Chronic Lower Back Pain - 1

Although I mainly teach fitness classes, one of the sessions that I do is aimed in particular at those suffering from Chronic Lower Back Pain.  The class has a range from desk workers (staff and students) with general back pain, fit runners, ex-gymnasts, older people with “stiff backs”, hip/shoulder/knee replacements alongside those with more serious back issues that have been referred to this class by the hospital physio's and local GP's. This class has been running for 15 years now and its continued success demonstrates the value in strengthening your back - being brave enough to do it and wise enough to understand that by exercising we can at least reduce pain, improve mobility and change quality of life.  Here are some of the things that we do in the session.  

The back itself works like a kinetic chain – or if you want, that old song where one part of your body is connected to another. It is therefore important that we treat the back as a whole because I bet if you have lower back pain, you have tight neck muscles...

Poor posture is often blamed for a bad back. But posture is reliant on the muscles of the body to hold it in position – otherwise it is just a stack of bones. So if we work the muscles around the torso correctly, we can improve back pain, alleviate long term damage, restore quality of life through lessening pain and improving mobility.

Working with backs is slightly different to training other muscles in your body. This is mainly due to the fact that we want to work smaller muscles that support the position of one vertebra to the next, as well as working on “movement patterning” which looks at the nerve response of the muscle.  

These “positional sense” muscles sense movement away from the body, speed of travel and point of gravity within our body – and adjust the spinal muscles to hold the back in position. Those who have had bad backs will know that it might only be a small movement or direction that then causes the pain –  this is because the positional sense muscles don’t function properly once you have had any kind of back "trauma"  - and even sitting still for hours on end can even cause sufficient trauma.  A "spasm"  is created when the positional sense muscles are not firing correctly, and therefore all the surrounding muscles contract to support the spine. This causes endless problems of its own – the pain created by the compressed muscles is bad enough, but the compacted space reduces the blood flow and oxygen level in the muscle causing it to work anaerobic ally  - i.e. like going for the burn 24/7. Lactic acid builds and causes the muscle to “burn” in pain. Remaining Lactic crystallises and that is the nice crunchiness you can sometimes feel in the muscle when you are having a massage....

Effective back work needs to concentrate on slow, controlled and sustained movement away from the body that will cause these positional sense muscles and the core to fire correctly. It also has to include stretching to release over contracted muscles and help ease the build up and recovery from lactic acid. We need to include some  "movement patterning" to remind the muscles how and when to contract in sequence. This means that when you get up from a chair bend down to do your laces up or even sneeze – the movement is easy and pain free. Mainly though it has to contain bravery and confidence – because working the back will cause the muscle to feel the contractions the same as doing squats and can often cause DOMS much like other exercises. The feeling of pain from working and strengthening is much like the pain of spasm. This pain is often felt in the lower back as many of the muscles we work will attach onto the lumbar vertebrae – which is why they strengthen the back.

I am often reluctant to give out exercise sheets for back exercises for that very reason. In order to strengthen the back, we have to work the back muscles – and poor alignment of the body or poor technique can sometimes make it worse. However, I am going to give you 3 things to do to help your back. Please be calm when you are doing these and focus of the feeling within your body as it responds to exercise.

Mirror Mirror on the wall.............. Understanding your posture requires you to take a good look at how you feel against how you look – so stand in front of a full length mirror and take a look. Feet – are they straight? Do they turn out (tight hips)? Knees – do they swing back? Do you keep some slight tension in the thighs to hold the legs in position (this is correct)? Hips – are they stacked under the shoulder, does the hip bone point forward and the front of the hip joint is flat (this is correct). Have you got a nice long space between the ribs and the hips? Chin should be tucked in. Long neck with ear lobes sitting over the shoulders.  Have a look from the side and the back (use a small mirror to see the long mirror). Are you shoulders equal height?  Remember all those “off centre” positions will follow you when you are lying down or sitting in a chair – so use some cushions to help get your back into position.

TVA – Deepest abdominal. Lie on back, feet hip distance apart and knees bent. You should be able to touch finger tips under your lower back. Chin tucked in. Breathe in and as you breathe out lift on foot about 2cm off the floor and maintain abdominal contraction. Hold 6-10seconds and repeat.

Swimming – on all fours without locking elbows. Hold abs away from your t-shirt, lift one knee and foot off the floor about 2cm without leaning on supporting leg. Place down. Lift on hand 2cm off floor without leaning. Place down. Now lift opposite knee and hand off the floor and try to remain in balance for 10 seconds. Place down and repeat – sit back and stretch if back is starting to cramp up.

You don't need to be in sports kit to do these exercises and the can be re-done up to 3 times a day - however, please wait until you have been up and active for about an hour before doing these - your back is vulnerable first thing in the morning.

Keep at it...never give in