Back pains - exercises and mobilization

According to the data, backache has been experienced in 60-80% of the population of Western countries at least once in their lifetime. Unfortunately, this is due not only to the excessive amount of physical activity but also the lack of it. For this reason, this condition may increase the percentage of cases in the current pandemic, where a large group of us have experienced a significant reduction in the level of physical activity and extended hours of work at the desk. In addition, there are genetic predispositions that may increase the risk of pain in the spine.

1. Structure and functions of the spine

When analyzing pains within the spine, it is worth paying attention to its structure. In the process of ontogenetic development, the spine of each of us should form the letter S. Thanks to this, during physical activity, it gains the ability to absorb shocks, which results in lowering stress on the vertebrae, spinal discs, and the spinal nerve. It should be emphasized in this case that the appearance of any abnormalities in the structure of the spine will reduce the above-mentioned ability. This will shortly lead to the appearance of micro-injuries that will result in pain.

2. Pain in the lumbar region

Lumbar pain is the most common pain in the spine. There may be so-called acute pain, a situation in which it appeared suddenly and for the first time. Unfortunately, it is very difficult to indicate the ground, i.e. the factor that contributed to the situation. Despite the fact that sometimes we may think that we know what it came from, more detailed research may not confirm our assumptions. In such cases, the diagnosis is only able to indicate the actual cause in 2% of cases. Very often this pain is self-limiting but may recur, which is called a chronic condition. Unfortunately, relapses are very often unpredictable and spontaneous, which can happen up to 85% of people (Gordon and Bloxham 2016).

3. Causes of pains in the lumbar spine

When analyzing the causes of pains in the lumbar spine, the so-called mechanical changes resulting from carrying heavy objects. Nurses who work in warehouses or on a construction site are the most vulnerable to this type of event. Interestingly, however, carrying heavy things or lifting them inappropriately may not, in itself, lead to pain. In this case, as some recent research shows, genetic structure may play a large role. There are suggestions that some of us are more prone to developing these types of ailments. At present, it is not known what can "activate" the increase of the organism's susceptibility to certain pain-inducing stimuli, however, this area of research is extremely interesting (Balagué et al. 2012, Zaniewska 2012).

However, also people who spend a large part of the day in a sitting position on a daily basis are practically just as likely to develop these ailments. The main culprit is poor posture, which leads to a weakened muscle flexibility. As a result, there is a situation in which the muscles no longer have the appropriate properties. The body, as a very intelligent mechanism, begins to get used to a certain position or lifestyle. He adapts to "new conditions", so at some point being with your head tilted, your back bent becomes something "natural". Unfortunately, the musculoskeletal system is not being adapted to this because evolution is too slow compared to technological development. This leads to posture defects, and eventually to the appearance of lumbar, thoracic or cervical pains. Most often, however, this problem affects the lower spine.

4. How to prevent back pain?

4.1. Core training exercises

In this case, prophylaxis is the key to success and will allow you to avoid being found in 60-80% of the Western community struggling with back pain. The researchers analyzing this issue primarily point to the strengthening of the deep muscles. Hsu et al. (2018) indicate that the stability of the torso determines the ability to maintain an upright body posture. In addition, it affects the level of our quality of movement by reducing excessive swings, thanks to which we improve our ergonomics of movement.

The deep muscles include: pelvic floor muscles, diaphragm, multisection muscles of the loins, and transverse abdominal muscles. Importantly, it is worth noting that a properly functioning transverse abdominal muscle will contract before moving the upper limb. Otherwise, its role can be taken over to a greater extent by other muscles, which will result in their strain. This is a phenomenon of compensation, which, unfortunately, may eventually lead to pain.

