Lower Back Pain
 Lower Back Pain is probably the most common
musculoskeletal condition afflicting humans. Estimates are
as high as 50% of Americans are currently experiencing some back
pain and 80% will experience it at some time. Lower back
pain can range from a mild annoyance to disabling. You may
feel pain in the lower back, the gluteal area, or the entire leg. Generally,
the more irritated your back is, the further down the leg symptoms
are felt. The source of the pain can be from a disc, joint,
ligament, nerve, muscle or any combination of these.
Most often, back pain is the result of accumulated stress and
strain to the back and hence, to recover you need to take a good
look at how you treat your back. If your back hurts after
sitting for a long time, then limit sitting time and consider getting
a better chair or support. If your back is sore in the morning
after sleeping on that 15-year-old mattress, you may need to treat
yourself to a new mattress. Did your symptoms get worse
after lifting a fifty-pound bag of dog food? Then try better
mechanics or get some assistance (or smaller bags).
As a runner, you may be more likely to experience pain after running
downhill or running longer distances. These two situations
tend to result in your back arching more than normal. Sometimes
a slight shift in your running posture can improve this. Try
to rotate your pelvis so that your back flattens slightly. You
will find this technique easiest to learn while lying down. As
you feel confident that you can flatten your back while lying down,
try it while standing, and then while running. A little
tilt can make a big difference. In the movie Prefontaine,
Steve’s coach tells him that he is sticking his butt out
too far and that he needs to roll it under. Actually, his
coach is a little more crass in his description, but it is a similar
posture.
When you are seeking help for back pain it can be confusing to
know what will work best for you. This is partly due to
the complexity of the back and our individual variations. There
is some recent research that may help to direct your efforts. The
program is based on the idea that there are basically four types
of non-surgical treatments for lower back pain. You simply choose
the category that comes closest to matching your situation. You
may find that you fit into more than one category or that over
time your situation changes and you need to shift categories. If
you don’t feel that any of these categories fits your situation
you will probably get the most benefit from trying the “stabilization
category”.
Specific Movement Category: Certain movements
can have a beneficial effect on your symptoms. If you find
that lying on your stomach and propping up on your elbows decreases
the pain in your leg or the pain moves more centrally towards your
back then perform several repetition of this movement. If
your pain decreases or moves more centrally towards the back when
you lie on your back and pull your knees towards your chest, then
perform several repetitions.
Treatment:
Manipulation Category: Manipulation is
more commonly described as getting your back adjusted or popped. If
your symptoms are less than 16 days in duration and your pain does
not descend below your knee, then it is more likely that you will
benefit from manipulation.
Treatment
- Manipulation has probably been a method of treating backs since
we began walking. Physicians (usually D.O.’s), physical
therapists, chiropractors, spouses, hairdressers, and teammates
have all joined in on the action, with varying degrees of success. There
are several manipulation techniques and theories about them. What
is known about this treatment is that a reflex muscle relaxation
occurs following it. You will generally feel less tense
and be able to move more freely because of the relaxation. The
current research also indicates that there is no change in the
position (alignment) of the spine after treatment. The
perceived “misalignment” is perhaps a result of muscle
tension. I suggest that you get a good reference before
seeking treatment.
Stabilization Category: Stabilization
has become a buzzword in the exercise world. Basically,
it is an approach to exercise that focuses on developing trunk
strength to help support or “stabilize” the spine. If
you have had 3 or more prior episodes, or are generally very flexible
then trunk strengthening / conditioning (stabilization) should
be most beneficial.
Treatment:
- Abdominal strength / endurance. My grandma use to say “there’s
more than one way to skin a cat”. When it comes
to abdominal exercises there are so many approaches that choosing
the right one for you is confusing. The approach I prefer
is to teach people how to contract the transverse abdominus,
which is the abdominal muscle that is reported to be most effective
in providing stability to the spine, and then use this type of
contraction while performing whatever abdominal exercise you
prefer.So the best abdominal exercise is the one that
is challenging, doesn’t hurt and you emphasize contracting
the transverse abdominus. An excellent routine is presented
in The Injured Runner – A Balanced Solution. To
help you
 learn how to contract the transverse abdominus try the
following exercise. Position yourself on your hands and
knees - keep your back in a relatively straight, relaxed posture. Next,
let your abdomen relax and hang down somewhat. Now, take
a deeper breath in through the nose, allowing your abdomen to
further expand; as you slowly and gently breathe outward through
the mouth purposefully draw your stomach inward. For some
of you this will feel like just the opposite of what seems natural. Practice
drawing the abdomen in while breathing outward and you will learn
how to use the transverse abdominus and not substitute with other
muscles. This is not a vigorous exercise, but you can
use it to learn how to contract this specific muscle. You
should feel some tightening around your lower ribs as well as
the sides of your abdomen; you may even sense some tension in
your lower back.
- Lower back strengthen / endurance. There has only been
one study, that I am aware of, that has shown that a particular
exercise will increase the size / strength of your lower back
muscles. These exercises were performed on an exercise
ball with the position held for 5 seconds and repeated to fatigue
(see Superman and Double Leg Lift). If
the position was not held for five seconds there was no change
in the size of the muscle, so make sure you hold at least five
seconds. You can also perform this exercise on a roman
chair, which is my preference if you are looking for
a vigorous workout. For added benefit try performing a
transverse abdominus contraction while doing these exercises.
To test your endurance you can perform the Sorenson test. Research
has shown that the average time that a person without back pain
can hold this position is two minutes and thirty seconds if you
are a male and three minutes if you are a female. Most runners
I test seem to be able to do about a minute longer than the average.
Traction Category: Traction is a technique
that may take pressure off your painful area. It is similar
to pulling on your finger to relieve a sore knuckle. To
see if this approach is beneficial for you, you will need a friend
to assist. Lie on a firm surface and have your friend grasp
your lower leg and raise it about thirty degrees directly upward
then gently pull as if to lengthen the leg. If you notice
a distinct relief of symptoms then this is the category for you.
Treatment:
- Have a friend pull the leg as described above. Hold
the pull for fifteen seconds and release for five seconds. Repeat
this cycle ten times, once or twice per day.
- A physical therapist or chiropractor can perform the traction
for you. Some have tables or machines that do the work,
or portable units that can be rented for home use. In
my experience, manual traction is more relieving than the machine
but difficult for the one pulling.
- An inversion table (see inversionusa.com) allows you to traction
your self with the help of gravity. Clip into the ankle
supports and spin yourself upside down (or however inverted you
want to be). There are some precautions with this approach. Be
sure you read about the precautions before purchasing, if in
doubt talk to your doctor.
|
