Managing Back Pain

IMG_4889 copyFrom a small ache to debilitating pain, 80% of people will experience back pain in their lifetimes. For some, an episode will occur once but for others, pain will become chronic. It can compromise an individual’s quality of life: keep a parent from enjoying time with their young children, affect daily routines, cause an athlete to stop competing or end a dancer’s career. The problem is that pain can cause one of two positive feedback loops. One: Your back hurts, so you stop exercising, your stabilizing muscles weaken, your back pain increases, you reduce activity levels even more, muscles weaken more, pain increases, etc. Two: your back hurts, you think you’re weak, you go to the gym to get stronger, pain increases, you work harder, pain increases, etc. This can go on and on and on. Why does all of this happen and how do you get out of the cycle? It requires a specialized focused approach, infused with care and awareness, and founded in anatomical knowledge.

It is all in the anatomy.

The torso is comprised of both stabilizing and mobilizing muscles (See The Hype About Stabilizing). Muscles deep within the spine constitute the stabilizers while the superficial muscles are mobilizers.  Generally speaking stabilizers are small and mobilizers are large and powerful.

While the vertebra of the spine are strong, the discs and ligaments are fragile.  In fact, these structures can only handle about 20 lbs of stress before they are damaged.  This means that without  muscular control, the spine would become unstable and be crushed under the average person’s weight.  Cutting edge research suggests that when a back injury occurs, there will also be an injury to the nervous system causing the spinal stabilizers around the injury to fire poorly.  Once an injury has occurred, the abdominals and back muscles become unable to stabilize the spine leading to chronic pain.

Think about the back pain sufferer in gym class and the mounting pain he or she experienced when trying to fix their pain. Traditional core strengthening exercises or fast paced sweat inducing classes focus on outer layer mobilizers not the stabilizers required to support the spine. To make matters worse, the mobilizers take up the slack to stabilize the injured joint, causing muscle imbalance and even more pain.

How can someone retrain their spinal stabilizers and recover from back pain?

The crux of the problem comes from needing to retrain your spinal stabilizers to engage, not overreact, and not turn off. Repairing communication between the brain and the spinal stabilizers around the injured joint requires slow focused exercise. Exercises like those found in Pilates.

Begin by imagining a corset cinching the waist together. This image, used by Pilates professionals around the world, gives you the sensory information you need to engage the transverse abdominus, stabilizing the spine.  Exercises like Ab prep engage the multifidus that runs along each side of the spine providing further stabilization. There are many examples of slow focused exercises in Pilates, but the most important aspect though, is that you work with a professional who can correct you when you fail to engage spinal stabilizers and create programming specific to your needs.

Remember harder is not better but neither is inactivity. If you’re dealing with back pain, consult with your physician, find a qualified Pilates instructor, and get to work!

 

References:

http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm

Rick Jemmett, Spinal Stabilization: The New Science of Back Pain Libris Hubris Publishing Canada, 2003

 

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