Friday, April 18, 2014
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Managing, treating and avoiding low back pain

A strong and well-aligned spine is key to improving performance with sports, recreation, work and home activities.

Managing, treating and avoiding low back pain

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A strong and well-aligned spine is key to improving performance with sports, recreation, work and home activities. A repeating theme that keeps arising in discussing injury prevention is the need to balance muscle strength and flexibility in all planes (anterior, posterior and sides).

Most athletes are quite strong with trunk flexing muscles, like the rectus abdominus (‘6-pack’ ab muscles) but lack trunk extensor strength. The trunk extensors keep the spine erect when upright and lift the trunk upwards when positioned face down. Similarly, there are a many common exercises focusing on the big, powerful trunk muscles, but there is a lack of knowledge about how to effectively strengthen the smaller stabilizing muscles of the trunk.

Our bodies are equipped with a group of muscles that surround our trunk and work perfectly together to create a stable bracing effect for the spine. This is what prevents discs from bulging out of place and painful spinal conditions. One of the most important stabilizing muscles, the transversus abdominus (TA), is engaged when you activate the lower abdomen wall by "drawing-in." 

Not to be confused with the diaphragm, which controls breathing or the rectus abdominus, which flexes the trunk forward, the TA serves to act like a girdle for the abdomen. In standing, it contracts along with the main posterior spine stabilizer, the multifidis for a bracing action all the way around. This co-contraction is the basis for a stabilization program that can be made more challenging by adding numerous arm, leg, and trunk positions either statically or dynamically and with the use of equipment including physioballs, medicine balls, body blade, Bosu, Pilates, TRX, etc.

It is equally important to strengthen these muscles while maintaining correct spinal posturing. Whether seated or standing, a neutral spine is key. The natural curve of the low back, the lordosis, needs to be maintained by tilting the pelvis slightly forward. In sitting, you will know it is in the correct position when you feel weight through the "sitz" bones, the ischial tuberosities and all of the spinal segments stack naturally from bottom, up.

A good cue to ensure you are co-contracting the trunk stabilizers is to imagine a string pulling you upward from the crown of your head this will automatically engage TA and multifidis and you will feel a firm, bracing action around your trunk. This should be the starting position for all exercises and even how you position yourself while seated throughout the day. I cannot over emphasize posture enough. It is how we carry our bodies a majority of the time that all too often, is the main reason for many of the patients' injuries I see in my office. 

My previous blog discussed the importance of stretching correctly. The muscles I recommend emphasizing to maintain healthy flexibility of trunk and spine include the hamstrings, quadriceps, quadratus lumborum (sides of trunk), and iliopsoas (hip flexors). Contact your local Physical Therapist for correct stretching form in these areas and/or to customize a stretching and spine stabilization program for you.

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It is not normal—although, too often it is common—to have low back pain. The statistics show 80 percent of people will experience low back pain. This means there is a problem with muscle activation, instability, inflexibility, weakness, posture and/or mechanics--- all of which can be improved. If you do not have back pain, incorporating trunk strengthening, stabilizing and stretching will keep you that way.


Read more Sports Doc for Sports Medicine and Fitness.

Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
About this blog

Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

Robert Senior Sports Doc blog Editor
Alfred Atanda, Jr., M.D. Nemours/Alfred I. duPont Hospital for Children.
Robert Cabry, M.D. Drexel Sports Medicine, Team physician - U.S. Figure Skating, Assoc. Team Physician - Drexel
Brian Cammarota, MEd, ATC, CSCS, CES Symetrix Sports Performance, athletic trainer at OAA Orthopaedics
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Rothman Institute, Head Team Physician for the Phillies & St. Joe's
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Rothman Institute, Head Team Physician - Eagles, Head Orthopedic Surgeon - Flyers
Joel H. Fish, Ph.D. Director - The Center For Sport Psychology, Sports Psychology Consultant - 76ers & Flyers
R. Robert Franks, D.O. Rothman Institute, Team Physician - USA Wrestling, Consultant - Philadelphia Phillies
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer at The Sporting Club at The Bellevue
Cassie Haynes, JD, MPH Co-Founder, Trap Door Athletics, CrossFit LI Certified
Eugene Hong, MD, CAQSM, FAAFP Team Physician - Drexel, Philadelphia University, Saint Joe’s, & U.S. National Women’s Lacrosse
Jim McCrossin, ATC Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Main Line Health Lankenau Medical Center, Team Orthopedist - Philadelphia 76ers
Justin Shaginaw, MPT, ATC Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
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