According to the National Institute of Health, about 80% of adults experience low back pain at some point in their lifetime. It is the most common cause of job-related disability and a leading contributor to missed work days. It is common, however often a physical therapist can help reduce the occurrence and intensity of lower back pain if those individuals that have recurring or nagging back pain.
If you consistently get increased back pain with specific tasks, this is promising for a therapist to hear. If your back pain comes and goes, this too is promising to hear. An evaluation helps identify the reason for back pain. A thorough examination would include not just the lumbar spine assessment, but should also include an assessment of your hips, knees, ankles, thoracic, and cervical spine screening. The spine is what we move around during daily life and if any part of the system as stated above is not moving well, it will impact your back. Waiting for “the big wham-o” of back pain to see a therapist is not ideal. If you experience intermittent back pain, see a therapist for a better understanding of why your back hurts and what you can do to prevent a “big event”.
In most cases, you can continue doing the things you enjoy, but modifications in movement strategies, intensity, frequency, or other factors may make the difference in routine back pain or not. Many patients have already been stretching and doing “core exercises” for their back, but continue to have pain.
Refining the definition of core and teaching how to utilize not only those six pack muscles, but the diaphragm, pelvic floor, and deep abdominal muscles can make all the difference in the world. Often mobility and flexibility issues have to be addressed that are causing adding stress to the lumbar spine, but that doesn’t necessarily mean knees to chest. Often rotational flexibility is limited in the trunk and hips and causing too much stress on the back. Having a therapist assist with squatting and lifting techniques to decrease lumbar strain can be beneficial as well. Therapists can provide you with exercises that will optimally address your deficits; not everyone with back pain is the same and thus googling exercises will likely not work.
Coming to therapy for lower back pain does not mean a bout of therapy for 12 weeks. Often learning what you need to be doing for yourself is enough and then allowing you to make these changes over a month or so, then returning to discuss progress can be very helpful.
One thing that I can almost certainly guarantee that will help and not hurt your back pain regardless of your situation is finding the transverse abdominals. These are the deepest layer of abdominal muscles that are oriented around the trunk like a corset. Lie on your back with knees bent (optimally with legs relaxed such as with knees on a pillow). Find the most prominent part of your hip bones (usually more towards the center of your body than you think). Slide about 3 fingers width to the inside of these bones and place all your fingers in this area. This is the easiest place to palpate or feel the transverse abdominus. Without holding your breath, draw in the muscles under your fingers. Some cues that may help, but not to be tried all together:
- gently drawing the hip bones closer together
- gently pull in the stomach like putting on too tight jeans (still breathing).
- Consider the pelvic floor muscles:
- Use the muscles that you would to stop the flow of urine midstream
- Use the muscles that would lift the testicles
Regardless of which cue helps, you should feel a tightening of the muscles under your fingers. The muscles should pull away from your fingers, not pressing out into the fingers. Buttocks muscles should be loose and not tightening and your lower back should not be moving (like a balloon is under the low back). Below is a video of learning to engage the transvese abdominus.
As you may notice as you watch the video, if the contraction is done correctly, you don’t see much happening from the outside of the body.