The treatment for each type of back pain should be unique.
The eleven bones of the low back area consists of the lumbar spine (which are the first five vertebrae, or moveable segments, of the spine), the sacrum and the coccyx or tailbone (the bony area between the buttocks), the pelvis and, to a certain extent, the hips (femurs). Joints are surfaces where bone meets bone. Without going into excruciating detail, there are approximately 20 joints included in the low back area. Each joint is surrounded by ligaments. Ligaments act similarly to tape by holding the joints together, allowing movement in some directions while restricting it in others. Muscles not only move the bones, and consequently the trunk, but they also stabilize the trunk when the extremities are moving. The lower back area has large muscles extending more or less from the sacrum all the way up to the arms (i.e., latissimus dorsi), as well as many smaller muscles, which only span one or two joints. Between the vertebral bodies are discs, composed of fibrocartilage and a gelatinous substance. They act as shock absorbers. The spinal canal runs inside the vertebrae and includes the spinal cord and spinal nerve roots. The nerve roots exit between the vertebrae and travel to all different parts of the body. The nerves which exit between the lumbar vertebrae supply the buttocks, thighs, legs, feet, as well as organs, such as the intestines. Some of those nerves combine to make up the sciatic nerve.
A person experiencing low back pain may have damaged any of the structures mentioned above. Some of the most common problems are:
Joint dysfunction/subluxation: if the joints are not moving symmetrically in all possible directions, an imbalance is created. The locking itself may be painful or may lead to compensations, such as tight muscles, improper body mechanics, irritation of the structures adjacent to the locking, such as nerves. The lumbar facet joints and the sacroiliac joints often exhibit this problem. Chiropractic adjustments or chiropractic manipulation works well in treating this condition.
Muscle strain, which is essentially a tearing of the muscle fibers, is usually caused by something mechanical (lifting something too heavy) but may be caused by postural problems or joint dysfunction. Treatment includes initial ice, then ice and heat, and modalities such as interferential current and ultrasound. Chiropractic manipulation can treat any underlying joint dysfunction.
Disc herniations are usually more painful and debilitating than muscle strains. They often, but not always, are accompanied by pain shooting down the back of the thigh (sciatica). The large majority of disc herniations can be treated without surgery. Chiropractors are experts in treating such conditions. Treatment may include flexion/distraction, and a series of low back exercises.
Various exercise protocols emphasize different aspects of lower back rehabilitation.
Low back extension exercise protocols developed by McKenzie emphasize re-establishing a lumbar lordosis, or curve. The typical exercises include variations on the yoga position of cobra and up dog. Butterfly and breaststroke typically require good lower back extension and McKenzie exercises can help increase that extension. These exercises are also most often used with disc herniations.
Williams exercises, based on lumbar flexion and flattening of the back, were based on the observation that people in cultures that squat, rarely have lower back pain. Flexion exercises include lying supine and bringing one’s knees to one’s chest. In swimming, the flip turn increases lumbar flexion.
Lewit, a renown neurologist, placed more focus on muscle imbalances. Tight muscles, such as hip flexors (psoas, rectus femoris) inhibit weaker muscles, such as abdominal and gluteal muscles. Treatment is first directed toward stretching the tight muscles and then strengthening the weak muscles. Although certain patterns exist, each patient must be assessed individually. If your hip extensors (gluteus maximus, hamstrings) are weak, in order to achieve hip extension during the flutter kick in swimming, you will tend to use your lumbar erector spinae muscles (low back muscles). Needless to say, you will probably not be the swiftest flutter kicker, and you’ll probably experience low back pain after long kick sets. This may also be a contributing factor for cyclists experiencing lower back pain during hill climbing.
Janda, another well-known neurologist, emphasized proprioceptive exercises. Proprioception is the ability of the brain/nervous system to asses the position of a joint in space. Good proprioception is an integral part of balance. While most exercises are floor exercises (on stable surfaces), most people injure themselves when their body is off balance (i.e., pulling clothes out of the dryer). Proprioceptive exercises train the body to maintain stability and balance in different situations. These exercises are often done with Swiss balls or rocker-boards or foam rollers.
In my opinion, a good chiropractor will choose exercises based on the patient’s problems and activities. The best exercise program is individually tailored and follows an increasingly challenging progression.
