Low back pain hits us all at some point, so we are very excited that Ann Wendel has written us this great article about treating low back pain (LBP), including her excellent photos demonstrating targeted stretches. Ann is a Licensed Physical Therapist and offered to give us a little info on her experience with treating LBP. Ann has been an avid supporter of Global Bodyweight Training and we couldn’t be happier to have her share her expertise with our readers.
You know the drill. You are in your office, working away. You drop your pen on the floor, reach over to pick it up, and BAM! Serious low back pain. It’s not like you were squatting your bodyweight or scaling a mountain; but, there you are, in a world of pain and wishing you had just left that pen on the floor! How did you get to that point and what can you do to speed up your recovery and prevent reinjury? That is the focus of this post.
Low back pain (LBP) is a common problem affecting as much as 80% of the population at some point in their lives. People of all ages, and both males and females are susceptible to acute and chronic low back pain. Back pain is the second most common reason for visits to the doctor’s office (outnumbered only by upper respiratory infection). Most cases of back pain are mechanical or non-organic, meaning not caused by serious medical conditions such as fracture or cancer. Muscular causes of low back pain or low back myofascial pain syndrome are often overlooked because they are not accompanied by structural abnormalities (i.e. not seen on imaging studies).
What may be the cause?
Let’s look at factors that may predispose you to low back pain. Among the many factors are obesity, lack of physical fitness, hypermobile joints, occupation, age, psychological stress, and smoking. Smoking has been found to have an overall detrimental effect on the intervertebral discs, by causing vasoconstriction (reduced blood flow) and decreased rate of healing. Other conditions such as osteoarthritis and osteoporosis may increase likelihood of low back pain, as may anxiety and depression.
When to see a Doctor
Before beginning any program of self-care, it is important to rule out serious pathology in the back. Pain can be caused by metastatic cancer, herniated disks, lumbar facet joint syndrome, and referred pain from visceral organs. If back pain is accompanied by loss of sensation in the legs, weakness of the muscles of the legs, changes in bowel and/or bladder habits, or increased pain with coughing or sneezing then a visit to a physician for further evaluation is warranted.
Things you can do on your own
If X-rays and MRI have ruled out serious pathology in the back, it would make sense to look at muscular causes for the pain. A combination of self-care, physical therapy, medications, and activity modification may be helpful in returning to prior level of function.If diagnostic tests are negative, you may be dealing with non-specific low back pain (NSLBP), defined as back pain without an identifiable cause. Muscle and myofascial trigger points are often overlooked as the cause of pain. A trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. Trigger points are responsible for stiffness and decreased range of motion in muscle, and can cause referred pain into other areas of the body.
Once muscle and myofascial trigger points form in muscle, they can alter body mechanics, cause muscle weakness, inappropriate co-contraction of muscles, disorganized sequence of muscle firing, and persistent functional change even after pain has resolved. It is important to begin treatment early, to prevent pain from becoming chronic in nature. Chronic LBP affects the function of muscles, decreasing stability and normal control of back movement. For early self-care of back pain, gentle stretching will help to relax tight muscles.
Let’s take a closer look at the muscles involved
We are going to look at six muscles in the low back, discussing their function and the ways they are most commonly injured. These muscles are:
- Superficial and deep erector spinae muscles: The erector spinae muscles run vertically along the spine in the mid-thoracic and thoraco-lumbar area. They function as a group to stabilize the spine and are often injured with chronic spine flexion (stooped posture or repetitive bending from the waist), lifting, twisting, carrying heavy objects, or falling.
- Quadratus lumborum: The quadratus lumborum is probably the muscle most commonly involved in LBP. It runs from the ilium (hip bone) to the 12th rib and extends the spine as well as hikes the hip. MTrP’s often form from a combination of bending, lifting and twisting, prolonged standing, rear end motor vehicle accidents, and leaning forward to lower a load.
- Psoas: The psoas runs from the lumbar vertebrae to the femur and flexes and externally rotates the hip. MTrP’s often form in the psoas from sitting for an extended time without a standing break, and can refer pain into the groin, hip and thigh.
- Abdominals: The abdominals flex and rotate the trunk as well as stabilize the spine. MTrP’s can be caused by dysmenorrhea (painful periods in women), endometriosis, coughing and vomiting. MTrP’s in the abdominals can refer pain to the low back and cause impaired ability to stabilize the spine during functional tasks.
- Serratus posterior inferior: The serratus posterior inferior (SPI) runs from the spine to ribs 9-12 and depresses the ribs during exhalation. MTrP’s in the SPI cause pain directly over the muscle.
- Gluteals: The gluteal medius runs from the ilium to the femur and abducts the hip. It is the main hip stabilizer in single limb stance and is often injured with falls and with running on a canted surface such as the side of the road. Pain from MTrP’s in gluteus medius refer to the sacrum and the low back just above the iliac crest.
(Low Back Pain of Muscular Origin, Gerwin, R., Adapted from Mense and Gerwin, Muscle Pain, Springer, 2010).
THE STRETCH PROGRAM
Following are photos of stretches for each of the muscles we discussed. Hold each stretch for 20 seconds and perform 4 times on the involved side of the body.
Erector Spinae Stretches
Quadratus Lumburum Stretches
Serratus Posterior Stretches
Gluteals and Piriformis Stretches
If pain and dysfunction do not respond to self-care measures, it may be time to see a physical therapist. Licensed physical therapists will provide an in-depth evaluation to determine a specific treatment plan based on your injury. Physical therapists utilize manual therapy, joint mobilization, stretching and strengthening of specific muscles, and modalities such as electrical stimulation, cold laser, and increasingly, trigger point dry needling. Physical therapists with specialized post-graduate training utilize dry needling to cause a local twitch response in the MTrP. The twitch response causes mechanical and chemical changes in the muscle to allow the spasm/pain cycle to be broken. Once the MTrP is inactivated, the muscle can be stretched and strengthened under the guidance of your physical therapist.
As we have discussed, LBP is a very common and often prolonged problem affecting most people at some point in their lives. Proper body mechanics, nutrition, exercise, and avoidance of smoking can help keep your muscles and disks healthy. If back pain does not respond to self-care measures, a physical therapist can work with you to determine the cause of the problem and develop a treatment plan.
ABOUT THE AUTHOR
Ann Wendel, PT, ATC, CMTPT: Ann holds a B.S. in P.E. Studies with a concentration in Athletic Training from the University of Delaware, and a Masters in Physical Therapy from the University of Maryland, Baltimore. She is a Certified Athletic Trainer (ATC) licensed in Virginia, a Licensed Physical Therapist, and a Certified Myofascial Trigger Point Therapist (CMTPT).
Over the past two decades, Ann has continually developed as a health care professional. She started her career working with high school, college and professional athletes, and later went on to work at an area hospital treating patients with a wide variety of Orthopedic and Neurological conditions. In 2003, Ann completed intensive training as a Thai Yoga Therapist, reaching the Advanced Level in her course of study. She owned and operated a private practice in Alexandria from 2003-2006, combining yoga, Thai massage, physical therapy and Pilates. Ann has completed 300 hours of a 450 hour Pilates Teacher Training Program through Core Dynamics Pilates, and enjoys combining Pilates and physical therapy in the outpatient orthopedic setting. Ann received her CMTPT through Myopain Seminars in 2011 and now utilizes Trigger Point Dry Needling as a treatment modality.