We hope you are finding our posts associated with lower back pain (LBP) very informative. We are back this week with another blog. This week’s blog is focused on the strengthening element of LBP rehabilitation.
You may have noticed from our previous two blog posts that strengthening plays a vital role in LBP rehabilitation and prevention. The strengthening element of rehabilitation plans are not solely focused on the muscles which act upon the spine, as seen in our previous post where muscular pain was discussed, various other global muscles pay a vital role in the movement of the spine. If there is a weakness in any one of these areas, LBP can be experienced.
We will focus on the particular areas involved in the rehabilitation of LBP in this blog, from the basics to more complex exercises.
Back to basics
Regardless of the extent of injury to the lower back, a patient’s strength or their build, all of our LBP patients will start of with basic exercises to target deep core muscles. These basic exercises prove vital in the initial stages of rehabilitation but they are also used throughout the rehabilitation programme as a starting point to every exercise. At first these exercises look diminutive and ineffective. It’s not until our patients are guided through these exercises, that they realise the vital importance of these during everyday life and their link to LBP.
Pelvic floor and core activation
The pelvic floor is closely related to the Abdominals in both function and location. The pelvic floor muscles play a vital role in the in functional movements in daily living such as bending over, lifting and even sneezing. The pelvic muscles maintain and increase intra-abdominal pressure during these movements (Arab et al.,2010). If this pressure is not maintained then the effectiveness of the Abdominals are reduced.
As we spoke about in last weeks post the Abdominals are vital in lumbar movements, if these don’t act sufficiently, there is more risk of a lower back injury. The pelvic floor, deep Abdominals and particularly the Multifidus muscle of the spine act together to stabilise the trunk during movement (Mohseni-Bandpei et al.,2011). Just like the pelvic floor muscles, if the Abdominals are not activated, there is an increased risk of injury. This is where core stability exercises becomes important.
Core strengthening mistakes
One mistake we see quite regularly when it comes to core and Abdominal exercises is the jump from the basic to more complicated exercises. Many of these exercises can actually cause LBP. These exercises include ones whereby the legs are outstretched, such as leg lifts, or those whereby the spine is forced into flexion, such as sit-ups. The further away from the body the legs go, the more force and pressure is placed upon the lower back. Commonly, in this instance the lower back begins to arch during the exercise. These exercises are based on a lever system, the longer the lever, the harder the exercise is as more weight is forced upon the core and lower back. Until the core can be fully engaged in the basic exercises and short lever exercises, long lever based exercises should not be attempted.
Core stability…What is it? And why is it important?
The main responsibility of the core is to stabilise the the trunk and to reduce the stress brought upon the spine. The core may be strong, but not necessarily stable, which is often misunderstood by patients and fitness professionals. For example, core exercise such as sit-ups may strengthen the core but don’t necessarily make it stable. Although it’s vitally important to target and strengthen the muscles of the abdomen and muscles local to the spine, our effectiveness to shift load and create movements associated with the spine goes beyond strength. We can help with the stabilising of the core by working on functional exercises and exercises associated with the movements of daily living, these exercises are vital in the rehabilitation of LBP but most importantly the prevention of further injury.
Global strengthening and why it’s important
We have spoken a lot about the importance of abdominal strength and its association to LBP, but there are many other muscles to consider when it comes to strength and their relevance to LBP. The lower limb is particularly important as its close relationship with the pelvis and lower back. A weakness in these muscles can alter the shifting of load through the pelvis and lower back which can cause LBP, examples of which can be seen in the image below. This can be seen in the Gluteal muscles, if one or more of these muscles are weak, it can cause the opposite side of the pelvis to dip during simple movements such as walking or running, this dipping can put extra stress on the surrounding structures and muscles, particularly the lower back. This is one reason why it’s important to strengthen the lower limb. This can be related to the hamstring and quadriceps all the way down to the foot, any imbalances or alterations in strength can affect the lower back and the posture of the pelvis.
We must consider above and below the area of injury as possible causes. The thoracic and cervical regions of the spine and their associated muscles and posture are also considered in our assessments. Just like the muscles of the lower limb, a muscle imbalance can cause poor posture generally or effect the transfer of load during upper and lower body movements
Through our assessments our therapists will test for strength and imbalances in the lower limb and upper limb. Our rehabilitation plans will be aimed at adjusting these imbalances.
We hope you have find this informative in relation to LBP and its importance in the rehabilitation and prevention of LBP. Many different factors are considered by our therapists in the diagnosing and treatment of lower back pain, and although the pain may be located to the lower back, this is not always the area of cause and concern.
Although strengthening plays a vital role in our LBP rehabilitation plans, there are many other forms of treatment which aid the rehabilitation of LBP. Next week we will introduce and provide information on the different types of treatments their benefits, and the science behind them.
If you require advice on strengthening or are suffering from LBP and not sure how to address the issue, don’t hesitate in contacting us at BSc Sports Therapy Clinic for advice, or to book in with one of our excellent therapists.