Dr Movement

A Pain In The Back

Movement is often the best medicine! Particularly for those with back & hip pain. Through keeping the spine mobilised & the system flexible you create the right foundation for stabilising key areas to create the further foundation for strengthening so that the system can eventually resolve pain challenges to the point of which they do not bother you again.

The body can be thought of like a bicycle wheel – The spokes are like muscles, the center is like the core & the rim is like the spine. If you have some spokes that are tight & others that are loose then it will pull the bike rim out of alignment & you will get a bumpy ride down the road!

Muscles link to & influence bone structures like the back & hip which can then influence how someone experiences pain – if the bike wheel or system is tensioned correctly then the body is aligned which often reduces pain symptoms through improving the posture & alignment of the system. You can do this through specific stretching & strengthening protocols.

There are general recommendations below but it is always advisable to get a musculoskeletal assessment so that the right specific interventions can be advised for your individual situation.

Another helpful metaphor when it comes to the spine & back pain is to think of the spine like a ship mast with ropes (muscles) coming off of it. It there are some ropes (muscles) that are loose & not tensioned correctly this will cause the other ropes of the mast to tighten up leading to strain on the mast & potential overloading of the roads or muscles resulting in pain – The way forward is to identify what is short & tight & what is long & weak in order to stretch what is tight & target what is weak in order to strengthen effectively.

Another helpful metaphor for the integrity of the structure of the body is to think of the structures of the body like a Jenga tower (this could be a knee, the back, a shoulder or the whole system). If you put a pint of water on top of the Jenga tower with all the blocks in then the tower is strong & stable to hold the water without any issues. As you start to remove blocks from the tower (muscles that are weak or switched off) there is more strain put on the other blocks (muscles that have to tighten in order to compensate for muscles that aren’t firing optimally).

Eventually the tower will collapse because of it’s instability & the pint of water on top of it – in this metaphor the tower collapsing is representative of an injury. For example in an injury may occur by picking up a heavy load in the gym, at work or in the garden due to instability in the system caused by an imbalance in the muscular system. The process to ensure that this is less likely to happen is to identify where the imbalances lie & perform the correct exercise interventions to rebalance & retention the system.

Exercises

  • 4 Point tummy vacuum – To activate & strengthen the deep core muscle, the Transversus abdominus which stabilises the whole core, the spine, ribcage & hips as well as tying the upper body & lower body together. Adopt a 4 point position. Breathe OUT fully – the exercise is performed with NO air in the lungs. Such the abdomen in deeply & hold for 10 seconds. Keep the spine neutral – do not the the upper back curve & the lower back flatten. This can be helped by imagining there are 2 headlights on your bum & “turning the headlights up”. Perform 10 reps of 10s for 2 – 3 sets 1- 3x a day.
  • ELDOA thoracic extension. The upper spine directly affects the lower spine. This is an exercise to mobilise & stretch the structures of the upper spine. Reach both hands forward then reach up one by one pulling the arms back towards the ears. Lift the body up & stretch towards the ceiling while imagining the upper spine actively decompressing through the movement.
  • Horse stance vertical – to activate & strengthen the deep spinal stabilisers & core. Adopt a 4 point position. Lift the left hand & opposite right knee & hover them above the floor for 10 seconds. Focus on keeping good alignment in the hips & pulling the abdomen in. Also focus on the lower back muscle activation. Swap to the other side. Repeat 6-8 times each side for 1 set. Build up to 3 sets.
  • Mckenzie pressup – a great exercise for mobilising the lumbar spine & similar to cobra stretch in yoga. Place your hands under your shoulders & push up while breathing OUT on the way up & in on the way down. Only go to where is comfortable & do not let your hips come up off of the floor. Seek to relax the lower back through the movement. As the spine becomes more mobile you will be able to go further. This can help to recentralise disk herniations. You can also do this to one side for a specific recentralisation but an assessment is always recommended before going to one side to ensure the movement is correct.
  • Shivasna – The most important pose in yoga for deep relaxation & a great pose for mindfulness. It can be incredibly useful when in pain to use mind management & relaxation techniques. The mind directly influences the body so tensions in the mind get reflected as tension in the body. Tension in the body can affect the bicycle wheel so through relaxation of the system we can help to bring better balance toy the system. Also when in a relaxed state the nervous system downregulates the pain receptors. Shivasna which is the lying down pose can be a fantastic way to achieve this relaxed state.
    • Lie down with palms open. If you need to support the back do so with a towel so that it is in a slight curve & neutral position. Come into your breath & relax the system with each breath out. Scan the body, taking note of any tensions. If you find tensions then breathe into them & relax. Areas of pain you can spend more time on – with each breath out gently relax the area. Move up the body breathing & relaxing – Feet, legs, hips, lower back, upper back, shoulders, arms hands, release tension. Finally pay attention to the muscles of the face & relax the jaw, moth & eyes. Take note of the mind – a lot of the time when thoughts come in it will correspond with some kind of facial expression or some tightening of the body. When this happens come back to the breath & relax the areas. Look to do 5 mins & build from there. Look to take this feeling & skill of deep relaxation into the rest of your day as it will help to manage pain while becoming more aware of the body & what is happening.
    • Mountain pose – The second most important pose in yoga. This is a fantastic pose for developing stability through body awareness of the system. It is also great for decompressing the spine so can help a lot with deep back injuries.
    • Stand with your feet parallel shoulder width apart & imaging 3 corners to each foot. Spend time to balance the weight distribution of each foot with itself, then from left to right. Take note where you may not feel balanced – this will begin the awareness training of the system so you can begin to know what is the right position & what is not which can help with pain management & rehabilitation as well as exercise & movement in general. Move your awareness up to the legs, keep them firm & strong with a light squeeze of the glutes – you should not be straining, think of bringing the principle of the Shivasna into this pose – firm yet relaxed. Breathe into the belly button while keeping the abdomen slightly contracted. Pull the shoulders back & lengthen the spine – imagine there is a string coming out of the back of your head pulling you up – this will decompress the spine. Keep being pulled up while making slight adjustments to the system to keep the alignment. Do this for 5 mins to start with & build on the time from there. Over time you will feel the deep balance & stability of the system improve.
    • Swimming – Great for pain management. Due to the sensory overload provided by the water the pain receptors down regulate, lessening pain symptoms. It can also decompress the spine. Be mindful of vigourous movements as well as breaststroke during the kick if you have SIJ issues. Generally speaking swimming also decompresses the spine so can be beneficial for pain symptoms.

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