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How to Cure Back Pain

Introduction

In the musculoskeletal system, we have two types of muscle groups, gross or prime movers, and fine or supportive movers. When prime movers and supportive movers work harmoniously together we can, in essence, call this a kinetic chain. Biomechanical dysfunctions start to occur when there is a disconnect between the motor control centers in the brain and the muscles.

With that disconnect comes injuries in the form of microtrauma due to gross muscle groups being inhibited and fine muscle groups being overstimulated or over-utilized. To fix this we have to work backward to solve the problem. We need to stimulate underactive muscles in order to inhibit and relax overactive muscles, we will refer to this as neural reconnection.

When the kinetic chain starts to become disrupted individual muscles become inhibited or overactive within that kinetic chain. For example, muscle imbalances at the shoulder comprising of an overactive pectoralis minor will drag the shoulder forward and down, rounding the shoulders (swimmer’s posture or swimmers shoulder). Now with poor biomechanics present, the body will continue this path of least resistance.

What we will learn is how to fix lower back pain thru some of these techniques. Things that can help fix lower back pain are muscle inhibition techniques for those muscles that are overactive, muscle lengthening techniques for muscles that have become short, and muscle activation techniques to awaken those short muscles.

This will be a basic guide to beginner level exercises for fixing back pain. We will presume that most readers are in severe pain and at the last straw is about to break your back and cause more back pain. While there are more advanced techniques that I utilize in my office, beginner level techniques are a SAFE way and the perfect starting point for every athlete and/or untrained person. Liebenson (2000b) states: The most important thing to remember about safe back training is ‘that in acute stages the exercises should reduce or centralize the pain, and in the subacute recovery stage they should improve motor control’.

Before we move on. You may be asking yourself, How do I know which muscle is overactive or inhibited? That’s the difficult part and where a chiropractor can help. Let’s first go over some characteristics that we may find in an inhibited muscle and an excited muscle. Here are the general assumptions:

Inhibited Over-Stimulated
Short Long
Tight Flexible
Strong Weak

While these assumptions are every so often correct, they are misleading for a 3  reasons:

  1. Tight muscles don’t always mean the muscle is tight.
  2. A short muscle is not indicative of over stimulation and strong.
  3. A long muscle is not indicative of weakness or poor utilization or recruitment.

First, without getting into too much detail. Two important sensory receptors to know about are the Golgi tendon organ (GTO) and Muscle spindles. GTO receptors are in the tendons, at both the origin and insertion points of muscle, which then attaches to the bone. GTO receptors sense changes in muscle tension and at which that rate of change occurs (Magill, 2007).

Muscle spindles receptors are located throughout the muscle and primarily detect length changes and the rate of length change (Magill, 2007).  When muscle become active and produce a force upon a tendon, the GTO will respond to the distortion applied to it and send a signal to the central nervous system (CNS), thereby regulating the amount of tension and force developed. When rapid muscle lengthening occurs, muscle spindles respond by sending a signal to the CNS, producing a contraction to the muscle being lengthened. These are protection mechanisms preventing injuries such as torn muscles and ruptured tendons.

Secondly, to cover points 2 and 3, the ability of a muscle to generate force are dependent on the muscles resting length. What does that mean? If, a short muscle has too much overlap of its filaments or a long muscle doesn’t have enough overlap, both could produce weak test results when compared to a muscle at ideal resting length (Sahrmann, 2002).

Muscle Inhibition Techniques

In skeletal muscles, the neural connection may at times become over stimulated between the brain and muscle thru the central and peripheral nervous system. This leads to biomechanical dysfunctions if not corrected early. Generally, there are no signs until pain shows up. Where one muscle group is overactive another is inhibited. To combat this we use Muscle Inhibition Techniques (MIT).

MIT’s are often referred to as trigger point therapy or myofascial release. Within this category, there are varying forms of the same concept, applying pressure to a painful or “knotted” muscle to inhibit the overactive muscle. This method can be performed with various cheap pieces of equipment such as a foam roller, golf ball, lacrosse ball, or tennis ball. You can even start big with the foam roller and work down to small with the golf ball if you are able to handle the pressure. In the video below, we will go over the common areas to perform MIT’s.

To Foam Roll the Lumbar Spine:

  • While sitting on the floor with your knees bent, line up the foam roller parallel to your hips.
  • Slowly lower yourself onto the foam roller.
  • Because of compressive and shear forces that can occur in this position, it is best not to lay completely flat on it.
  • Slowly rotate onto one side of the lumbar paravertebral muscles, supporting yourself with your legs and hips.
  • Next slowly inch the foam roller in the desired direction, either up toward your shoulders or down toward the hips
  • Once you find a tender spot slowly oscillate up and down about 1-3 cm rolling it out, as the name suggests.
  • Next, if desired, keep the foam roller on the tender spot for 10 – 30 seconds.
  • Finally, while keeping pressure on the tender muscle, incorporate some movement of the leg and hips. With the leg that is on the side, you are foam rolling, slowly slide it into a straightened position and slowly bring it back toward your hip. Your other leg should be bent for support.

