Treating Back Pain Effectively
- Pelvic Alignment Issues:
- The pelvis is the body’s base of support if it is twisted and out of alignment the rest of our body will be out of alignment. This will lead to an impaired distribution of force up through the spine and down through the legs leading to back pain, bulged discs, sciatica, radiculopathy, and other back pain-related issues. The pelvis consists of two sides, your left and you’re right pelvic innominate, both of these sides connect to the spine through the sacroiliac joint that is between the pelvis and the coccyx. There is supposed to be on average of 27° of rotation on each side of the pelvis. This movement goes anteriorly and posteriorly as well as up and down, like a “C” shape. If one side of the pelvis is stuck, forward or backward, it will create rotations in the spine and malalignment’s in the pelvis and lower extremities. To correct these issues you first need to figure out what type of alignment issue you have. If you are able to go to a Physical Therapist for an evaluation please do so. But a good way to assess yourself is to sit down in a long sitting position with both legs out in front of you. Is one of your legs shorter than the other? Whichever leg is shorter would indicate that the pelvis on the shorter side is rotated backward, posteriorly. This could be because your hip flexors are too weak or that your hip extensors, Gluteus maximus as well as the long head of the biceps femoris, the semitendinosus, and the semimembranosus muscles. Contralaterally the longer leg will have tight or strong hip flexors and weak hip extensors. Address and understand which side is rotated anteriorly and posteriorly and work on increasing range of motion and strength in your hip flexors and hip extensors to create an equal range of motion and strength on both sides. An easy technique to perform would be a muscle energy technique where you would contract opposing muscle groups on opposite sides of the body, hip flexors, and hip extensors.
- Bulged Discs:
- Bulged discs can occur for lots of different reasons both acute or chronic injuries. Once you have a bulged disc it can increase pressure on nerves that are going from your spine to your lower extremities and cause increased pain in your low back as well as radiating pain down your legs. Sometimes the symptoms of a bulged disc in the low back can be similar to that of constipation. In the cervical spine, a bulged disc can cause radiating pain down your arms and into your fingers. When addressing a bulged disc it is important to understand what caused the disc to bulge in the first place. Was it caused by an acute injury such as a fall, car accident, sports injury? Or did it come on slowly over time, chronic, due to bad postural alignment and posture? look at the alignment of your vertebrae and see if any are out of alignment. Have a Physical Therapist assess you for malalignments and for spinal abnormalities. It is also important to look at muscular strength in the abdominals and in the stabilizing muscles of the spine. Often a treatment plan will include multiple different parts. If acute or chronic and the pain is substantial traction and decompression interventions will be performed to gap the disc away from the surface it is being pressed up against. This allows for the nerve endings on each of the joint surfaces to stop being triggered and “firing” which will decrease the amount of pain that you are experiencing. This also allows for the disc to begin to take its normal shape. When the pain is more tolerable it will be important to look at the joint and vertebrae alignment. Sometimes manual mobilization techniques are needed to realign joints, other times manipulation techniques are used, and sometimes self-mobilization techniques that you can do on your own. Once your pain is subsided and your joints are realigned it is very important to begin to strengthen your muscles to hold your joints in their correct position so they don’t “slip” back out of alignment days, weeks, or months later.
- Weak Supportive Musculature:
- When addressing lower back pain it is very important to strengthen supporting musculature. A few muscle groups to focus on would be the erector spina muscles and the transverse abdominis. The erector spinae muscles run the length of your spine, with 3 muscles on each side. To stabilize and strengthen these muscles it is best to do so in a quadruped position, on all fours. Without a weight, to begin with, raise your left arm and right leg reaching out away and up. Be sure to switch and alternate accordingly, add weight as needed. Another muscle to strengthen is the transverse abdominis. This muscle crosses your abdomen and attaches all the way around to the spine. This is one of the main stabilizers of your low back and lumbar spine! The isometric contraction of this muscle will create a spinal neutral position causing your lumbar spine to “flatten”. You can perform this laying on your back, in sitting or standing. The goal is to create a neutral spine by rotating your pelvis backward and creating the feeling of pulling in your belly button. You should feel your stomach start to tighten and your lower spine to flatten, hold this position for 5-10 seconds.
