Are you part of the 80% of the population who has suffered from low back pain? Do you want to know how to prevent it from becoming a recurrent chronic problem? Let’s start with some basic anatomy. Your spine is made up of a sequence of vertebrae, separated by discs. At every level of your spine (there are 5 levels in your low back, 12 in your upper back and 7 in your neck) there are 3 joints. When our back is working correctly this large number of joints allows our spine to move in multiple directions, to bend forwards and backwards, to lean to the side and to twist. Our muscles have two jobs. One job is to move the spine into these varied positions, for example if you lie down and contract your abs your spine will flex forward. Their other job is to stabilise the spine by holding all those joints together and stoping them from getting jammed up like a rusty hinge. In order to perform these two jobs are body has developed two different types of muscles. The first group, the movers, are our big superficial muscles like our biceps, our quads and our 6-pack muscle. These muscles need to be strong to move our body, carry loads and propel us forward when walking or running. The second group are our deeper stabilising muscles such as our deep tummy muscle that supports our back, our deep neck flexors that support our head and neck and the lower part of our trapezius muscle that keeps our shoulders back and down. These muscles hold us in correct posture and stabilise our joints as we move around. They need to have excellent endurance as they are working in the background all the time. If we look at the muscles in our back in more detail it can help us to understand what goes wrong when we get low back pain and our how to fix it. We have 3 layers of superficial tummy muscles, the 6 pack muscle and 2 layers of obliques. These muscles are working when we curl our trunk like a sit up, side bend and twist or when we cough or laugh. Your core muscles that protect and stabilise your lower back lie deep in your tummy. Your deep core muscle, called the transversus abdominus, wraps around the abdomen like a corset. When it contracts it sucks everything in like a weight lifters belt to stabilise the lower back. As well as having a muscle wrapping around the front we also have a deep muscle as the back, known as multifidus, which acts like the lacing on the corset. These two muscles are also helped by our pelvic floor muscles which sit at the bottom of the core like a sling, and our breathing muscle called our diaphrapgm which sits on top like a lid. When all these muscles are working well together our low back is both stable and mobile, allowing us to bend, lift and twist painfree. We know from clinical trials researching low back pain that when low back pain occurs our brain switches off these deep stabilising muscles and tries to use our superficial mover muscles instead. Hands on treatment from your physiotherapist will help to get your joints moving again and get rid of your pain, but it does not automatically fix the way the muscles are working. To get your deep tummy muscles strong again you need to do specific core muscle exercises. Otherwise your back remains vulnerable to injury and you will find your pain returns. These exercises can be shown to you by your physiotherapist and may seem quite challenging at first, especially if you are not used to using these muscles. They focus on getting the pathway from the brain to these muscles firing again and can require a lot of concentration to start with. Once you have the basic idea of turning these muscles on it is important to progress the exercises to incorporate movements of the arms, legs and torso. This is to make sure the stabilising muscles are working well when we are moving around during the day. Practising these exercises will help to prevent your low back pain becoming a recurrent problem and is particularly important if you have had pain for more than 6-12 weeks. Many people find it hard to stay motivated to practice these exercises once their pain has gone, or find it difficult to know if they are performing them correctly. However just like going to the gym or changing our diet, if we only do it for a week or two, it is not going to give us any long term benefit. If you are one of those people who struggle to find the time to do the exercises at home or would like regular feedback to ensure you’re exercising correctly Pilates can be the answer. Why Pilates? Pilates exercises have a strong focus on the core muscles and are designed to help ensure correct technique. They also increase your flexibility, making sure your back stays supple. Pilates works all areas of the body. This is very helpful for people who have had low back pain because of tightness in their leg or bottom muscles or poor alignment in the knees or ankles. You will also find your posture improves with Pilates, taking pressure off not only your low back but also your neck and shoulders. What to look for in Pilates class? Pilates classes with low class numbers will ensure you get adequate attention and individualised feedback. Make sure you are being supervised by a qualified instructor, or even better, someone who is also a physiotherapist, to ensure you get the most benefit out of the exercises and you don’t develop any bad habits. This is particularly important if you still have pain or you have had other injuries. It is also important that people who have experienced low back pain start in a beginner’s class so that you have time to learn the basic exercises first. This way you will have a solid foundation to move from as the difficulty increases.
“If your spine is inflexibly stiff at 30, you are old. If it is completely flexible at 60 you are young.” Joseph Pilates