To Roll the Lumbar spine with a tennis ball:

  • While lying on the floor with your knees bent, line up the tennis ball under one side of your lumbar paravertebral muscles
  • Next slowly inch the tennis ball in the desired direction, either up toward your shoulders or down toward the hips
  • Once you find a tender spot in the muscles, slowly oscillate up and down about 1-3 cm.
  • Next, if desired, keep the tennis ball on the tender spot for 10 – 30 seconds.
  • While keeping pressure on the tender muscle, incorporate some movement of the leg and hips. With the leg that is on the side, you have placed the tennis ball, slowly slide it into a straightened position and slowly bring it back toward your hip. Your other leg should be bent for support.
  • Finally, once the heel has come back to the hips, lift your foot off of the floor bringing the knee toward the chest and then lowering it.

 To Roll the hip muscles with a tennis ball:

  • While lying on the floor with your knees bent, place the tennis ball under one hip
  • Next, lean back onto either the hands or elbows and slowly roll toward the outside of the hip
  • Once you find a tender spot in the muscles, slowly oscillate back and forth over it about 1-3 cm.
  • Next, if desired, keep the tennis ball on the tender spot for 10 – 30 seconds.
  • While keeping pressure on the tender muscle, incorporate some movement of the leg and hips. With the leg that you are treating, slowly slide it into a straightened position and slowly bring it back toward your hip. Your other leg should be bent for support.
  • Finally, with the knee in a bent position and over the tender area, slowly rotate the hips inward and outward.

Muscle Lengthening Techniques

There are a few ways in which we can lengthen muscles to help lengthen short muscles. It is best to first identify which muscles are short. If you are tight throughout because you never stretch, we can stretch bilaterally. But, if you have a significant difference in length from one side compared to the other we should stretch unilaterally to balance. Take for example the hamstrings, you may stretch one leg at a time and notice that there is perhaps a 15 degree or more difference in flexibility, the deficient side is the one we would be trying to address.

With that said, before we do any muscle lengthening we need to warm the muscles up. How do we do that? We need to perform some activity that gets those muscles moving for at least 5 minutes. Generally, a nice short brisk jog around the block works or even bodyweight squats as both of these methods activate all of the hip and lumbar musculature. Stretching should be performed after blood flow is recruited to the areas of intent to reduce injury risk.

The muscle groups we are going to address are:

  • Anterior hip flexor group (i.e. Psoas, Iliacus, Rectus Femoris).
  • Posterior hamstrings/adductors (i.e. Biceps Femoris, Semitendinosus, Semimembranosus, Adductor Magnus, Brevis, Longus, and Gracilis).
  • Rotator and Extensor group (i.e. Gluteus Maximus, Medius, Minimus, Obturator externus, Superior Gemellus and Quadratus Femoris).
  • Erector spinae (i.e. Iliocostalis, Longissimus, and Spinalis)

 

Two ways we can lengthen the hips are through Static Stretching and Post-isometric Relaxation (PIR).  Most of us know what a static stretch is. Holding a muscle in a lengthened state for a short period. But what is PIR?  PIR brings a muscle to maximum length, and then contracted for a short duration, no more than 10 seconds. After 10 seconds, the muscle is relaxed and then taken further to its new length.

The two stretches that are versatile and simple we will be going over are:.

Lunge Stretch (To stretch the hip flexors):

With the front leg, place the heel under or slightly forward of the knee.
The back leg is stretched back and away from you.
Slowly lower your hips into the stretch.
To incorporate PIR approximate the back knee and the front heel.
Hold for 5 – 10 seconds.
Relax the contraction and then take the hip into its new lengthened position.

Adductor Stretch:

In the same position, you can now stretch the adductors by simply rotating the back foot toward your opposite hip.

To incorporate PIR in this position you again are trying to approximate your front foot and back knee. Hold for 5 – 10 seconds. Relax the contraction and then take the hip into its new lengthened position.

Seated Hip Stretch

For this stretch, we will be sitting on the floor with your arms reaching back to support you. Cross one foot over and onto the opposite knee. If you have pain in the knee, to reduce tension on the knee joint that is being crossed, simply lower or stretch out the supporting leg.

Even with the new position, we can still get a good hip stretch. To get a good stretch actively try and push the lower part of your chest forward. We do not want to round our back or dip our chest because if we start bringing the bottom knee toward our chest and continue to round our back, the stretch angle doesn’t change. So, sit up tall when doing this and all stretches.

To incorporate PIR into this stretch, push the supporting knee into the supported ankle. Hold for 5 – 10 seconds. Relax the contraction and then elevate the supporting knee toward the chest without changing your posture.

Seated Hip Stretch

The video has a more in-depth tutorial.

Muscle Activation Techniques

When muscles become dormant or underutilized we need to stimulate them to become more active. The best and most obvious way of doing that is thru strengthening. We have to understand that the body  works in three different planes of motion:
The Frontal plane – an imaginary line cutting the body into a front and back half.
The Sagittal plane – an imaginary line cutting the body into a left and right half.
The Transverse plane – an imaginary line cutting the body into a top and bottom half.

