Low Back Pain - A Movement Solution
Movement - if you don’t use it you will lose it!
I know your back pain. I don’t have a vertebral fracture or central canal stenosis (both suck) or any other involved injury or pathology. But my back hurts. No real injury or pathology, just the human condition that our vertebral discs degenerate throughout the spine. I know my discs have degenerated because my low back is stiff when I wake up. My back gets stiff the next day after a workout. Sometimes, if I sit too long, my back takes a few steps to loosen up. With the exception of acute injury or disc pathology, all low back pain comes from faulty spinal mechanics. As we age, our the vertebral discs degenerate, moving our already extended lumbar spine into excessive extension. This excessive spinal extension causes joint irritation and/or nerve root irritation. To deal with a stiff, aging back you have to move, and in very specific ways. First, you must restore lumbar spine flexion, then rotation.
The five lumbar vertebrae as a unit curve forward, putting the lumbar spine’s resting posture in extension. In between the five lumbar vertebrae are lumbar discs that act as shock absorbers. Each lumbar vertebrae also has two joints (called facets) on its superior surface and two joints on its inferior surface. These joints dictate how each vertebrae interacts with the one above and below it. To make matters even more complicated, nerve roots emerge from the spinal cord and pass in between the lumbar vertebrae as they course out into our hips and lower extremities. The bad news is, as we get older the vertebral discs begin to degenerate, losing their thickness and their height. This degeneration has implications for those facet joints and nerve roots.
Facet joints, like all other joints in the body, need space to function properly. As the height of the lumbar discs decrease, the space between the facet joints decrease, causing pain, inflammation, muscle spasm, and a loss of proper spinal mechanics. As this acute inflammation continues, it brings about a downward spiral of changes to the joint and surrounding soft tissue, that becomes chronic and ultimately the joint will become arthritic. This condition often manifests and central low back pain, pain situated right on the spine or immediately adjacent to the spine.
In case of nerve root irritation, the space between the vertebrae (this is where the nerves exit the spinal column) becomes too narrow for the nerve to exit cleanly. Nerves also like space, so as the vertebrae begin to touch the nerve, it become irritated causing the body to inflame the area. This condition can present itself as radicular or referred pain. Low back radicular pain due to degeneration can occur on one or both sides of the body and radiates out from the spine into the buttocks and legs.
The question is, why and how does movement help with offsetting the degeneration of our lumbar discs.? The answer has to do with our spinal mechanics. Again, the resting posture of our lumbar spine is oriented towards extension. This is helpful in dissipating force and providing stability. However, as the lumbar discs degenerate, this orients our lumbar spine into even more extension, causing the facet joint and nerve irritation discussed above. This excessive extension needs to be offset with flexion.
Seated Flexion
Flexion of the spine is synonymous with bending forward. A very simple and effective exercise is repeated toe touches. Begin by sitting on a chair, gently bend forward and touch the floor. Pause briefly at the floor and sit back up. Repeat that motion for 10-15 repetitions, 3 x daily.
The anatomical structure of spinal vertebrae is such that when we bend the spine forward as a whole, the space in between the individual vertebrae opens up, creating room between the irritated joints and room for the nerves to exit the spine freely. Frequency of the movement is very important here, as each time we repeat this motion, the soft tissue around the joint stretches and relaxes a bit, improving the joint its mechanics. If we can begin to open up the space between the vertebrae and improve how they move relative to each other, we can improve the mechanics of those painful spinal segments, reducing the inflammation, and calming the irritated tissue.
Once we have restored the lumbar spine’s ability to flex and we have the pain moving in the right direction, it is time to focus on restoring spinal rotation. Rotation is a combination of flexion and extension. For example, when I rotate my spine to the right, the left side of my spine must flex, while the right side of my spine must extend.
Supine Rotations
Lay on your right side with your top leg (left) bent and your bottom leg (right) straight. Extend your left arm out in front of you and begin to move it in a wide arch as you rotate your left shoulder to the left and towards the ground. Your hips should not move as you lay your left shoulder flat on or near the ground. Bring your arm and shoulders back to the starting position and repeat. Repeat that motion laying on both sides for 10-15 repetitions, 3 x daily.
The two exercises noted above are very helpful in restoring proper lumbar spine mechanics. However, they don’t alway completely solve the problem. Each exercise has a progression that further enhances both lumbar flexion and rotation. Furthermore, when treating this condition, I will introduce exercises to address hip mobility and core strengthening. To that end, the following link is to my lumbar mechanics page.
To conclude, there are spinal conditions, like fractures, disc bulges or central canal nerve impingements that are beyond the scope of what I discussed here. In those cases it is helpful to have imaging of the spine to determine the stability of the injury and if a surgical solution is necessary. That said, most spine related pain can be addressed with movement. The key is to begin with movement that restore flexion and then address rotation.