As an osteopath I treat a wide variety of conditions, yet lower back pain (LBP) is by far the most prevalent. Optimal back rehabilitation necessitates removing the cause and adding proper stability.
There are many myths promoting lower back mobility, but evidence suggests that it leads to more back problems. Some people believe that strong stomach and back muscles will reduce a back injury risk. However, research has shown that endurance, not strength, is more protective. Exercise used in the past to promote lower back mobility is contrary to current research. The reality is that repetitive spinal movement will eventually result in tissue injury, increasing the risk of developing lower back pain.
Every patient is slightly different morphologically with some more prone to LBP than others. Factors that might predispose patients include: obesity; certain occupations or sports, underlying pathologies, structural deformities, poor posture and poor work ergonomics.
Osteopathic medicine aims to prevent surgery and promote spinal health. I’ve seen many patients who’ve regretted going the surgery route and who would have rather opted for conservative spinal health management had they known better. Understanding spinal movement and function is important and knowing what spines should and shouldn’t do is crucial. Too often I see people in gyms performing exercises incorrectly with poor technique and faulty movement patterns which over time will result in tissue trauma and ultimately back pain.
Patients are often referred for Pilates and yoga to help with their back pain. A few weeks later their back pain is worse than before. There are numerous reasons for this. One, they might have a flexion-intolerant spine. Two, they might have an extension-intolerant spine. It needs to be emphasised that underlying tissue injuries and damaged structures vary and therefore certain treatment modalities may not be appropriate. Alternatively, they need to be revised to be more patient-specific.
There’s a place for both Pilates and yoga. However, know whether you need mobility, stability or both and whether you have a flexion- or extension-intolerant spine. When energy travels through the body during exercise it’s absorbed by the different joints. Inadequate joint function can lead to overload of other structures, resulting in tissue trauma and pain. Ensuring good joint mobility and stability is paramount. Hence it’s imperative to see an expert who can assess your back and advise you on the most appropriate exercises.
Will sitting on a Swiss ball develop core stability? Research has found that by sitting on a Swiss ball one increases muscle co-activation, resulting in an elevated spinal load. Without proper spinal stability, tissue injury may occur. Therefore, in most cases this exercise isn’t recommended.
There’s also uncertainty regarding certain gym exercises and their long-term effect on soft tissue structures. One area of concern is when training the abdominal muscles. The focus should be on strengthening the core without encouraging lumbar spine motion. Sit-ups should be completely banned as the spinal load is well over 3000N which will result in a disc herniation over time. This includes exercises such as poorly performed crunches.
Back strengthening exercises such as back extensions on the Roman chair result in spinal compression and isn’t recommended. A similar exercise in group classes is when lying flat on the stomach raising both arms and legs simultaneously. This is a poorly designed exercise as it generates over 6000N of compression on an already extended spine. It will compress facet joints and crush the posterior spinal ligaments. A much safer exercise is what we call the ‘bird dog’ where there’s less spinal load.
The popular leg press machine creates a potential environment for a herniated disc due to lumbar flexion when pushing with both legs. Therefore, it’s recommended to use the machine with one leg only, allowing the pelvis to stay neutral and avoid lumbar flexion.
Certain occupations demand hours behind a desk and computer. Badly designed workstations may result in poor posture which could result in tissue overload with increased muscle tension, stiff joints and ultimately muscle and joint pain, headaches and even neurological symptoms.
The sleeping position is also important. Spending 7 – 8 hours a night in a certain position could either facilitate the healing response or aggravate it. Movement patterns also are vital in avoiding tissue trauma: How to get in and out of bed? How to sit and stand correctly? How to get on and off the toilet and in and out of a car?
All the above is important because osteopathic medicine aims at finding and treating the cause and not the symptoms.