Have you or a loved one ever suffered from back pain? If you have, you are far from alone! Statistics show low back pain (LBP) is the single leading cause of disability worldwide and does not discriminate between populations; from young teens to postpartum moms to middle-aged individuals to senior citizens. You may have even tried investing in new gadgets to get rid of pain.
What causes LBP and how can we fix it? First we must understand why LBP occurs. Pain is multifactorial. There is usually not one cause, and to find the origin of pain, a detailed assessment by a physician or physical therapist is recommended. However, for the purpose of this article, we will dive into possible and common anatomical causes affecting posture, overall muscle strength and stability.
Let’s start with postural muscles (deep core/back muscles). These muscles are constantly working to keep us upright. They need to be “on” basically all the time to do so. Contrary to popular belief, there is no “perfect posture.” In general, we like to aim for a neutral spine while relaxing and during movement, with stacked alignment (ribs stacked over hip/pelvis.) This neutral spine and stacked position allows muscles to be in the proper position to contract at the right time. In many cases, just bringing more awareness to body positioning can make a big impact on pain. If someone is out of neutral alignment, it can lead to a weakened core and LBP.
Problems commonly arise when for some reason our deep core muscles become weakened. This can be due to many reasons (pregnancy, injury, poor prolonged positioning, etc.). They can become inhibited over time and now we are left with poor core control. So I can just do crunches and planks and then I will be fine right? Not necessarily! There are many core muscles that are layered one over the other with different muscle to bone attachments. These attachments dictate if these muscles are “movers” or “stabilizers.”
The deeper muscles act as postural and stability muscles. These stabilizing muscles not only have to be strong enough to help us move, but also have to contract at the right time. Timing is everything. They are proactive and anticipate movement to stabilize us without us even knowing. The more superficial core muscles (also known as the “6-pack” muscles and obliques) are labeled as “movers” to help us bend and rotate to perform our daily activities. Both “stabilizers” and “movers” are important but serve different purposes. The deep muscles stabilize us, giving us a good base (or foundation) for movement.
When one area of the body is weak, another will come in to help, or compensate. Our body is smart and tries to find the most efficient way to move (even though efficient is not always the best). For example, if the deep stabilizing core muscles are weak, other muscles (like the superficial core muscles) come in to do all the work to help stabilize. However since these muscles are not postural muscles, they will fatigue a lot faster by working so hard to maintain alignment. This can lead to further compensations in the body, overworked muscles and thus pain down the line. You may wake up one day in pain thinking you injured yourself yesterday (which can be true in some cases), but in most cases, this injury was a few weeks or months in the making.
The good news is your muscles respond very well to retraining. All hope is not lost. With proper education and practice, you can learn how to get stronger and your muscles can re-learn how and when to contract. Additionally, retraining in proper alignment can decrease the work muscles have to do and can save energy during high level activities such as running. If you suffer from low back pain, are tired of popping pain meds and investing in gadgets that don’t work, don’t give up. Find a local PT who can help.
But how can you start in the meantime? A great way to start improving deep core control is simply through breathing. Engaging our diaphragm (primary breathing muscle) is helpful to our body in so many ways. It allows for rest (and who doesn’t need more of that right?), relaxation of our nervous system, decreases anxiety, and yes, engages our deep core. We want what we call a 360 degree breathing pattern — as you inhale through your nose, allow your belly, back and ribs all expand simultaneously. Then try a nice long exhale out through your mouth until you feel all the air is out. Try five breaths. Many people find this very challenging since they have not been breathing this way for a long time. Give it a try for a few days and if you feel the difference let me know below.
Jenny is a local private physical therapist and owner of Next Step PT. She specializes in general orthopedics for adults and teens, pregnancy and postpartum, running gait analyst and more. For a free PT consultation or more information, contact [email protected].
