Sciatica & Low Back Pain
80% of people currently have or had low back pain in their lives. Back pain is so common because the lumbar spine is the link between our heavy upper torso and our hips and legs. As humans we are very habitual; sleeping in the same position, standing with your weight on one leg, sitting postures, etc. When we are in similar postures for long periods of time your tissue starts to adapt leading to dysfunction. Then in some cases over stressing the back; yard work, trying to move something too heavy, will make you more susceptible to injury.
When treating the lumbar spine our goal at Pro Motion PT is to alleviate the stresses put on the spine from our postural habits in order for it to be able to function in it’s optimal position. Then work on strengthening the muscles associated with stabilizing the lumbar spine.
Your Hips: For every low back pain patient we also look at what the hips and pelvis are doing. This is the foundation the lumbar spine is resting on. When a patient does not regularly stretch and strengthen their hips the muscles around the hip becomes tight and it limits the hip’s range of motion. Hypothetically, lets say when you bend forward your hips do 50% and your spine does 50%. But if your hips are lacking range of motion and only contribute 30% of the movement then your low back is taking an extra 20% of strain every time you bend forward. Also how we sit, stand, and move as well as your hip mobility will affect the way our pelvis rests.
You have two pelvic bones, in the back they are connected by the sacrum, two SI joints, and on the front it is conned by a pubic symphysis. There is not a lot of movement in these joints but they can play a role in how your lumbar spine rests on your pelvis. The two pelvis bones and be rotated forward and back or one side can be elevated. This pelvic posture can change the perception of your leg length, making one longer than the other. When you are standing we always want our eyes and shoulders parallel to the horizon, so your spine will adjust to the hip and pelvic compensations by bending to one side or rotating and putting increased strain on that specific area of the spine. That could be why bending one way is much more painful than the other side.
Muscles contributing to Low Back Pain: When looking at long term success from low back pain you have to pay attention to all the muscles that directly influence the lumbar spine. There are the main players in your back pain; lumbar erector muscles, Quadradus Lumborum and your Psoas muscles. These muscles can become tight and weak and have active trigger points that refer pain to different areas of you back and hips. Pro Motion PT finds great success with Dry Needling, cupping and soft tissue work to help alleviate these issues.
But if you look at the lumbar spine in a more broader perspective we can conclude that the lumbar spine makes up the posterior aspect of you entire core. Let us talk about the core and how each part of the core can affect the lumbar spine function. We think of the core as a box. The sides of the box are your abdominals. You have 4 layers of abdominals, the most superficial layer is your Rectus Abdomens, your 6 pack. It is a main mover and doesn’t play much of a role in core stability. Below that is your Internal and External obliques and your (name slipping my mind right now). These muscles for a sort of corset around your core. Since our spine can move freely in all directions these muscles play an important role in providing stability. The bottom of the “box” is the pelvic floor and the top of the box is the diaphragm. With proper posture and diaphragmatic breathing your diaphragm and pelvic floor work in synchronicity, When we breath in the diaphragm contracts and is pulled down and at the same time the pelvic floor relaxed and drops down. As we exhale the opposite occurs, pelvic floor contraction and diaphragm relaxation This is very subtle but very important. Being in a slouch posture your diaphragm is working in a shortened position and becomes tight and weak. And with hip tightness and pelvic alignment issues your pelvic floor most of the time becomes tight and overactive. This leads to an overall dysfunction of the core, putting increased stress and strain in low back. From all of these issues the overall effect of these dysfunctions lead to a global compression of the lunar spine. Our discs, the segment between each vertebrae are like sponges and full of water. When you have constant compression of the discs the present with smaller disc space and this is when x-rays diagnose you with Degenerative Disc Disease. By alleviating the compression forces on the spine it allows the discs to absorb more water and provided more space between vertebrae.