- Tight Hamstring Muscles:
- There is compelling evidence to support the pathomechanical correlation between tight hamstring muscles and low back pain. In studies that show this correlation, it is typical that one leg has tighter hamstrings than the other. When performing a stretching program it needs to stretch for a minimum of 60 seconds if you are <40 years old and for a minimum of 240 seconds if you are >40 years old. As we get older there is an age-related loss of the mass of our skeletal muscles and also their strength, this is called sarcopenia. This results in a decrease in the mobility of our muscular tissue. Thus as we get older we need to stretch longer to have a lasting effect on our soft tissue. To stretch the hamstring straighten your legs while in standing, bend over, and touch your toes. In sitting you can bring a leg up onto an elevated surface in front of you, reach out towards your toes and hold the position. It is always best to try and lock out your pelvis by rotating your pelvis backward prior to stretching, this will make sure you are targeting and stretching your hamstrings.
- Tight Hip Flexor Muscles:
- The hip flexors attach from the upper legs and into your’ your pelvis and lower back. This is unique in that this is the only muscle that attaches your lower body to your upper body! Hip flexor tightness is a very undertreated cause of back pain as well as other pain patterns and syndromes. If the hip flexors are tight, short, they will create an increased lordotic curve in the lumbar spine, a curve in. This creates an adverse distribution of force that will place a lot of the pressure of gravity on just a few vertebral columns instead of an even distribution of force when the spine is aligned. Tight hip flexor muscles, when shortened, can create a decrease in stride length when walking and running. This not only slows you down but it leads to poor compensation mechanics in other joints in your hips and legs and can lead to further problems in your hips, knees, and ankles. A lot of the time these problems that happen further down the chain are far away from the root of the problem and the reason for them never gets addressed! It is very important with any joint pain that you look at one to two joints above and below the joint that is in pain. So what can you do to fix this? STRETCH and stretch often! Mobilize and massage your hip flexors by targeting muscle fibers that are accessible around the outer edges of your pelvis near your anterior superior Iliac spine.
- Impaired Postural Alignment:
- We all sit a lot more than any other time in history! Because of this, it’s no wonder we start to have postural alignment issues. Our low back hurt our upper back and our necks hurt. We all just become one big ball of tightness and stress! When spending long hours in front of a computer or at a desk without proper muscular queuing and postural reminders we slowly start to round our shoulders, our head/neck start to move forward, our pelvis rotates more posteriorly. We start conforming to the position we place ourselves in. To correct these we need to break it up! Yes, you could buy a contraption to wear around your shoulders or a sensor that connects to your phone. But the issue is once you don’t have that contraption you fall back into bad habits! So let's break the habits ourselves and create new pathways that will last long into our future. We can stand up, take a break, and move every hour or so. This increase in circulation and change in position gives us time to get our blood flowing and loosen up a bit! Workout and exercise routine and develop a workout program that you are able to follow 3-5x/wk. not only will this help your short-term problem, but it will set you up for success in your future health goals! Switch out your chair for a standing desk or an aerobic ball. These are great alternatives to replace the traditional sit-down style desk and cubicle. Change it up and feel the difference! These are just a few suggestions to break up the bad habits of our day and help correct our posture and alignment!
- Piriformis Pain Syndrome and Sciatica:
- It is a very common diagnosis, sciatica! Some Doctors may even use the longer diagnosis and call it Piriformis Pain Syndrome. This small hip muscle does a lot of work and takes a lot of abuse. This is one of the only muscles in our bodies that work in two different directions depending on what position the femur is in correlation to the pelvis/hip. The Piriformis muscle can perform both internal rotation and external rotation. As we get older and start to put on more weight in and around our hips this muscle tends to get stretched/pinched more. The space in and around the area starts to get crowded and bunched up. The Sciatic nerve goes straight through the middle of the Piriformis muscle fibers and is a prime entrapment site for the sciatic nerve. Pain from a pinched sciatic nerve at the piriformis entrapment site can radiate all the way down your leg and into your foot! A great way to treat this is to start stretching the piriformis muscle as well as stretching into hip external rotation! The other important part is to be sure to manual massage the piriformis making sure to really get in there and move that tissue around. You will know you found the correct muscle when you feel that jolt!
- Poor Lifting Mechanics: