Recurrent Lower Back Pain

I am often asked about why mechanical lower back pain is recurrent. I have four related explanations that I think have validity. These are:

• The first is the tension between mobility and stability
• The second is the fact that muscle guarding leads to atrophy
• The third is mechanical with respect to disc behavior
• The fourth is deconditioning

Mobility vs Stability
The premise is that we stand on a stable foot with an ankle that moves, we have a stable knee and a hip that moves, our lumbo/pelvic region should be stable, our thoracic spine mobile, our shoulder girdle stable, our cervical spine mobile.

If you accept that premise, then the logical conclusion is that restriction somewhere leads to mobility somewhere else. A restricted hip, for example, can lead to lumbar break down as greater stresses are transferred to the structures of the lower back, especially the discs, during such activities as forward bending. Segmental hypermobility (excessive mobility in one motion segment) is very destructive to the soft tissues, especially the disc.

To treat the mobility/stability dysfunction, a good assessment needs to be followed up with a personalized exercise program to lengthen shortened tissues and strengthen weakened tissues. A good hamstring lengthening program will go a long way to decrease excessive forces across the lumbar spine.

Muscle Guarding
The deep para-spinal muscles such as Multifidus for example, are muscles that guard when the back causes one pain. The guarding, a localized tightness can extend as many as 5 levels up and 5 levels down in the lumbar spine. This is not a problem on its own, but the fact that guarding leads to atrophy of those same muscles, and the atrophy is a precursor to mechanical lower back pain especially in a segment that is hypermobile. The weakenss of the atrophied para-spinal muscles allows the component motion of sheer to occur which in turn causes local nerves to complain and pain to be experienced. Strengthening the para-spinal mucles is key to resolving segmental dysfunction. Muscle guarding and segmental dysfunction go hand in hand.

Mechanical Factors
The lumbar disc has an axis of rotation that is close to the front of the disc. This means that the posterior lateral corners of the disc are actually subjected to the greatest stress during rotation. This gradually leads to failure of the posterior lateral fibers of the disc and eventual disc herniation. Paying attnetion to one mechanical functions - ike facing what you are doing, avoiding combining bending with twisting and lfiting, avoiding prolonged static postures and so on is the best medicine.

Deconditioning
The simplest way to say this is that very few fit people have recurring mechanical lower back pain.

There it is. Much of this is then in your control. You can get in better shape , with special attention being paind to restrition and weakened areas (like the hamstrings on one hand and the core on the other), and the spinal rotators as well. And you can avoid lifting things that are awkward to lift, or use really goo dmechanics when you do sit around or have to do serious lifting.

Finally, don't forget to use ice....30 minutes of ice (ice and water in a plastic bag right on the skin) is a great way to manage pain long term. You will get up to two hours of relief, and possibly even eliminate pain altogether.