Spinal

Article by John Miller

What Causes Recurring Back Pain?

If you suffer back pain, you’ll know that it has a nasty habit of returning. Not only is it painful, but it can interfere with your work, sport or just everyday life.

Acute back pain usually settles with conventional spinal treatment. However, the recurrence rate is too high. There’s an 84% chance of recurrence within one year! (Hides et al. 2001)

Why Does My Back Pain Come and Go?

Researchers discovered that a couple of deep muscles in your abdomen and lower back need to contract to support your spine. When they work correctly, you’re much less likely to suffer back pain. The bad news is that these muscles turn off every time you suffer back pain and don’t automatically turn on again. This muscle inhibition leaves your back at risk of injury.

However, the good news is that you can quickly retrain these deep muscles in your abdomen and lower back. The most effective retraining method is via real-time ultrasound. The chance of lower back pain (LBP) recurrence within one year reduces significantly.

For more information, please get in touch with your PhysioWorks physiotherapist.

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What Are The Best Core Exercises?

Your deep core stability muscles retraining uses specific low-level activation exercises. While a very skilled physiotherapist training in deep core activation can observe and palpate for the correct muscle contraction, the best way is to see them working on a real-time ultrasound scan.

Real-Time Ultrasound Physiotherapy guidance allows you to see how your muscles are contracting in real-time. This visual feedback will enable you to correct your specific deep core muscles inside your stomach, lower back, and pelvic floor as you attempt to contract those muscles.

Beware of  Advanced “Core Stability” Exercises!

The fitness industry is full of fitness instructors who profess to know how to activate your core stability muscles. Unfortunately, the wrong core exercises will do you harm. Most progress your core exercises far too quickly and bypass these critical muscles to strengthen your outer abdominal muscles further and leave your deep core muscles weak. Research evidence has found that this renders you vulnerable to lower back pain and injury.

Article by John Miller

Deep Inner Core Stability Muscles

The deep core stability muscles of the lower spine include:

  • Transversus Abdominis (TA)
  • Multifidus (MF)
  • Pelvic Floor (PF)

core-stability-muscles

Transversus Abdominis

The Transversus Abdominis (TA) is the deepest abdominal muscle. It is the "corset muscle" of the spine and pelvis. In the typical situation, TA contracts in anticipation of body motion to guard the spinal joints, ligaments, discs and nerves.

Multifidus

Multifidus (MF) muscles are very short muscles running from the transverse processes (on the sides) of one vertebra up to the spinous process (the middle of the back) of the next vertebra upwards. Their primary function is back stability. They do not produce an extensive range of movement but work to provide small, "fine-tuning" postural changes all day long.

Pelvic Floor & Diaphragm

The TA and the MF work with your pelvic floor and diaphragm to make a flexible but stable region around your lumbar spine. This ability to stabilise your lumbar spine in its many positions enables you to overcome back problems and reduce your reoccurrence chances.

More info: Real-time Ultrasound Retraining

How Good is Your Core Stability?

Research clearly shows that core stability retraining has short and long-term benefits for low back pain sufferers. The good news is that we also know that core stability training markedly reduces your chances of re-injury.

Research on lower back pain sufferers has shown us that if you can re-activate your core stability muscles, your chance of recurring back pain reduces.

Your chances of not experiencing another bout of low back pain (LBP) within twelve months are almost three times better if you have undertaken an ultrasound-guided exercise program84% vs 30%.

After three years, you still have a two in three chance of not experiencing low back pain if you did the exercises. Adding even more research support, if you didn't do the exercises, you only have a one in four chance of being pain-free. You're still over twice as likely to not experience another episode of back pain. Hides et al. (2001).

PhysioWorks physiotherapists have professional knowledge in the training of core stability muscles. The difficulty has always been how to quantify a patient's level of stability control. That is, until now.

The solution has been to develop a useful and clinically practical method of assessing your core stability level. We can then determine, and at what level it fails to cope with your body's demands. That is, what is the individual client's functional Back Stability Score (BSS)?

How Do We Assess Your Core Stability?

Your PhysioWorks physiotherapist will assess you to determine your current symptoms, pathology and functional requirement. Then, they'll physically test you to decide on your back stability based on your ability to activate your core control muscles (transversus abdominis, multifidus and gluteals).

If you can isolate these muscles, we can test further when your core stability muscles lose control of your spine and become inhibited or fatigue. This testing assists us in determining what tasks make you vulnerable to back pain or injury.

What Happens After Your Core Stability Score is Determined?

Based on your functional needs, your treatment directs towards your specific areas of weakness. The result is a much stronger, stable and pain-free back. If you would like to know your Back Stability Score, please contact PhysioWorks.

What are the Benefits of the Functional Back Stability Score?

