Why do I have back pain? Why does my back hurt sitting down? Why does my back hurt to bend? Why is this happening to me? Why, why why???
Lower back pain is very common, in fact it’s scary to say, but 80% of Australian adults will experience lower back pain at least once in their lifetime! (1)
The stats are huge, but how can we go about getting rid of back pain or ensuring that you never even suffer from it in the first place? Well, to get rid of your back pain for good, first you need to understand some reasons why you might be suffering from it.
As crippling as lower back pain can feel, in most cases conservative treatment is more than enough to relieve the pain. The good news is, your lower back pain often is not the result of a major issue such as disease, damage to structures or anything more sinister.
For our peace of minds, if you experience any of the following: traumatic events, night pain, pain not changing, numbness/pins and needles in your bottom/legs/feet, and changes to your bowel/bladder function you should speak with your health care practitioner (1, 2).
One main cause of lower back pain is sedentary lifestyles
By this we mean such things as prolonged sitting and no physical activity which includes working, as work is incidental exercise and something your body becomes accustomed to.
When we are sedentary our joints stiffen, and our muscles become weak or tight. In particular, the muscles that weaken are our core and glutes, which are vital muscles groups for providing muscular stability, strength, and endurance (1).
Why is your core so important to avoiding lower back pain?
Many people presume the core is our six pack and how they may aesthetically look. When individuals also hear the phrase ‘brace’ or ‘core stability’ it is assumed that by tightening our abdominals, holding our breath or doing several sit ups helps strengthen our core. But this is far from training our deep core.
The spine has three subsystems that play an integrated role in maintaining its stability:
1. Active (muscles)
2. Passive (joints, discs, ligaments and bones)
3. Control (using your nerves to control your muscles – neuromuscular control)
Injury and disuse (sedentary lifestyle) play a role in weakening these subsystems. The good news is, evidence-based exercise can re-establish strength and stability!
The Deep Core is made up of four muscles:
- Transverse Abdominus
- Pelvic Floor
Together they are the main structures that support, control and move your lower spine and pelvis. If properly used and maintained, they will collectively be so efficient that they function 24/7 without active thought.
When lower back pain strikes, our deep core muscles stop actively supporting us, ultimately reducing our core stability and increasing our vulnerability to further injury (5). Now that our deep core is no longer doing its job, naturally other muscles will take on an extra role of support as a subconscious attempt to protect the body, reduce movement, and avoid pain aggravation. However, this leads to compensations, muscle restrictions/tightness, poor movement patterns and generally no decrease in pain.
Turning the Deep Core back on
In order to restore the stability and support our deep core provides us, we have to turn them back on! Research has shown core stability exercises restore our neuromuscular system in controlling and protecting the spine during movement thus, preventing injury and improving lower back pain.
You need exercise that is tailored specifically to you and your individual condition to restore coordination, control, strength, and endurance of the deep core muscles (2). Furthermore, core stability exercises are fantastic for pain relief and improving back-specific functional capacity in the short term (3). For long term boosts, it is then important to restore core stability and correct our movement patterns in combination with strengthening the surrounding muscles to further stabilise the lower spine and pelvis region (2, 3).
What role does glute stability play?
The glute muscle group includes the Gluteus Minimus, Gluteus Medius and Gluteus Maximus. They play a major role in providing the necessary stability, strength, and power, to support the spine/lower back and the lower body during movement.
Medius and Minimus play the stability role, while Maximus is our power! Without our glutes, we lose pelvic stability and power, we increase the pressure onto our passive structures, which will lead to excessive movements and compensations, to eventually lower back pain!
Evidence has proven that the connection between the spine and hip is reduced and activation of the glutes is delayed in those who have lower back pain or a history of it. The glutes can be affected in numerous ways; whether they are inhibited due to faulty biomechanics, weak because they are not being used properly, or are in a spasm and are tight. Hence, it is key that you are assessed by a health professional (Accredited Exercise Physiologist or Physiotherapist) to ensure your treatment plan is individualised to maximise your recovery (6).
Get Moving (if you’re moving with great movement patterns)
“The Deadlift” is one of the most primitive and frequently performed movements in our daily lives, but are we performing it correctly?
Many people fear the movement (especially when injured) and fear re-injury (4). When we stop and avoid movement we stiffen up, weaken our muscles and increase the pain experienced.
The bottom line is that we are designed to move. Look at an average day and you’ll see that it is full of movement – bending over to pick up our washing, groceries, kids toys and more from the floor.
None of us want to stop moving, so why let lower back pain limit you and affect your day and activities? To improve our capacity to move, we can move better and learn how the pattern of movement is important. Once our movement pattern is correct, we can then focus on improving our strength and stability in our core, glutes and hamstring to make the movement precise – the result is healthy backs and no pain!
So, what exercise prescription is required to eradicate lower back pain?
Individualised Programs – we’re all different and one size does not fit all. You need a program that is tailored to your situation, needs and lifestyle.
A program that targets core stability, general exercise and great movement patterns – Exercise prescription is based on evidence! It is important that you are provided with a holistic, tailored and guided exercise program, including correct activation and technique.
Progressive functional strength training – deadlifts, squats, push/pull, carry (the list goes on) can sound intimidating, but the truth is we do these movements every day. With safe weight training we can increase our muscular strength and endurance, rehab our lower back pain, and prevent re-injury.
What’s an Accredited Exercise Physiologist?
An Accredited Exercise Physiologist is a university-qualified, Allied Health Professional under the organisation ESSA – Exercise and Sport Science Australia. An Accredited Exercise Physiologist specialises in developing, prescribing, and delivering safe and individualised exercise interventions for a range of populations. This includes individuals with acute/chronic conditions, injuries and disabilities. It’s for all of these reasons that an Accredited Exercise Physiologist is so well positioned to help you with any back pain.
Book an appointment
If you would like to come in for an assessment with our team and experience for yourself how to get rid of back pain, or even work to ensure that and other types of pains are less likely to occur, contact us on 02 8607 4000 or request a call by completing this form.
This blog was written by Mikaela Sultana, Head Exercise Physiologist at Precision Physio – St Marys. If you would like more information, or to work specifically with Mikaela, you can contact her through the Precision Physio St Marys clinic: 02 9623 2220 or book in online.
(2) Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests 2015 DOI: 10.3109/09593985.2014.959144
(3) A meta-analysis of core stability exercise versus general exercise for chronic low back pain 2012 DOI:10.1371/journal.pone.0052082