The 7 Low Back Pain Confusions discussed the importance muscle length, strength and timing in low back pain prevention and rehabilitation. First, I’ll give an overview for these three main categories and discuss the 10 minute program.
COR Physical Thearpy Low Back Pain Solution
COR Physical Therapy Muscle Length
Improving muscle length is essential and the most important aspect for rehabilitation, in my opinion. Tight muscles will inhibit other muscles from working properly.
For example, squeeze your finger as hard as your can. Next, maximally flex your wrist and squeeze your finger again. If you did this right, you should have felt a significant decrease in strength when your wrist was maximally flexed. The cause of this strength was an altered position of your muscle fibers, changing the length/strength relationship. Each muscle has a strongest joint position, unfortunately daily habits (posture, sitting, sports) put your body in suboptimal resting positions, causing impaired muscle firing. These impairments in muscle length not only cause weakness, but can cause symptoms. Poor resting position can cause myofascial adhesions (fancy term) more commonly known as “knots” in muscle causing symptoms. Self myofascial releases (SMR) are simple methods for improving myofascial adhesions. For these techniques you will need a baseball, tennis ball, or foam roll, but first, follow these rules:
COR Physical Therapy Self Myofascial Rules:
- Lie on the tennis ball focusing on the instructed areas
- The more sensitive or tender the area, the slower you should go
- Stop if the exercises causes pain, but a little discomfort is expected
- Perform for 30 seconds – 2 minutes
SMR Quadratus Lumborum
SMR Piriformis
SMR TFL
COR Physical Therapy Stretching
These self techniques improve most muscle length issues. Unfortunately, stretching specific muscles also play a role in improving myofascial adhesions and muscular imbalances. The purpose of stretching is to make the muscle and surrounding fascia (outer covering of muscles, like a sac) more supple and increase in length. The most important aspect of stretching is compliance. When you stretch you get an immediate increase in tissue length. This is due to the elastic properties of the tissue and improved stretch tolerance. However, the term elastic implies, this change will not last long. When you repeatedly stretch muscle and its fascia; you get a ‘plastic’ change in the tissue – a lasting change. To achieve this you must stretch daily. Missing several days will put you back to square one. Everyone has the potential to do the splits, but not many of your muscles are trained to handle the stress. Compliance will improve your tolerance to stress. To improve we have found that stretching each muscle for 30 seconds daily will get you results. You should feel a stretch sensation, not pain. As with any exercise, if it causes your ‘pain’ – stop.
Standing Psoas Stretch
COR Physical Therapy Muscle Strength, and Timing
Muscle strength and timing are closely related in early prevention and symptom resolution. These exercises are the basics, but I have seen them do wonders from grandparents to professional athletes. However, depending on the demand you are putting your body through, these may not adequately strengthen in every plane of motion. Most low back symptoms are from instability. Performing the following exercises in the compact position emphasized stability and minimizes movement. All the strength and timing exercises must be performed in this position. If these exercises hurt your back, it is likely you are performing them wrong or you have a more serious condition. Obtaining the compact position helps stabilize the low back, while allowing the hips to move freely. When performed properly there will be no low back pain. These exercises will maximally contract the abdominals, while preventing low back movement. This contraction will improve the resting position of weak, long musculature, by over-correcting the core. The theory is after the muscles are over-corrected, the muscles will lie in a better resting position optimizing life. The compact position also helps with muscle timing. Altering hip flexion, abduciton, extension, etc. with maximal abdominal contraction improves their timing and rhythm, preventing injuries. These exercises are the basics for proper stabilization, set the base today!
Abdominal Bracing Rules Rules
- Lie on your back with your knees bent. Posteriorly tilt your pelvis, “tucking under”, to maximally contract your abdominals.
- Do not let that position change AT ALL during the exercise.
- Stop if the exercise causes ‘your pain’.
- Stop if can not keep the correct back position.
March II: 3 sets of 5 repetitions
If you have symptoms during this exercise or if you can’t keep the compact position try the alternative.
Alternative: Abdominal Bracing, 10 sets of 5 seconds
Lie on your back with your knees bent. Next, place your hand under your low back and tighten your abs as much as possible, by posteriorly tilting your pelvis and bringing your ribs and pelvis together. Hold, then repeat.
Hip Abduction with Band: 1 set of 30 seconds
Lie on your back with your knees bent. Obtain the brace your abdominals with your hands underneath your low back. Put theraband loop around the thighs, above knees. Keeping the back position, pull knees apart and then let them come together slowly and under control. You will have a tendency to arch your back when you pull your knees apart. Do not let this happen.
Balanced Triangle
