Understanding of low back pain has improved exponentially in the last 15 years. Physiotherapy researchers at The University of Queensland, Australia, along with other research teams worldwide have proved conclusively that paraspinal muscles are negatively affected by pain. An early surprising finding was that these muscles do not automatically heal and return to normal strength, even after the pain has entirely gone.
Back pain causes specific muscles in the lower back and pelvic area to become weaker, reduced in size and infiltrated with fat. This compromises paraspinal muscle function and the spine itself over time. Restoration of spinal muscle control and co-ordination is considered to be perhaps more crucial to long term health and function of the back rather than gross strength.
A research team led by Prof Paul Hodges had a clinical hypothesis that ongoing muscle change or inhibition might be the primary reason for episodic or repeated low back pain. The suggestion was that if local muscles around the spine remained in a weakened state long after the initial pain had cleared the spinal region would be at risk. Thus an awkward movement, lifting too heavy a load, or bending too far too frequently would further strain the spine. This would cause even more mechanical overstrain than in the first back pain episode and could potentially add to pre-existing damage to the mechanical low back.
They further identified which exact muscles of the back and trunk were the most critical for optimal healthy spine function. This led to development of a whole regime of exercises which are now used around the world to rehabilitate paraspinal muscle inhibition after back pain.
In back rehabilitation the first vital step is initial re-activation of the precise inhibited paraspinal muscle (not always the same in different patients). Next step involves multiple repetitions at low force to regain endurance in back muscles. Only when activation and endurance at low levels of muscle force is in place, does overall or global strength become the rehabilitation focus.
For optimal rehabilitation, each step must be correctly taught and practised. Miss a step and rehabilitation is incomplete, leaving the lower back at risk of re-injury in the future.
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Simon Coghlan and the team of Chartered Physiotherapists at TherapyXperts Mount Merrion can be consulted at 01 2834303 © TherapyXperts. All rights reserved
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