Low back pain is the most common type of physical pain worldwide.
You would expect that seeing as it's so common that we would know basically everything about it, right?
Unfortunately, despite its commonality, the complexities of the low back pain experience remain opaque, so to speak.
But that's not through lack of trying. In fact, there is a plethora of high-quality research studies that have attempted to illuminate the shaded truths around low back pain - namely why does it occur, why does it persist, and what can we do about it.
We'll save why does it persist for a later date, as it's worthy of a stand alone blog post. But how about we skim over the other two? Just to get up to speed.
Why does it occur?
This really is the million dollar question, and one in which we don't have great consensus on. From previous weeks, we know that the development and perpetuation of pain is influenced by factors in the biological, psychological, and social domains.
But this is what makes it complex - negative changes or beliefs in any one of these three domains do not always have to be present for low back pain to occur.
For instance - somebody who is experiencing severe pain in the low back may show dramatic changes to the lumbar spine area on a radiological scan, but someone who has closely comparable results may be completely pain free. This works vice-versa - in that:
somebody can be experiencing severe low back pain, but show no structural changes on a radiological scan.
Interesting phenomenon, eh?
In the case of origins of pain, it appears to be all about danger signals. You'll remember this from a few weeks ago:
Pain is not created in the body, but rather is a sensation created in the brain when the brain deduces, on the basis of all of the available information and stimuli at that moment, that the body is in danger and a change in behaviour is required.
The body tells the brain that it is in danger, not that it is in pain.
The latter is for the brain to decide.
So the development of pain can be due to biological, psychological or social factors (typically a combination of all), but it's up to our brain to determine whether pain is necessary. Let's leave it at that for now.
What can we do about it?
Unlike the "Why", we do actually have some clarity in this area. First and foremost, the literature is quite clear on the benefits of movement and exercise in preventing and treating low back pain.
Benefits can be accessed, to a lesser extent, through general movement (i.e. walking, swimming), but the real money is in conscious, thoughtful movements that move the low back and surrounding areas (upper back; hips) through their natural ranges of motion and conditions the muscles that act upon these joints.
As we've mentioned repeatedly in prior weeks - a movement program in and of itself is a great place to start, but if you are somebody who, for either personal, cultural, or any other reason, believe that movement and exercise is not good for you and your specific case of low back pain, then you will not experience the full benefits available.
A best practice scenario for an intervention for a physical ailment would look something like the following:
1. A progressive movement program, that focuses not only on correcting the muscle imbalance, but on the movement of the body as a whole
2. Concurrent education for this individual around pain, the influence of psychological and social factors, and the importance of exercise and keeping mobile in pain recovery
A successful implementation of these two aspects concurrently would not only improve one's physical health across the parameters of strength, mobility, etc., but it would elicit the additional benefit of increasing one's feeling of control over their pain. This allows would, in turn, allow them to better self-manage any current discomfort (such as low back pain) and any future physical ailments with a higher sense of confidence.
Knowledge is power. Movement is medicine.
But instead of just talking about it, how about we actually give it a go...
The main focuses of the program include:
Increasing hip and spine mobility
Strengthening the low back through it's range of motion
Strengthening the muscles acting upon the hip and low back
1. Scorpion Stretch
- Stretch hip flexors & increase hip/ spine mobility
- Strengthen gluteal and low back muscles
1. Lay face down on the mat with your arms outstretched to either side at shoulder height
2. Raise your left foot straight up towards the ceiling
3. Bend at the knee and bring your left foot over to your right side. Tap the ground with your toes
4. Hold for 1-2 seconds, then repeat on the opposite side
5. Repeat 6 times on each side
2. Up Dog/ Down Dog
- Increase hip and lower limb flexibility
- Strengthen upper limb & activate abdominals
1. Start in a high plank position (top of a push up)
2. Move your hips up and back until you reach a downward-facing dog position (breathing in)
3. Shift your weight forwards, drop your hips down, and look up until you reach an upward-facing dog position (breathing out)
4. Remain in each position for 1-2 seconds, then repeat 6 times in each direction
3. Marching Bridge
- Improve gluteal and abdominal strength & stability
Improve control of your pelvic movements
1. Lay down on your back with your knees bent and your feet flat on the floor
2. Pull your belly button in towards your spine and flatten your low back onto the mat
3. Lift your hips up until your body forms a straight line from your shoulders to your knees
4. While holding your hips up, raise one leg and lift your foot off the ground, ensuring that your hips stay level
5. Hold for 1-2 seconds, lower your foot to the ground, then repeat 6 times on each side
As we've mentioned before - it's unfeasible for us to include all the necessary education into this blog post alone. There is a myriad of scientific research supporting the role of exercise in pain management and injury rehabilitation. Nobody is on the other side of that issue. But, for understanding pain itself, this short, 5 minute video below could be a great place to start.
Link - Persistent Pain Explained: https://www.tamethebeast.org/#tame-the-beast
Video taken from Tame The Beast (https://www.tamethebeast.org/#abouttamethebeast)
If you do experience low back pain we do encourage you to implement this movement program into your daily routine.
NOTE: These exercises are at an intermediate level. If you are experiencing low back pain to a severity of more than 5/10 (10 being the worst) then we advise you to consult with a physiotherapist to discuss the appropriateness of the program.
Let's give it a go: twice per day (morning & afternoon) for 4 weeks
If you suffer from physical discomfort, or are motivated to prevent future physical issues, then the PreActive app is the one for you. We work together with academics and clinical professionals to combine the power of evidence-based physical health content and technology to produce a wellness platform that has been shown to improve the health of its users.