Nearly 80% of Americans suffer from low back pain at some point in their lives. As a health & wellness professional, it has been my job to keep up with the latest research on the use of mind body approaches for pain management. While there is no quick fix or a one-type plan that suits everyone, most people are open to trying a mindful movement approach and are willing to retrain their way of thinking about traditional exercise. The only good thing low back pain is that it ‘gets our attention’ and is a great motivator to inspire positive change with long-term benefits!
My advice is to always have a medical professional evaluate the cause of chronic pain, as there could be an underlying issue that is well beyond the scope of our practice. A medical professional is also trained to diagnose the dysfunction and cause for pain and gives us an indicator as to the course of treatment. Pain management through medication and physical therapy is typically the norm for initial treatment. The general feedback with pain medication is that most people in that situation know that pain meds are a temporary solution as they only the mask the underlying cause of the pain in the first place. While they are necessary to manage pain, being able to discover alternative methods for pain management and the ability to regain a freedom of movement is the number one priority of my clients. We are fortunate enough to have a Clinical Doctor on staff that can prescribe Pilates exercises that address soft tissue restrictions, pain relief therapy and exercise protocols for rehabilitation. I firmly believe that the easiest thing to first look at is the person’s posture as it is gives us a picture as to the health and structure of the joints. For instance in the center of the body postural changes are usually characterized by such things as a shortening of the hip flexors, a hiking or tilting of the hip or pelvis, a tightness of the hamstrings. Muscular imbalances such as tightness and weakness are usually the culprit of postural deviations, which account for extra stress on the joints and the discs. The most common disturbance in posture is the ‘tucked-in glutes’. It is characterized by the pelvis being pulled forward and the glute muscles (buttocks) in a constant state of contraction. Visually you can see that the low back has a flattened appearance, which is not a good picture as the low back (lumbar spine) needs to have a normal lordotic curve to maintain adequate space between the vertebrae. When that space is compressed, pain and discomfort is usually felt in the lower back (lumbar spine) where it meets the sacrum. Because of the loss of that natural curve and the muscular forces pulling the glutes underneath, a trained eye can see that the body also tends to lean back in a somewhat passive position. This also puts a lot of strain on the low back for the body to remain in that altered state. People with this kind of posture tend to walk stiffly and with limited movement in their hips. The person is often so used to standing that way that they have not know it be the source of compression on their low back. Just by pointing out the deviation, the individual can start to make some conscious simple changes to align posture and eliminate pain. Try this exercise – while sitting in a straight back chair – curl the spine up by tightening up the glutes and bringing it forward. You can immediately feel the pressure in the low back and abdomen. You will feel the pressure release as soon as you bring the seat back behind you and sit up tall. Try the same thing laying flat on a mat with the knees bent and arms by your side. Push the low back into the mat by way of curling your tail upward. You will feel how you are overworking the seat, which has now caused the hip flexors to shorten and the abdominals to ‘pooch’ forward. Now release it by feeling the sacrum lying heavy on the mat and the hips flexors and glute muscles relaxed. You should feel as there is no muscular effort but a sense of length to the low back, without the pelvis tilting forward or backward. Not only does it give a more flattened appearance to the abdominals but it is also a pelvic position that allows one to activate the deepest layer of muscles in the abdominals that will in turn aid in stabilizing the whole lumbar pelvic region. Once that posture is correct, a proper strengthening program can be introduced. Ideally, light weight exercises are protocol. Using heavy weights in the initial recovery takes the focus away from the stabilizer muscles that protect the low back. Those deep muscles are best activated by the ‘neurons’ in our brain telling them to ‘turn on’. A perfect example in the instance of where ‘less is better’. Properly stretching tight muscles is also key as it will allow for adequate flexibility at each joint so there is an equal balance between the opposing muscle groups. ‘Active Isolated Stretching’, which promotes holding a stretch for no more that 1.5-2 seconds over several repetitions is great for this purpose.
Freedom of movement is a beautiful thing and allows us to enjoy health and wellness to it’s full potential. As our population ages, exercise is no longer a luxury but a necessity to optimal well-being. Modalities of exercise that really promote safe and healthy movement and are taught well can give a work out than many would be surprised can leave you sweating just as much as cross fit session but without the injuries. Continue to move well! Remember that ‘No Pain = No Pain’!