• Teresa Conrad

Low Back Pain


Low-back pain is one of the major forms of musculoskeletal degeneration seen in the adult population, affecting nearly 80% of all adults. Research has shown low-back pain to be predominant among workers in enclosed workspaces (such as offices), as well as in people engaged in manual labor (farming), in people who sit for periods greater than 3 hours, and in people who have altered lumbar lordosis (curve in the lumbar spine). It's estimated that the annual costs attributable to low-back pain in the United States are greater than $26 billion. In addition, 6- 15% of athletes experience low-back pain in a given year.


The typical muscles that might be tight or overactive when suffering from lower back pain are:


Peroneals Lateral gastrocnemius

Soleus Iliotibial band Lateral hamstring complex

Adductor complex

Psoas


The typical muscles that might be weak or underactive when suffering from lower back pain are:


Posterior tibialis Flexor digitorum longus

Flexor hallucis longus

Anterior tibialis Vastus medialis Pes anserine complex

Gracilis Sartorius Semitendinosus

Gluteus medius Hip external rotators

Gluteus maximus Local stabilizers of the LPHC


Common joint dysfunction


First metatarsophalangeal joint

Subtalar joint Talocrural joint Proximal tibiofibular joint

Sacroiliac joint Lumbar facet joints


Origin of Lower Back Pain


There is a high amount of LBP in sports. For example, 85% of male gymnasts, 80% of weightlifters, 69% of wrestlers, 58% of soccer players, 50% of tennis players, 30% of golfers, and 60 to 80% of the general population were reported to have LBP. This leads to a higher chance of lower back injuries. Static malalignments (altered length-tension relationships or altered joint arthrokinematics), abnormal muscle activation patterns (altered force- couple relationships), and dynamic malalignments (movement system impairments) can lead to LBP.


Static Malalignments (altered length-tension relationships or altered joint arthrokinematics)


Optimal muscle performance is determined by the posture (length-tension) of the lumbo-pelvic-hip-complex during functional activities. If the low-back arches, low-back rounds, or excessive lean forward, the activation and the relative moment arm of the muscle fibers decreases leading to injury.


Vertebral disk injuries generally occur when there's a combination of motion with compressive loading. Compression combined with bending and twisting movements about the disk contributed to earlier degeneration in saturated intervertebral disks.


Pelvic asymmetry (iliac rotation asymmetry or sacroiliac joint asymmetry) has been shown to alter movement of the HMS in standing and sitting. Pelvic asymmetry alters static posture of the entire LPHC, which alters normal movement of the spine. This links to LBP. It has also been demonstrated that hip rotation asymmetry, in particular decreased hip internal rotation range of motion, is present in clients with sacroiliac joint dysfunction.


Abnormal Muscle Activation Patterns (altered force-couple relationships)


People with LBP have been reported to demonstrate impaired postural control, delayed muscle relaxation, and abnormal muscle recruitment patterns, notably the transverse abdominis and multifidus activation is diminished. A similar delay in activation of the internal oblique, multifidus, and gluteus maximus was observed on the symptomatic side of individuals with sacroiliac joint pain.


The loads, forces, and movements that occur about the lumbar spine are controlled by a considerable number of ligaments and muscles. The ligaments that surround the spine limit intersegmental motion, maintaining the integrity of the lumbar spine. These ligaments may fail when proper motion cannot be created, proper posture cannot be maintained, or excessive motion cannot be resisted by the surrounding musculature. Therefore, decreasing the ability of local and global stabilizing muscles to produce adequate force can lead to ligamentous injury.


Dynamic Malalignments


Low-back injuries can cause decreased control of the core, resulting in poor stabilization of the spine. Decreased core control may contribute to increased valgus positioning of the knees, which can lead to increased risk of knee injuries. It's important to train the trunk to increase hip adduction and internal rotation to prevent dynamic malalignments and potential injuries.


How to Prevent Lower Back Pain


You can reduce the chances that you experience lower back pain by:


Eat healthfully so you keep your body weight within a healthy range

Get regular exercise to keep your core and back muscles fit and flexible

Avoid prolonged sitting

When you do sit, maintain good posture

Use proper techniques for lifting (lift with your legs rather than your back)

Be core concisous when bending or twisting

Avoid situations where your spine is vibrated for long periods of time

Get enough sleep each day


If you have back pain that doesn’t improve within about six weeks, see your health care clinician or a back specialist.


Sources: NASM 2014

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