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. You’re much less likely to suffer back pain when they work correctly. 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.

The chance of lower back pain (LBP) recurrence within one year reduces significantly. 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.

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.

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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

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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?

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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

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Article by John Miller

What Causes Lower Back Pain?

How Do Researchers Categorise 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 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 irritates 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 be successfully rehabilitated 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.

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Back Pain Prevention Tips

Here's some beneficial advice to help you prevent back pain and enjoy life to the maximum.

Posture

I'm afraid that your mother was right. If you slouch, you'll end up with problems. Just one of those problems is back pain. You'll find other issues elsewhere on this website. Think "Grow Tall". Imagine that you have a string screwed onto the back of your head, just above your hairline. Then think that someone is dragging you up off the chair you are sitting on. Hold this "grow tall" position for 10 seconds and repeat every half hour.

As well as significantly reducing your chances of back pain, you'll note that your chest has lifted, shoulders are relaxed, the chin tucked in, the head is level and stomach muscles have contracted. You can repeat this posture in sitting, standing, sleeping, walking or running. Try it, and the physio will work for you too! Not bad for such a simple exercise.

Posture Supports

Lifting

The best method to avoid back pain from lifting is delegation. If this isn't an option for you, try the following:

  • Use back support to lift loads over 15 to 20kg.
  • Bend at the hips and knees with your feet shoulder-width apart.
  • Firmly grip the load and hold it close to your body.
  • Think "grow tall" to tighten your stomach muscles and look upwards to straighten your back.
  • Stand using your muscular thigh and buttock muscles to lift.
  • Once upright, turn by using your feet. Avoid twisting your back.

Sitting

Use the "grow tall" principle each 15 to 30 minutes while sitting. A supportive chair or lower back cushion is essential if you must sit. If possible, don't stay seated for too long. Regularly stand up, stretch your back and walk short distances for various postures. After all, we were designed for hunting and foraging - not sitting in front of a computer!

Posture Supports

Exercise

Fitness has many benefits. Stronger, more flexible muscles and less weight stress the bones and discs. PhysioWorks provides exercise programs to keep your back relaxed, strong and pain-free. Exercise can involve aspects of flexibility, strengthening and postural control.

Consider Real-Time Ultrasound Retraining to ensure you are doing it right!

Sleeping

A quality pillow and mattress are necessary for a healthy spine. You do spend somewhere between one-quarter (1/4) and one-third (1/3) of your life sleeping.

Do it in comfort! You'll need to consider a new mattress if you wake up through the night or in the morning with back pain. Would you please ask your PhysioWorks therapist for advice at your next visit?

Driving

Use the "grow tall" principle each 15 to 30 minutes while driving. The combination of sitting and bumpy roads is a recipe for back pain. A  lower back cushion is essential if you must go any distance.

If possible, don't stay seated for too long. After all, we were designed for hunting and foraging - not sitting in front of a computer! Regularly break your travels to walk and perform simple stretching exercises for various postures and a healthy spine.

Posture Supports

Article by John Miller

Is An Exercise Ball Good for Lower Back Pain?

Exercise Ball & Back Pain

Back pain is often the result of having weak stabilising muscles supporting your joints. Without solid support, your joints collapse. Your bony skeletons don't stand up by themselves. The bones are held upright by efficient, supportive muscles that work across every joint in your body.

Research has shown us that pain causes these supportive muscles (known as your "stabilisers" or "inner core stability muscles") to stop working. Research on lower back pain sufferers has found that these muscles stop working every time you experience back pain.

Even worse, in most cases, these muscles don't automatically start working again when your pain goes. They need to be deliberately re-started by your brain.

Your exercise ball is an unstable surface. When you sit or exercise upon one of these balls, your body automatically recruits your natural balance reactions. One of the critical components of your balance reaction system is the activation of your core stabilising muscles. With repeated use over just a few days, your stabilising muscles will usually automatically start working again in most cases.

So, doe the use of an exercise ball help lower back pain? In most cases, YES. But, in some cases, it can aggravate your lower back pain. Would you please consult your trusted back pain physiotherapist for an individualised assessment and back care program?

There are several ways to reactivate your core stability muscles. One of the most effective is to use a Physio Exercise Ball. Usually, some simple exercises can often automatically 'kick start' these stabilising muscles.

Your physiotherapist has special training in the reactivation techniques of these stabilising muscles. For more advice, please get in touch with your physiotherapist.

