Low back pain (LBP) is currently one of the most common AND expensive musculoskeletal disorders in the world.
LBP can be defined as ‘muscle tension or stiffness located in the area between the 12th rib and the inferior gluteal folds’ – your ribs to your butt!
It is believed that 60-80% of all adults world wide will experience LBP in their lifetime; with the highest prevalence found amongst the 40-60 age groups. Research is now showing that LBP is also increasing in the younger populations i.e. under 20 years of age.
There are many causative factors for LBP. As little as 10% of LBP has an identifiable cause which means that up to 90% of cases may have no underlying cause.
POTENTIAL CAUSATIVE FACTORS.
Mechanical Loading.
Let’s put the ‘Red Flags’ such as trauma, injury and structural defects to one side for now.
Those working in hard manual work certainly have a higher incidence of LBP. Children who carry a back pack that weighs more than 20% of their body weight are now showing higher levels of LBP. Sedentary jobs and those who spend periods of time hunched over their mobile telephones or playing computer games do to.
Functional Movement and Alignment.
Your muscles work on a pulley and lever system IE if one is shortened then the other is lengthened. With any injury there is a decrease in muscle activation in the affected area. Other muscles will respond by becoming over active. This change in recruitment patterns particularly when applied to your back will pull your pelvis out of its correct natural alignment, leading to uneven weight distribution in the intervertebral discs and the potential for LBP to develop over time.
Pychosocial.
Scientific data on LBP and psychosocial factors is still limited and at times is inconsistent. Many of these factors are considered ‘Yellow Flags’ when it comes to LBP. For example job dissatisfaction, poor social support etc. The use of psychosocial screening tools is essential. For example Fear Avoidance Questionnaires and the ABCDEFW (Attitudes, Behaviours, Economic, Diagnosis, Emotions, Family and Work) Back Pain Screening Pneumonic look specifically at attitudes and beliefs, economic issues and emotions amongst other things.
Personal trainers working with clients with LBP should ensure that they utilise a combination of tests during their assessment process not solely relying on physical tests. These are known as subjective and objective test. Objective tests are the physical tests for example deep breathing, pelvic tilting, squat test and Thomas Test etc and subjective tests make up the more psychosocial or psychological screening tests discussed above.
TWO COMMON POSTURAL CONDIITIONS LEADING TO LOW BACK PAIN.
Lower Cross Syndrome.
This syndrome is typically found in individuals who sit for prolonged periods of time with their spine in a flexed position. IE leaning forwards.
Vladimir Janda MD, an expert in muscle imbalances, describes Lower Cross Syndrome (LCS) as ‘over activity of the thoraco-lumbar extensors, rectus femoris and iliopsoas group as well as reciprocal weakness of the glutes and abdominal muscles.’
IE in layman’s terms if the abdominal muscles and glutes are weak then the erector spinae and iliopsoas (hip flexor) groups are tight.
LCS may present with an increased lumbar lordotic curve or lower back arch.
Why? If you sit in a constantly flexed position your erector spinae group has to work extra hard to hold you in an upright position while your iliopsoas and rectus femoris (muscle at the front of the thigh making up the quadriceps group) are constantly shortened leading to the tightness described.
In this syndrome your pelvis is typically in an anterior tilt. It is a distortion syndrome of your lower lumbar kinetic chain. Imagine your pelvis as a bowl containing liquid. If you stand with your hands on your hips, would this bowl be tipping liquid out of the front or the back? If is from the front then it is an anterior tilt.
Pelvic tilting as an objective test is a fantastic tool. It allows us to test the motor control between the spine, pelvis and hips. A tilt either posteriorally or anteriorally will lead to increased stresses on your lumbar spine.
How can we correct this?
- Stretching including the use Self Myofascial Release or SMR is one way of stretching out these tight muscles. Your muscles are covered with fascia – a type of connective tissue. This tissue has in all likelihood become tight and restricted leading to hot spots. The aim of SMR or foam rolling is to break down these hot spots by relaxing the contracted muscle, therefore reducing inflammation and increasing lymphatic drainage while stimulating the stretch reflex. It is a bit like rolling out pastry with a rolling pin but more painful!
- Strengthening and stabilization training. You should aim to work on the weakened muscles of the glutes and the abdominals through specific programming and look at improving your lumbo – pelvic hip control.
- Client education. As a fitness professional our role is to explain to our clients why they have the pain they do. The client then gains an understanding of why and is at less risk of injury and ultimately will be able to self manage. This is known as Motor Learning Progression.
Upper Cross Syndrome
This syndrome is typically found in individuals who sit and work at a desk all day.
Janda describes Upper Cross Syndrome (UCS) as ‘over activity of the upper trapezius, levator scapulae, sternocleidomastoid and pectoralis muscles and reciprocal weakness of the deep cervical flexors, lower trapezius and serratus anterior.’
IE in layman’s terms if the upper traps, levator scapulae, sternocleidomastoid and pecs are tight the neck flexors, serratus anterior and rhomboids are weak.
Due to these imbalances in the head and shoulder region, UCS may present with an excessive forward head tilt, hunching in the thoracic spine with shoulders in an elevated and protracted position.
In this syndrome the poor posture will lead to chronic pain overtime, muscular aches and pains, headaches and premature ageing in the intervertebral discs.
How can we correct this?
- Stretching including the use Self Myofascial Release or SMR is one way of stretching out these tight muscles. Your muscles are covered with fascia – a type of connective tissue. This tissue has in all likelihood become tight and restricted leading to hot spots. The aim of SMR or foam rolling is to break down these hot spots by relaxing the contracted muscle, therefore reducing inflammation and increasing lymphatic drainage while stimulating the stretch reflex. It is a bit like rolling out pastry with a rolling pin but more painful!
- Strengthening and stabilization training. You should aim to work on the weakened muscles of the glutes and the abdominals through specific programming and look at improving your lumbo – pelvic hip control.
- Client education. As a fitness professional our role is to explain to our clients why they have the pain they do. The client then gains an understanding of why and is at less risk of injury and ultimately will be able to self manage. This is known as Motor Learning Progression.
As previously highlighted many causes of LBP remain unclear but with time both of the syndromes mentioned above can be treated. These are common postural problems and very relevant to the age that we currently live in. Don’t become a victim of your environment. Regular exercise, regular stretching. Make it part of your life today!
Pippa Crowther.
