Updated: Nov 9, 2021
A plethora of reasons
It would be impossible to write a blog about back pain without mentioned what might be causing it. The truth is – the development of low back pain is so vast and complex due to the various sources of pain, that each individual case needs to be considered separately from any other, and diagnosis is difficult due to its multifaceted nature. Although MRI scans are used to diagnose low back pain, research shows a poor correlation between the structural problems identified from an MRI and clinical presentation. Diagnosis is confirmed following a Q&A and physical assessment.
But below – I have created an infographic illustration to show possible sources. It’s important to understand that other illness or disease can cause back pain which are not non-specific, mechanical, or nerve-related, which is why it’s important to contact your GP if you develop back pain.
It is the brain we need to train
In recent months I have seen a large increase in people complaining about lower back pain, both in clients I teach and others approaching me after their GP recommended Pilates. Before the Covid 19 pandemic it was already a concern about how we humans live and the lifestyles we have adopted in the modern and developed world – and it is evident that we do not move as much as we are supposed to nor how we were designed and intended to move. This is the main reason we are experiencing the dysfunctions and misalignments in our bodies, which leads to chronic illnesses, conditions, injuries, and pains.
As humans we have evolved far away from hunters and gatherers era thank goodness – I’m happy I don’t need to go out and gather fruits, roots, and berries whilst my partner is out with his spear hunting for game. Instead, I get to hop in my car, drive down to the shop, use the travelator and push a trolly around just picking whatever I fancy. The toughest part in my shopping trip is the few seconds of lifting the bags into the car from the trolly and then from the car into the house. This is when injuries tend to spring up on people as the bodies lack fundamental muscle strength to support physical activity which exceeds the load bearing capacity of tissues and joints.
'..this modern lifestyle we are living - has caused a movement deficiency'
We sit or stand for hours and hours due to work – we work far too many hours and no matter how good your posture and alignment is – staying too long in one position is a guarantee to cause problems. We are designed to move. Even in sleep – our bodies move numerous of times – the body itself knows it needs to – it’s our brain we need to train.
Human intelligence has created a lazy human, and this modern lifestyle we are living - has caused a movement deficiency - something we all share, and its backfiring with a vengeance.
The Pandemic – Cherry on The Cake
Lockdowns brought more stillness into our lives. Some of it good. The kind which gave us the opportunity to re-evaluate our lives, and what is truly important. What we can cut out and declutter to find peace and tranquillity in our lives. In some ways it felt like a lifestyle cleanse.
But the physical stillness from being locked indoors in long periods of time, sitting by the laptops, phones, TV and missing out the daily movements of going out to work, socialize and daily errands has had a big impact on our physical wellbeing. Now that life has returned to a new normal, we will feel the impact of the year and half we had of lockdowns. Some people are still working from home, and this tend to lead to more hours - sitting in front of the desk than pre pandemic time. More than ever do we need to train smart to tackle dysfunctional muscles, joints, and overall misalignments.
Possible causes and risk factors in developing Low Back Pain
As mentioned before - this does not include other illnesses and diseases (infection, cancer, kidney stones etc) that can bring on low back pain.
Management & Treatment
Depending on the case, low back pain can be reversed, and life can go on pain-free. It might not feel like it's possible for the sufferer but with lifestyle changes, persistence, and dedicated work - we can create a more stable environment for the spine. There are a vast number of choices of treating the pain out there which can benefit each case differently. From manual therapy (physiotherapy, chiropractor, osteopath) and other interventions such as laser, acupuncture, and percutaneous electrical nerve stimulation (PENS) to massage, painkillers, and injections.
STOP AND THINK!
There is absolutely nothing wrong with using the above treatments - when we are in extreme pain, and something works fast - it is a huge relief! I would do the same if I could barely get out of bed in the mornings. But these are temporary and short-lived pain/symptom management fixes. A chiropractor can adjust your spine and relive the tension for a short period of time, but before you know it you need to go back to be realigned again. Because your body will go back to its habitual position. It treats the symptoms and not the cause. If there is an imbalance in your muscles due to weak core, hip flexors, piriformis, and back muscles - they will just pull your bone structure to that place where pain is felt again and again. If the problem is weak muscles - we must strengthen them. If the cause is imbalances - we need to build balance. It’s about going to the root cause and fix it from within and by all means use other treatments as short-term fixes to cope until you have given some effort, time and persistent training to develop a healthier posture, muscles and functional mobility.
Being as physically active as possible throughout the day - avoiding long periods of sitting or standing. - Use 50/10 rule; for every 50 minutes of sitting - get up and move for 10. This rule can be applied to anything else you do a lot of daily.
Practice Pilates - which has a strong efficiency for managing the symptoms.
Other exercises such as swimming and walking.
Yes, it is an individual thing but...
If movement deficiency, poor posture and weak muscles are the problem then that is what we need to focus on. Of course, the wide range of pathologies associated with low back pain, providing exercises recommendations that are appropriate for all is not possible. Therefore, it is vital that everyone is considered case by case and that exercises are tailored to their state. However, there are some general guidelines that should be factored into a training program for those suffering with low back pain.
We need to strengthen
Hips (incl. buttocks)
Back (low, mid & upper)
The body will be what you ask it to be
We are often told that back pain is due to weak core muscles. Whilst this is very true, it isn't the only culprit. If the body is constantly in a sitting position due to occupation for an example, the hips (+bum) and back muscles will also weaken due to nothing being asked of them. They are placed in a relaxed, inactivated, and slacked state for hours, days, months, and years. If they are being instructed by us to be slack - then they will become slacked. This in turn will cause imbalances with other muscles groups, create poor posture and unhealthy habitual movement patterns.
The core is the powerhouse of the body. Its where the centre of gravity is situated and when we use it properly it will keep the posture in an optimal position. It stabilises the spine and creates a perfect balance throughout the body parts to work in perfect harmony together. I often say that the core muscles are like a seat belt in a car - for safety, activating all 4 core muscles creates thoracic pressure and stabilises and protect the spine during your daily activates. Activation does not need to be at 100%, this would be strenuous, and it will cause unnecessary strain. Simply 20% activation is enough.
The hips - where the upper body meets the lower, supports the spine. It is at the base of the spine and its paramount to keep this base strong and supportive. In most lower back pain cases - there is a dysfunction in the hips and it is the root cause of the problem. Especially the deep bum muscle - piriformis. Activation in flexion, extension, internal and external rotations is needed.
The back often gets forgotten about in back problems. Sounds ironic - but as the core always get the attention and the blame, and back exercises can feel like 'poking the fire' and might worsen the pain, it gets left alone. The approach however is key, and as always it is about smart training rather than hard training. Humans spend a lot of time keeping the spine and shoulders in relaxed and slacked flexion (forward bend) for an example - so we need to spend time working/activating in opposite position and direction, extensions.
As mentioned a few times in this post - exercise recommendations will depend on each individual case and its important to note that my recommendations are not a prescription to fit all! Clients that attend my classes are very aware how I modify the exercises to suit the individual: variations, modifications and adaptation. I post a lot of recommendations on my Instagram Page and I'm slowly building a library of subjects which you can find in the highlights of my profile https://www.instagram.com/sfmovement/?hl=en
Although I have had to divide Spine Health and Hip Health into two different categories - they go hand in hand because our body parts work together in unison and one joint effects another, its what we refer as BioFlow Anatomy and Biomechanics.
Movement Heals. Intentional, smart, specific and articular movements.