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Smoking Effect on Lower Back Pain

Researchers have discovered a link between smoking and lower back pain. It also sheds light on the causes of degenerative lumbar spine problems. Numerous researchers have proposed a link between smoking and low back pain, but the exact nature of that link has mainly remained untested in long-term studies. A recent study on smoking and low back pain, which examined 1,337 doctors, followed some participants for more than 50 years.

Research Findings

Researchers discovered that smoking history, high blood pressure, and heart disease - all of which are risk factors for narrowing the arteries - significantly increased the likelihood of low back pain.

These same risk factors and high cholesterol levels were also significantly associated with lumbar spondylosis development (degeneration).

Why?

These findings support the theory that the arteries' narrowing may cause lower back pain and degenerative disorders of the intervertebral discs. Researchers have suggested that damage to the discs and joints' vascular structures (blood supply) is the injury mechanism in low back pain.

Conclusions from Smoking and Low Back Pain Study

The study concluded that the development of lower back pain was significantly associated with smoking history and high blood pressure. The development of lumbar spondylosis was significantly associated with smoking history and high blood pressure and cholesterol.

What about Diabetes and Lower Back Pain?

The good news for people with diabetes was that diabetes did not increase lower back pain or lumbar spondylosis (degeneration) incidences.

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Lower Back Pain Research

Lower back pain (LBP) is one of the most common conditions in health care. Approximately 80% of the population will suffer low back pain at some point in their lives. Lower back pain costs our country billions of dollars every year through absenteeism and injury rehabilitation.

It is critical to all those who suffer from low back pain that a safe and effective treatment protocol can beat lower back pain. Australian physiotherapists lead the world with groundbreaking research to improve the treatment and prevention of low back pain.

At PhysioWorks, we are glad to offer both immediate pain-relieving techniques and longer-term preventative programs to stop recurring lower back pain.

How Can PhysioWorks Help Your Lower Back Pain?

Well-designed research and highly skilled clinical practice have physiotherapy evidence as a safe, effective and low-cost management approach for low back pain.

PhysioWorks' physiotherapists are highly skilled. They are well respected to assess, diagnose, and successfully treat patients with low back pain from musculoskeletal dysfunction.

Our injury management involves not only 'joint manipulation' like some other health practitioners, but also less forceful but equally effective passive examination and treatment techniques, effective therapeutic exercise (strengthening and stretching) and vital advice on posture, lifting and movement pattern abnormalities. In other words, your physiotherapist will address the immediate problem and then help you stop it from coming back using many techniques and skills.

Evidence-Based Physiotherapy for Low Back Pain

Physiotherapists have undertaken substantial research investigating the techniques used according to stringent research guidelines. Physiotherapists base their treatment protocols on scientific research evidence, unlike some alternative back pain remedies.

Based on a comprehensive review of the scientific literature, the Australian Physiotherapy Association (APA), with assistance from the Musculoskeletal Physiotherapists Association (MPA), has developed a recommendation for the successful treatment of low back pain.

Low Back Pain - Acute (less than three months)

There is considerable evidence to support that spinal manipulative therapy (SMT), including passive mobilisation and manipulation, McKenzie therapy and the encouragement of early active movement, rather than bed rest, is effective in the short-term management of low back pain.

SMT provides a better short-term improvement in both pain and the return to normal activity levels than the comparison regimens of traction, massage, short-wave diathermy and epidural injections.

Compared to placebo or other conservative treatment, a recent meta-analysis reports twelve out of sixteen trials favourable for SMT.

Chronic Low Back Pain - Greater than three months

There is strong evidence to support that exercise programs result in a faster return to work rate, reduced absenteeism, and disability than control groups.

Your PhysioWorks' physios possess the necessary skills and education to individually assess each low back pain candidate and then appropriately design, prescribe, supervise and progress your successful low back pain exercise program.

Currently, physiotherapists are pioneering research investigations into the mechanisms contributing to chronic and recurrent low back pain. The evidence to support their efficacy is continually increasing.

The spinal manipulative techniques (SMT) are more effective in managing chronic low back pain than bed rest, pain killers and massage, with six out of eight trials supporting this evidence.

More importantly, the combination of SMT and specific exercises have increased support in managing low back pain. Your PhysioWorks physio has the necessary skill and knowledge to provide you with optimal low back pain care.

Real-Time Ultrasound-Guided Treatment

The best way to activate the correct core stability muscles is to see them working on an ultrasound scan. Yes, it's just like seeing an unborn baby. We now have this fantastic technology at several of our PhysioWorks clinics.

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