Understanding the Problem of Low Back Pain
Low back pain (LBP) is one of the most common musculoskeletal conditions and approximately 70-80% of the population will experience at least one episode of LBP during his/her lifetime. Although it affects all ages, it is more frequent in middle aged people. Most frequently, a first LBP occurs in people aged between 20 and 40 years old1.
Most cases of LBP (85 %) are classified as ‘‘non-specific’’ because a definitive and specific diagnosis cannot be achieved2. In 85 – 90 % of the patients low back pain is non-specific. That means that patients experience pain without a specific medical diagnosis and is mostly caused by weak muscle strength. In other cases the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small facet joint between two vertebrae. The problems mentioned above cause reduced movement and postural control, reduced movement awareness and altered range of motion.
Leading experts have increased their focus on the importance of the deep low back muscles and one of their most important findings is that people with weak muscle strength and endurance have a greater risk of (chronic) low back pain.
Muscle weakness could lead to overstrain muscles to compensate, which then leads to spraining muscles and/or ligaments. That is why deep muscles need to be trained properly with a tailormade and guided exercise program. The importance in the exercise problem is focusing on small controlled movements to contract the deeper muscles properly.
Prof. Dr. Ingo Froböse, Professor of Prevention and Rehabilitation, highlights the need of training the deep lower back muscles.
Use it or lose it. Only exercises on a regular basis ensure strong muscles and a healthy back. The secret of a healthy, fit back are the deep, stabilising back muscles. Once you train those muscles with motivation and fun, you are on your way to feeling good long term.
Photo: Monika Sandel
The Deeper Anatomy of the Problem
Have you ever wondered what exactly is happening when you experience low back pain and what muscles are the most affected?
There are, amongst others, three major muscles which, if not trained properly, are affected by or can even negatively contribute to low back pain:
- Abdominal muscles
- Pelvic tilt muscles
1. Abdominal muscles
(Image source: danceguadagno via wikispaces.com, CC BY-SA 3.0, Pearsons Education, Inc.)
The muscles of the abdominal are:
Transversus abdominis – the deepest muscle layer. Its main roles are to stabilise the trunk and maintain internal abdominal pressure.
Rectus abdominis – slung between the ribs and the pubic bone at the front of the pelvis. When contracting, this muscle has the characteristic bumps or bulges that are commonly called ‘the six pack’. The main function of the rectus abdominis is to move the body between the ribcage and the pelvis.
External oblique muscles – these are on each side of the rectus abdominis. The external oblique muscles allow the trunk to twist, but to the opposite side of whichever external oblique is contracting. For example, the right external oblique contracts to turn the body to the left Internal oblique muscles – these flank the rectus abdominis and are located just inside the hipbones. They operate in the opposite way to the external oblique muscles. For example, twisting the trunk to the left requires the left side internal oblique and the right side external oblique to contract together.
Especially the Transversus abdominus is often affected. The transverse abdominal helps to compress the ribs and internal organs, providing stability for chest and pelvis (thoracic and pelvic stability).
Together with some other back muscles the abdominals form a “belt”-like structure. When they contract at the same time, they work like a brace providing stability to the lumbar spine.
Normally the transversus abdominis muscle is in contraction always while standing and sitting. In normal conditions the transversus abdominis muscle contracts by itself, but in patients with low back pain the muscle doesn’t contract naturally. This can lead to an unstable core, which is a risk factor for low back pain. Without a stable spine, the nervous system fails to recruit the muscles in the extremities efficiently, and functional movements cannot be properly performed3.
You can train your transversus abdominis in Valedo’s torso, twist, special, floor and core districts.
2. Multifidus muscles
The multifidus muscles are the most important stabilizer of the spinal extensor group, responsible for spine stability and posture, and run the length of the spine. They parallel another muscle group known as the erector spinae, and if these muscles are weak, you are very likely to suffer from back pain.
People with low back pain often lose the ability to contract these muscles.
In order to bring the multifidus muscles back to strength, a tailored stabilization exercise program that stresses deep abdominal and isolates the multifidus muscles contractions is advisable.
You can train your multifidus muscles in Valedo’s torso, twist, hip, special, floor and core districts.
3. Pelvic tilt muscles
Many muscles are involved with a pelvic tilt movement:
1. Abdominal muscles
2. Back extensor muscles (Erector spinae, Multifidus)
3. Hip extensors (Psoas muscles, Iliopsoas etc)
4. Hip flexors (Latae, Rectus Femoris, Sartorius)
5. Hip extensors (Gluteus Maximus, Hamstrings)
People with low back pain have not the ability to perform pelvic tilting.
The ability to dissociate lumbar movement form pelvic movement is therefore important, and correction of faulty lumbar-pelvic rhythm is vital4.
You can train your pelvic tilt muscles in Valedo’s hip district and special district.
Back Pain and Exercising
Get up and moving for a healthy back!
Besides medical treatment today there are a number of approaches in order to treat Lower Back Pain, for example physical therapy, behavioural therapy, multidisciplinary therapy and exercise therapy both in supervised clinical as well as self-guided home environments.
However, there are many possibilities to get up and moving for a healthy back which are sometimes even less time- consuming and less expensive than conventional measures.
Be more active in daily life
The first step into a back pain free future is a balanced lifestyle which incorporates not only regular exercises but also integrates activities in daily life situation. Rather take the stairs than the elevator and why not go out for a walk during lunch?
A good active day could look like this:
Of course, there are always days where outdoor activities are just not an option, due to weather, long working days or a stressful schedule.
But exercising at home can be quick and just as helpful in achieving sustained back health.
Exercise at home!
Scientific studies and professionally reviewed literature show that a general exercise program appears to be an effective way of managing back pain that is not resolving on its own5.
A home exercise program can be effective in diminishing pain6 improving functional disability7, showing lasting improvements even after one year of adherence8, improve patient’s motivation and program adherence. Self-supervised home training may be as effective as a supervised strength muscle training program9.
Of course, adherence to a set home exercise program is crucial for a successful rehabilitation of low back pain10, but even here studies show that exercise programs at home seem to have a better adherence rate than exercising in centres11.
- M. Seguí Díaza y J. Gérvasb. El dolor lumbar SEMERGEN 2002;28(1):21-41
- Peter O’Sullivan Diagnosis and classification of chronic low backpain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy 10 (2005) 242–25
- Aruin S.A., Latash M.L. Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Exp Brain Res (1995) 103:323-332.
- Hart JM, Weltman A, Ingersoll CD. Quadriceps activation following aerobic exercise in persons with low back pain and healthy controls. Clinical Biomechanics. 2010;25: 847-851. (level of evidence 1B).
- J. Moffett & McLean, 2006; J. K. Moffett et al., 1999
- Bronfort et al., 2011; Martin Descarreaux et al., 2002; Dogan, Tur, Kurtais, & Atay, 2008; T. Kuukkanen & Malkia, 1996, 1998; Mannion, Helbling, Pulkovski, & Sprott, 2009a; Pensri & Janwantanakul, 2012
- Shirado, kukaen 1996
- Bentsen, Lindgarde, & Manthorpe, 1997a
- Bentsen et al., 1997a; T. Kuukkanen & Malkia, 1996
- Mannion et al., 2009a
- Ashworth, Chad, Harrison, Reeder, & Marshall, 2005