Below are some examples of exercises aimed at improving the deep (core) muscles:

• front side plank

• hollow body

• Ab Roller

• Farmer's Walk

• Dead Bug

• Exercises in a step with the wall sticking on the upper or lower lift rod

4.2. Tissue mobilization (roller + static stretching)

If we have the opportunity, the best solution to loosen tight tissues will be a visit to a good masseur. However, in the event that we do not have the funds or simply the time, we can apply an easier and cheaper solution. It is a roller that is also used by professional athletes of various disciplines. The foam roller is used for the so-called myofascial release (SMR), thanks to which we can gain a home physiotherapist by spending PLN 40 once. To obtain maximum results in improving the range of motion and possibly reducing the Delayed Muscle Pain (DOMS), it is worth rolling the muscle lengthwise for 45 - 60 seconds (Cheatham et al. 2015).

However, Hughes and Ramer (2019) indicate, based on their analyzes, that relieving muscle pain may require up to 90 seconds of rolling. The mentioned authors also indicate that at the moment there is no consistent research that would indicate the most optimal roll rate or the time that should be allocated to a given muscle.

However, static stretching appears to be the most efficient solution to increase the range of motion (ROM). However, care should be taken as overstretching sore tissues can worsen the pain if it occurs in the muscles. Experts in the field of physical preparation and rehabilitation in such cases recommend using a roller first, and then introducing stretching that will not lead to significant pain (Wiewelhove et al. 2019)..

5. What to do when back pain appears

It is best to go to a specialist who will conduct appropriate tests that will help him make a diagnosis, on the basis of which we can introduce effective solutions. Rather, we would recommend to avoid acting on your own, especially when the pain radiates to the leg (lumbar radiculopathy). In the case of radiation to the leg, the situation seems to be more complicated because it significantly reduces the quality of movement, disrupts reflexes or reduces feeling.

If it is not possible to go to a specialist, you can also use the measures that have been proposed as prevention. Suh et al. (2019) proved in their research that stabilization exercises (core training) plus a simple walk are an effective solution in reducing pain in the lower spine. Yang et al (2015) recommended mobilization exercises to their patients in addition to stabilization exercises. Thanks to this, not only the frequency of pain was reduced, but also a significant improvement in the strength of the torso extensors and increased mobility in the thoracic spine.

Summary

Lower back pain may appear in people who work physically and mentally. It has been suggested that genetics may play an important role in the susceptibility to the appearance of pain. In order to avoid aches and pains, you should first of all take care of the quality of your movement. For this purpose, it is necessary to strengthen the deep muscles responsible for the proper maintenance of the spine's functions, as well as ensure the proper range of motion by using a roller or stretching.

Before taking any pain-reducing measures, it is worth consulting a specialist who will conduct tests that will help you choose the most effective therapeutic program.

Reference:

Hsu S-L. i wsp., Effects of core strenght training on core stability, Journal of Physical Therapy, Science, 30(8), 2018, s. 1014 - 1018.

Cheatham S.W., The effects of sel-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: A systematic review, International Journal of Sports Physical Therapy, 10(6), 2015, s. 827 - 838.

Hughees G.A., Ramer L.M., Duration of myofascial rolling for optimal recovery, range of motion, and perforamance: A systematic review of the literature, international Journal of Sports Physical Therapy, 14(6), 2019, s. 845 - 859.
Wiewelhove T. i wsp., A meta-analysis of the effects of foam rolling on performance and recovery, Frontiers in Physiology, 10, 2019, s. 1 - 15.

Gordon R., Bloxham S.,A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain, Healthcare, 4(2), 2016, s. 1 - 19.

Zaniewska R., Okurowska-Zawada B.i wsp., Analiza jakości życia pacjentów z zespołem bólowym dolnego odcinka kręgosłupa po zastosowaniu przez skórnej elektrycznej stymulacji nerwów – TENS, Medycyna Pracy, 63(3), 2012, s. 295 – 302.

 Balagué F., Mannion A.F., Pellisé F., Cedraschi C., Non-specific low back pain, Lancet, 379(9814), 2012, s. 482 – 491.

Suh J.J. i wsp. The effect of lumbag stabilization and wal king exercises on chronic low back pain, Medicine, 98(26), 2019, s. 1 – 9.

Yang S.R. i wsp.  The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients. Journal of Physical Therapy, 27(12), 2015, s. 3851 – 3854.