Understanding Low Back Pain

We have looked at some tips for low back pain in a previous blog, so this week we want to give you a bit more information about low back pain itself.

Understanding the anatomy – different structures involved can give you an idea of healing time frames and what you need to do to help yourself. Similar areas of pain can have multiple structures of involvement. 

Understanding what these are can help you to avoid the triggers of your pain. In this blog we will go over some common causes of low back pain as well as some spinal hygiene practices which are vital to keep your back healthy in the long run. 

Low Back Pain Anatomy

The low back covers the structures between the hip joints and the bottom of the rib cage.  This involves the lumbar spine, discs, nerves, ligaments, pelvis, sacro-illiac joints, pubic joint, hip joints, multiple muscles and fascia. The most notable muscles include those which make up the ‘core’ (QL’s, rectus abdominis, transverse abdominus, internal and external obliques, erector spinae like multifidi and the psoas), the latissimus dorsi, glutes and hamstrings.

The vertebrae have lumpy parts which you can feel, called spinous process’. The have a disc between each level, which is made of a tough outer layer and gel like inner layer. Vertebrae have facet joints which allow the bones to articulate, bending and twisting. The spine houses nerves which exit each level, controlling muscular contraction, organ function and sensation. Ligaments and fascia limit end range of motion and hold everything together.

Common Low Back Pain Causes

Different forces load the spine differently! The two main forces are compression forces (squeezing down) and shear forces (perpendicular to compression, resulting in a rubbing). Varying postures and movement habits result in compression and shear forces.

The hip joints are designed for movement and repeated bending, the spine, whilst flexible, can be irritated by this. The hips are designed to create motion and the spinal muscles are designed to stop it.

This stability is created through muscular stiffness – not strength! Lack of stiffness allows extra movement which can trigger pain. This is why if stretching isn’t helping your low back pain… you should probably stop. As it is could be creating an imbalance. A lack of endurance leads to improper stiffness and therefore repetitive stress injury through bending / twisting / extending. The lack of protection through muscular stiffness and endurance is a predisposition to injuring the low back. 

Spinal Hygiene Practices for the Low Back

Work on better movement in each and every day. Working on the mobility of the hips and shoulders will allow your spine to be more stable. Avoid movement patterns which cause the pain (bending, twisting, loading and postures which irritate you). Often we just ‘get on with it’, this can be like picking a scab. It won’t allow the tissues to heal.

• Try and expand your ability to move, within a pain free capacity. If low back pain starts after 20 minutes of walking, start with 15 minutes. Add 30 seconds a day. You’d be surprised how much further this can take you. 
• Work on the opposite muscles to slouching – reach up and back for 10 seconds when sitting. Have your arms behind your back when standing instead of crossing your arms in front. 
• Try chores like hoovering or loading the dish washer differently. Use two hands with the hoover and keep it central, load the dish washer from the side for less bending. You can also lunge to load it instead of bending. 
• Keep a variety of postures without staying in any one in particular for too long. Such as not sitting or standing too long without moving.
• Try and go on a walk 2-3 times a day for a minimum of 10-15 minutes. Work up to three 30-minute walks per day. Walking is one of nature’s best remedies when applied slowly and progressively.  

The “Big 3” Exercises for a resilient Low Back 

The curl up, side plank and bird dog are three exercises everyone can be doing at some level to build resilience in the low back.  The goal is to breathe normally throughout and accumulate 1 minute a day for each one (6 lots of 10 seconds with some rest between).

1.The Curl Up

• Lay on you back with palms on the floor under the small of your back. 
• Have one knee bent with your foot on the floor and the other knee straight with the leg on the floor.
• Draw the bottom of your rib cage down toward the top of your pelvis. This will engage your abdomen. 
• Raise your elbows and head off the floor slightly through this process. 
• Hold for approximately 10 seconds. 
• Don’t bend your low back when doing this.

2.The Side Plank

• This can be done with bent knees or straight ones, depending on your ability. 
• Lay on your side and support your body with one elbow / forearm, hip and outer leg.
• Lightly brace your stomach and push through the hips until you are supporting yourself with your elbow and knees (or feet).
• Hold for approximately 10 seconds. 
• Avoid twisting through the pelvis. 

3.The Bird Dog

• Get on all fours. For comfort, you can put cushions under your knees. 
• Find a sweet spot where there is minimal stress on your spine. 
• Raise the opposite arm and leg away to hip / shoulder height. 
• Hold for 6-8 seconds. 
• You can start with just the leg / arm if you are struggling with balance.