With that said, when movements occur they occur in various combinations of these planes of motion. Therefore, when rehabbing the lower back for pain or other joints for pain, we do need to address all planes of motion.
Why? Because you are only as good as your weakest link.

Below are a few beginner level examples of strengthening rehab exercises to help stop your back pain.

In order to strengthen the posterior chain as a whole, we will start with the bird dog exercise. This is a great exercise that tests one’s core strength and stability. If you are shaky are wobbly on this exercise, it makes sense why you have back pain. This exercise addresses many facets of core and lower back strength. This exercise activates the Transverse abdominis which is the deepest abdominal muscle. While it is true that the Transverse abdominis is vital to back and core health, the muscle also has the effect of pulling in what would otherwise be a protruding abdomen (hence its nickname, the “corset muscle”). https://en.wikipedia.org/wiki/Transverse_abdominal_muscle
This exercise will also address the posterior oblique sling, which encompasses (from top to bottom):

  • Lower Trapezius
  • Serratus Posterior Inferior
  • Latissimus Dorsi
  • Thoracolumbar Fascia
  • Lumbar Multifidi
  • Contralateral Gluteus Maximus and Medius
  • Contralateral Hamstrings

To perform the bird dog exercise:

  • Begin on your hands and knees with your knees positioned directly beneath your hips and spread apart about 12 inches. Place your hands directly beneath your shoulders with them spread apart about 12 inches.
  • Tighten your abdominal muscles pulling your belly button into your spine (not sucking in your gut). Maintain a neutral spine, keeping your back and pelvis neither tucked under you nor hyperextended.
  • With one are reach forward and slightly above shoulder height. With the opposite leg, kick it back while trying to elevate the thigh to hip height or slightly above it.
  • Maintain your core tightness thru the movement. Do not allow the belly to sag and hyperextend the hips. Remember, the Spine likes to stay neutral.
  • Lower your arm and leg back to the starting position and repeat on the same side.
  • Complete 6 to 8 repetitions before switching sides.

bird dog exercise

Next, we will look at the side lunge. This is a great exercise to address both sagittal lumbopelvic hip strength and frontal lumbopelvic hip strength. When done correctly, the entire hip is strengthened as a whole. This will also address the posterior chain comprised of Gluteus Maximus, Gluteus Medius, the Lumbar Multifidi and Piriformis.

  • Stand with feet parallel and hips distance apart.
  • Position your dumbbell or kettlebell where comfortable to help you maintain balance. I often position it at chest height to address posture in the process.
  • Contracting your core for stabilization.
  • Step to the side while keeping both feet facing forward and the weight of your body on your heels.
  • Once you have placed your foot, hinge at the hips and push them backward.
  • Now shift your weight over the top of the foot until your shin is vertical and your knee is directly in line your toes. Preferably any of the toes 2-5.
  • At this point, your opposite leg should be fully extended with your body weight firmly distributed over the bent leg.
  • Push up with your leg bearing the weight and return to the starting position.
  • Repeat the movement 6-10 times.

Common faults when performing a side lunge are individuals may step far too wide or they allow their knees to collapse, putting the knee at risk.

side lunge with kettlebell

Functional Dynamic strength

The two exercises provided address 1 to 2 planes of motion. Functional Dynamic strength addresses all 3 planes of motion and incorporates tri-plane unstable surfaces. The end goal for this type of training is preventing an excessive instability and providing proprioceptive stimuli. This creates an overall functioning training environment to prevent injury by continuing to strengthen the Gross motor muscles and fine motor muscles creating overall stability. I don’t recommend functional dynamic strength training unless you are functionally sound and are in later stages of rehab, or are in season for a sport and are trying to prevent future injuries. An example of functional dynamic strength would be single leg lunges on a cushion with a rotary medicine ball throw, or a bosu ball squat with medicine ball throw. I recommend seeing a professional to evaluate you before attempting this type of training.

How Can a Chiropractor Fix My Back Pain?

Chiropractors function to improve more than just back pain. Chiropractors help improve posture, strength, flexibility and overall range of motion. When seeking a chiropractor, it is best to find out how they treat their patients first. For one, they should not have a cookie cutter approach and have a Ford Motors type treatment, where each person moves from station to station until everything is complete. The chiropractor should be well rounded in their approach, incorporating strengthening physical therapy type exercises, stretching, chiropractic adjustments, myofascial release such as Active Release Technique, and perhaps a modality to relieve acute pain. The best chiropractors incorporate all of these and utilize them as needed and vary each one from treatment to treatment and may utilize one aspect more than the other in different phases of care. Be certain in what you want your outcome to be. Some people want to just be out of pain, some want a complete lifestyle change, while others may just want an adjustment because that’s what we are known for.

Whatever your goals are to eliminate pain, when seeking a chiropractor you may want to ask:

  • What is your philosophy?
  • How do you treat each patient?
  • How long before I start feeling better?
  • What if I don’t get better?
  • Will I need surgery?

If you ask these questions, you will most certainly find the right chiropractor for you.

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