Lower Back Pain - the Core is the Cure

If you have low back pain the cause is likely that you have little or no control over your stabiliser muscles- the multifidus and transversus abdominus muscles.
With low back pain sufferers these muscles are used as phasic muscles, which means they cannot endure long periods of activation and aren't being used for their primary purpose as stabilisers.
The goal of the practitioner is to convert these muscles into stabiliser muscles by reconditioning the body's nervous system.
The method by which this is done is a slow and deliberate procedure whereby the client learns to activate their stabiliser muscles with small movements whilst maintaining a healthy pelvic tilt.

The first step is to acquire a normal pelvic tilt in a prone position and to become conscious of the transverses abdominus muscle. This is done by sucking the belly button toward the spine. During this activation the client must breath normally without reducing the tension on their Transversus Abdominus.

The client must be reminded that the tension on their TA is only about 20% of their overall strength and that control is the key not strength.

Evaluating the pelvic tilt can be done via a biofeedback unit or more roughly by standing against a wall and making sure your thenar eminence can fit between the wall and your lower back.
As the sessions proceed, the movements the client are asked to perform become more varied and more weight is applied by having the client perform movements from the prone and supine position to standing and sitting positions.
Once the client has accomplished moving correctly and confidently without being consciously aware of their core muscles the core muscles themselves become load bearers instead of the spine and its attaching ligaments. Once this occurs, there is a considerable reduction in the level of low back pain.

It has been proposed that the spine itself is not a load bearing structure and studies on cadavers have shown that with the spines stabiliser muscles removed, the spine degrades and segmentally breaks down with only a little weight added to it.

In contrast to before treatments began, the client now activates their core stabilisers before any movements are precipitated regardless of direction.

the function of this early activation is to utilise the intra-abdominal pressure which acts alongside the muscles to give structure to the body.

Eventually the client can proceed to activating the perineal muscles and diaphragm alongside the stabiliser muscles to integrate the concept of intra-abdominal pressure for complete control of the core region, this can also help with incontinence issues and develop proper breathing patterns, reducing strain on the thoracic region and accessory respiratory muscles.

For a more detailed account of this process read "Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain".

Take note that this is a long and sometimes frustrating process of reconditioning the motor system but in the long run highly successful.

Alex Nielsen

www.massagemuswellhill.co.uk