My Back Hurts, Now What?
Last week we talked about the extension compression stabilizing strategy (ECSS). I had described the reason for its prevalence, the utility in it, and the long-term effects it can have by creating low back pathology. We now have a better understanding of the issues with this stabilizing strategy and how we can create stability with better strategies. This week, I want to focus more on what we can do for those already suffering from the effects of ECSS or other trauma in the low back.
Low Back Tightness:
For those suffering with chronic and consistent low back tightness, we need to stop using the ECSS as soon as possible in exercise AND daily activities. When we adapt the ECSS, we often take that strategy with us through the rest of the day, cranking our lumbar paraspinals on and compressing our low back. We need to stop doing this by, again, learning to brace correctly with the diaphragm and begin relaxing the low back muscles before and after exercise. See the last article “Low Back Pain After Lifting?” for more on how to use the diaphragm for stability. Here are a few drills we can do to begin turning the low back muscles off for the rest of the day…
Drill 1: https://youtu.be/dorwwNPyIeY
Drill 2: https://youtu.be/OTiTSaRr4do
Disc Bulge/ Herniation:
If you have low back pain that sends shooting pain down one or both legs, radiates into the glutes or hamstrings, or is associated with any lower extremity weakness, seek evaluation from a healthcare professional (IRPC is happy to help!). If you have a hope to recover from this as quickly as possible, maintain any training or exercising stimulus during the rehab process, and want to come back from this BETTER than before without a ticking clock for the next occurrence of a similar injury, then working with a professional is necessary.
Treating injuries like this can be complex. We include treatments that address the musculature, spinal mobility and stability, and the nervous system. It really depends on what the examination finds that determines what we need to do. Regarding the nervous system, you will need to find positions that help alleviate the painful symptoms and avoid activities that are actively provoking it. A comprehensive exam will then tell us which movements we DO want to use to address the nervous systems involvement.
For the musculature and re-training the biomechanics, we mostly want to start with diaphragmatic breathing. The first stages of this is linked in the last article with a description, here is a link to the first breathing drill we want to use…
Breathing drill: https://youtu.be/3loMbIozr4Y
From here, we can start re-training the core strength that we progress around the motor control of the new diaphragm stabilizing strategy. Here is a very simple start to that…
Dead bug progressions: https://youtu.be/MmInJ-FUMKA
Again, the way we do this depends on your particular injury/ pain and your goals. We can confidently say that starting in these positions will help, but progressing from here will require specificity.
Low Back Sprain, Strains, And Other Pain Generators:
For this category of injury, we need to understand the magnitude of your pain and injury. For severe strains, more time is needed in the low intensity rehab. The good news is that we can use this time well to re-create motor control patterns of breathing, stability, and improve vital range of motion throughout the body. From here, we slowly start building up the tolerance of the injured tissue alongside the new stabilizing strategy that will not lead to further strain and compression of the low back.
Conclusion:
We discussed a lot of potentially complex areas of assessment and rehab. Although I cannot give specific treatment plans here due to individual considerations and exam findings, learning to begin using the diaphragm for stabilization while opening/ relaxing the lower back muscles with the drills shown here will always be a good place to start!
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-Dr. Nick, D.C.
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