Back pain can put you on the sidelines. A 2009 review in the Journal of Physical Therapy by physical therapist Luciana Macedo and colleagues concluded that spinal stabilization exercises are an effective way to reduce pain and return to activity. These exercises target specific groups of muscles that are the foundation of a strong back. Persistent low back pain can inhibit or shut these muscles down leaving your back vulnerable to further injury.
Significance
Millions of Americans live with back pain. More than $86 million is spent each year on medical costs related to lower back pain. According to the American Chiropractic Association, 80 percent of Americans will experience back pain. The majority of lower back pain is caused by mechanical factors such as muscular or postural strain.
Key Muscles
Muscles that are the key deep stabilizers of your spine and the focus of spinal stabilization exercises include the transverse abdominus, the pelvic floor muscles and the multifidus. The transverse abdominus wraps the abdomen like a corset or back brace, running perpendicular to the spine. When it contracts it draws the abdominal wall inward toward your spine. The pelvic floor is the base of the abdominal cavity and works with the transverse abdominus. Women contract it by thinking of stopping the flow of urine and men can think of lifting their testicles. The multifidus is present at each level of the spine and is responsible for stopping rotational forces. Together these muscles allow the spine to resist movement and forces that can injure your back.
Effects
If you have a history of back pain or spinal trauma your muscles will become shut off or inhibited and eventually weaken. When they fail to stabilize the spine, excessive force is placed on segments of the spine resulting in strain and injury. Normally your muscles contract instantaneously during activity to resist these forces. With dysfunction their response becomes delayed and back pain develops.
Assessing Weakness
Specific muscle and movement testing can identify weakness. A skilled physical therapist can identify which segments are weak and which muscles are not functioning correctly. They may use diagnostic ultrasound and biofeedback to measure the contraction and size of these muscles. Appropriate and safe exercises will be provided that address your specific weaknesses.
Misconceptions
Spinal stabilization exercises that are traditionally used may expose you to injury risk if you demonstrate weakness in the key stabilizing muscles. Without connecting to these muscles first, you run the risk of increasing spinal strain if you challenge the muscles beyond their ability. You must create a foundation with early exercise and advance carefully to your desired level. Even if you feel you have strong abdominal muscles you may not be recruiting the deep spinal stabilizers.
Exercises
When a muscle is shut down it can be challenging to turn it back on. A skilled therapist can teach you to target the muscles correctly and progress you through a safe and effective program. Exercises start at a basic isometric level and move through more dynamic challenges until these contractions become part of your normal activities.
References
- "Journal of Physical Therapy"; Motor Control Exercise for Persistent, Nonspecific Low Back Pain: A Systematic Review; Luciana Macedo et. al.; January 2009
- American Physical Therapy Association: Report Shows Motor Control Exercises Reduce Persistent Lower Back Pain
- American Chiropractic Association: Back Pain Facts and Statistics
- "Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain"; Dr.Carolyn Richardson, Gwendolen Jull, Dr. Paul Hodges, Dr. Julie Hides; 2003
