Back pain is one of the most common complaints brought to the clinic. 2.8 million adults in the UK suffer with chronic or recurring back pain. So what is going on here and why won’t back pain go away?
Why do we get back pain?
In order to understand how to fix back pain, we need to understand where it comes from and how it starts in the first place.
Our spines have 3 curves in them. One in our neck area (cervical), one in our rib area (thoracic) and one in our lower back (lumbar). The presence of these curves is really important to the function of our spine and the muscles that attach to it. The vertebrae of the spine need to be aligned correctly so they have space to flex and sway depending on the forces acting on them by the nearby muscles.
The vertebrae are held in position by ligaments and muscles, deep within the body. The ligaments, we can’t do much about, but the muscles can be trained and strengthened to ensure they are doing their job properly.
When these tiny muscles aren’t working effectively, the vertebrae sit too close together, creating stiffness and pain. Discs and nerves get affected creating dysfunction and damage, arthritic changes can occur, further affecting the function of the spine.
In years gone by, we were more active; now we spend most of our days sitting. Lack of movement creates weakness and weakness creates pain. This is why so many people have back pain and especially lower back pain.
Can back pain be fixed?
Absolutely! Back pain can certainly be fixed, but not by taking pain killers or resting. Strength is needed to solve long term back pain, it isn’t a quick fix, it takes time to strengthen muscles. It also needs specific exercises that target the deep muscles of the back.
We see plenty of people who lift large weights in the gym that have back pain. We also see plenty of people who do pilates that have back pain. Not all exercises are equal. For example, plenty of people say they have a great core because they can do the plank exercise, but if we put them on an unstable object such as an exercise ball or stability disk, they can’t stabilise their spine. This is because it is very easy to “cheat” the plank exercise and never actually use your core muscles at all!
Through your spine you have very small muscles that attach between one vertebrae and another. They are designed with lots of sensory organs that notice movement and react accordingly to stabilise and protect the spine and the precious spinal chord. These muscles are not under your conscious awareness, you cannot think about them and get them to move like other muscles. They sense movement and react to that movement.
Therefore, we have to strengthen them by putting the body in a specific position, one that forces these muscles to switch on and strengthen. This is what we mean by specific exercises. Once these muscles are functioning correctly again, you will find that your back pain starts to recede. It doesn’t matter how long you have had the pain, how old you are or how large you are. If these muscles get stronger, your back will be happier.
How do I strengthen my back when I am in pain?
Most back pain comes with movement, so even if you are in a lot of pain, there are ways to get some strength in. As the strength begins to increase, slowly the movement will return and pain will subside.
The easiest way to start strengthening your core, is to lie on your back with your knees bent. Slowly pull your tummy button towards your spine, try not to grip with your bottom muscles or move your pelvis. Hold that position for a count of 5 and then relax. This gets you to activate a muscle called your Transverse Abdominis, which is a key core muscle and starts a chain reaction that gets lots of other deep muscles to start working. This exercise needs no movement at all. Simply suck your tummy button towards your spine.
To advance this exercise a little, add some breathing in…. this is a little bit more complicated. Take a slow deep breath in, but as you breathe in, don’t move your chest, just let your tummy rise and fall. Once you have that air in your tummy, HOLD the breath and pull the tummy in, again hold for 5 seconds.
When you get good at this, we can add in some of the spinal stabilisers. This time you need to position yourself on your hands and knees. Keep your knees under your hips and your hands under your shoulders. Your bottom should be pushed out so that you have a curve in your lower back, rather than a flat spine.Take that slow deep breath again and slowly suck your tummy up towards your spine without letting your pelvis or spine move. Hold the breath again for 5 seconds. By not moving your spine, you have started to activate the tiny muscles of your back.
How long will it take to strengthen my spine?
Muscle adaptation typically takes 6 weeks, so you need to be consistent for at least 6 weeks. The exercises above are entry level and can be made much harder, taxing the deep muscles of the spine more and more. We tend to increase the difficulty every 2 weeks. Most clients notice a change in 2-4 weeks and in 4-8 weeks are noticing a marked improvement in their pain levels.
No two people are the same though, so while these exercises are a great starting point, it is always best to come in for an assessment so we can see exactly why you are having so much trouble with back pain.
Take a look here: to see how we treat persistent back pain.
Find out more about the Transverse Abdominis muscle here
