Spinal arthritis, degenerative disc disease, bulging or herniated discs, nerve entrapments, stiffness, muscle knots, and sciatica are some of the most common spine conditions that we see at Movement Solutions. Almost everyone will experience back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, back pain can make many everyday activities difficult to perform.
There are common risk factors that can contribute to having lower back problems. These include mobility restrictions at the thoracic spine (upper back) and hips. In addition, weakness of the lower back, core, and buttock muscles can contribute to pain. In some cases there are movement errors that lead to a back injury. This might include trouble loading the hips (i.e. posterior chain) when lifting from the ground.
Having prerequisite mobility at the thoracic spine and hips as well as core stability are crucial for normal movement. The lower back often gets beat up because it compensates for two regions of the body that are supposed to have a lot of mobility. Our culture and habits lends itself to sitting for 8-10 hours per day. This can lead to a stiff upper back and stiff hips. The lumbar spine often compensates for this lack of mobility by moving excessively. This may contribute to pain or injury or the lower back.
In our physical therapy office, we first step we often take in reducing pain and restoring mobility is performing hands-on manual therapy. This might include dry needling, soft-tissue mobilization, joint mobilization, or manipulation. The effects of some of these treatments can be reinforced with foam rolling. By simply applying pressure through tense and stiff muscles, tension can be released and mobility can be gained. Some of the exercises that we prescribe patients include foam rolling the t-spine and hips as seen in the videos below.
However, foam rolling alone won't provide any lasting gains in mobility. The reason for this is because stiffness and tension is usually driven my weakness of the stiff muscle as well as the muscle groups above and below that region. More over, the body needs to learn to actively use the motion it gains through passive implements (manual therapy and foam rolling). In order to develop lasting mobility, inactive muscle groups must be activated and strengthened. We have specific exercises that we we intentionally use to target these weak regions. Some of these can be seen below.
Once we actively developed mobility, the next step is to work on stability. Spinal stability begins with co-contraction of the abs and the glutes. The abs and the glutes provide the necessary stability to keep the spine protected with loaded movements. One of the best exercises to work on core stability are plank and plank variations. The RKC plank is one of the best variations of this exercise that really emphasize the abdominal muscles.
Finally, we know that if our patients have good mobility and stability in static positions but still have back pain when moving or exercising, our rehab program isn't very effective. We teach our patients to move well under load and use the mobility and stability they have in a dynamic exercise. One of the best exercises for spine health is a deadlift.
At our physical therapy office, we usually start with kettlebells because it is easier to learn the skill of hinging at the hips. When performed with good technique, deadlifts develop strength though the posterior chain (lats, lower back, glutes, and hammies). It often takes good coaching and practice to learn to load the hamstrings and unload the spine. But it's a skill worth mastering as it translates to all hinge movements including swinging a kettlebell and picking a bag of dog food from Costco.
In the absence of pain or injury, the above strategies are an excellent way to prevent injury to your spine. However, if your back is in pain, a more nuanced approach is necessary. The reason for this is because pain changes movement. Movement compensations need to be identified with a thorough assessment. An individualized plan needs to be developed to correct dysfunction. Manual therapy should be considered in the presence of pain and mobility restrictions. And a carefully planned exercise progression should be undertaken to recover from pain and injury and return to activity.
If you live in Greenville, South Carolina, are active (or want to be active), are between ages of 40-60s, and have back pain, the providers at Movement Solutions would be happy to talk about how we can help. We are happy to begin with a free phone consultation where we you can talk on the phone to one of our providers. We get give you guidance on treatment options and how you can get your life back. Call us today at (864) 558-7346. We look forward to hearing from you!