For Patients

  • You have a quantitative guide to your functional goals.
  • You have a current status score. Progress is measurable.
  • You can progress quickly through the BSS levels to maintain motivation and self-esteem.
  • Individualised treatment. Different retraining options depending upon desired outcomes.
  • You can self manage in the long-term.
  • Your goals are functional (task-related) rather than merely a strength score.
  • Quantitative Feedback for You, Your Health Practitioners and Insurers.
  • Achieve stepped goals and sensible, steady exercise and treatment progressions.
  • We'll educate you on how to prevent future injuries.
  • You'll be introduced to ergonomics and understand the best postures for you.
  • You will prevent future bouts or at least minimise their severity.
  • It's a research-backed solution.
  • It's perfect for all ages and physical abilities.
  • There is a clear path for progression.
  • You perform your exercises in the comfort of your own home without expensive gym equipment or membership.
  • You'll have personalised professional guidance for assessment, reassessments and progressions.
  • You'll be pain-free ASAP.

For Clinicians & Insurers

  • It's a precise measure of your functional capacity.
  • It allows better judgments on patient directions, e.g. returns to work.
  • It offers better-individualised advice and treatment.
  • It reduces jargon through measurable standardisation.
  • It's a practical measure that can be related to other outcome measures such as Oswestry Disability Score.
  • There is a clinically relevant correlation between subjective and objective findings.
  • It reduces malingering.

What Conditions Does the Back Stability Program Improve?

Core Stability vs Pilates

The whole 'core stability' phenomenon started in the 1920s with a chap named Joseph Pilates, whose exercise regimes have become quite trendy in the last ten years.

Pilates talked about developing a 'girdle of strength' by learning to recruit the deep-trunk muscles. Even without complete knowledge of anatomy and the benefits of the latest muscle activity research, he was aware of these deep muscles' importance and their supportive effects.

Core stability training targets explicitly the smaller and deeper back and stomach muscles. Once recruited, these muscles control the position of the spine during dynamic movements of your body.

Is Pilates for Everyone?

Sadly, No! Exercise programs that aim to develop your deep core strength can often do just the opposite. The most common reason for injury and back pain is the incorrect timing of core muscle recruitment. 

Pilates, Yoga, gym strengthening, and other exercise forms place high demands on your core stability system. Abnormal core muscle recruitment order increases your injury chance proportion with the exercise difficulty.

Remember, if you build a tower on a weak foundation, it will eventually topple. Look what happened to the Leaning Tower of Pisa. It's got lousy core stability! The same goes for your core stability muscles.

However, recruiting the deeper core muscles before your superficial layers, just like adding floors to a sturdy skyscraper and your back, will forever be healthy and pain-free.

Why is it Important to Specially Retrain your Core Stability Muscles?

Research has identified that the order of core muscle recruitment is one of the most critical factors in preventing or resolving pain. Once the core muscles become weak and their timing is incorrect, you can experience prolonged back pain and are at a much higher risk of re-occurrence. Real-Time Ultrasound Physiotherapy has proven particularly useful to correct the muscle recruitment order.

To solve your back pain and reduce your re-injury risk, you must retrain these muscles back to an appropriate level for your needs. If you are relatively sedentary, you may only need a low level of control. However, if you are a high-level sportsperson or a manual worker, you will need to work up to a much higher core strength level.

What Should You Expect?

You need to consciously activate these muscles in the initial stage and incorporate them into an exercise program. Many people find it difficult to isolate these muscles and need help to be able to activate them effectively.

Research has discovered that real-time ultrasound-guided treatment is the most effective way to retrain an isolated and well-timed core stability contraction successfully.

More information

Article by John Miller

What Causes Lower Back Pain?

Researchers and spinal health care practitioners categorise lower back bain into the following categories:

1. Specific Spinal Pathologies  (<1%)

2. Radicular Syndromes (5-10%)

3. Non-Specific Lower Back Pain (NSLBP) (Bardin et al., 2017)

Specific Spinal Pathologies

Some conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include:

These conditions do require early diagnosis and prompt referral to the appropriate medical specialist.  Luckily these conditions account for less than 1% of back pain sufferers, but you don't want them missed.

Some referrals should be IMMEDIATE!

Radicular Syndromes

Lower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of back pain presentations to general practitioners.

Radicular pain (e.g. sciatica)

The most common pinched nerve in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you suffer radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve).

The following back injuries may cause radicular pain:

Pain is due to swelling or space-occupying material adjacent to the spinal nerve. The affected nerve may be irritated, resulting in radicular pain. Or, even worse, become pinched or compressed, resulting in radiculopathy.

Radiculopathy

Lumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your walking ability.

Spinal Stenosis

Spinal stenosis is a slightly different condition and relates to the narrowing of the spinal canal. Spinal stenosis is usually more prevalent as you age.

Non-Specific Lower Back Pain (NSLBP)

Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify lower back pain sufferers with no specific structure injured. It is a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms.

Fortunately, these conditions account for approximately 90-95% of lower back pain and can nearly always successfully rehabilitate without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.

NSLBP Causes

The causes of NSLBP are numerous but roughly fall into either sudden (traumatic) or sustained overstress injuries.

Most people can relate to traumatic injuries, such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (e.g. poor posture) are probably more common and straightforward to prevent. In these cases, positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain.

Most commonly, NSLBP causes include back muscle strain or back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly your acute disc health and predispose you to severe pain.

The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment are the easiest way to recover quickly from lower back pain and prevent a recurrence.