Understanding and Overcoming Low Back Pain
A Series by Tim McCullough, PT
People with low back pain often develop abnormal movement and postural patterns. The first installment of the low back pain series examines a person’s reaction to low back injury.
Using Big Muscles For A Small Muscle Job
When a person hurts their lower back, the pain and inflammation sets off the alarm system of the body. The brain sends the message to protect the injured area and often we “brace” our trunk muscles to protect the back. This is a normal “adaptive” strategy with acute pain, and in most cases it allows the area to heal and settle. Normally, 80 to 90% of people recover from lower back pain in two or three months.
Very soon after back injury, the local deeper muscles of the back often turn off and atrophy. These muscles are called the multifidus. They are small muscles that are positioned perfectly to control small segments of the spine with as little as 1-3% of their max effort. The larger superficial muscles of the spine, (especially the paraspinals in the mid-back region) are not turned off by injury.
Even after the initial healing process is over, these muscles often become overactive in attempt to protect the spine. Even with light activities, they start working hard, creating high torque and load on the spine and keeping it irritated. Because these larger muscles are staying “on” all the time, it is difficult for the local more efficient back muscles to get back on track.
The abdominal muscles often have a similar reaction to low back pain. The upper abdominals brace and the lower abdominals and pelvic floor muscles can be inhibited. Similarly the larger muscles in the upper abdominal area create high forces and torque with their inefficient attempt to protect the spine.
Why does it hurt just sitting and doing light activities? Why doesn't it ever completely go away? Even though much of the healing is done, the body is still loading this sore tissue with heavy forces, because big muscles are being used for small muscle jobs. This pattern of muscle use can cause pain with the most basic activities such as breathing and sitting.
Although low back pain often goes away on its own, research has shown that it will return within the next twelve months in 80% of cases if one does nothing. It also has shown that a specific exercise regime targeting these smaller muscles reduces that chance by 50%. We know that 8-20% of the time the pain becomes chronic. The worst 5-10% of low back pain cases becomes chronic, and makes up 75-90% of all the costs spent on lower back pain.
The basics of correct posture
Back pain should be treated proactively - just because the pain goes away doesn’t mean you are back to normal. You are likely stiffer, have less posture awareness and are weaker in key muscles of your back. Take initiative and get checked to help prevent the likelihood of re-occurrence.
What role does the way you breathe play in understanding and overcoming lower back pain? Find answers in the next installment of Tim McCullough’s series on back pain.
Part 2 will be comming soon!
