As you may well have noticed, we often blog about back pain and that’s because its such a common issue and in most cases, actually very easy to improve. So, here we go once again, but looking at Back Pain in a slightly different way to some of our previous blogs.
In the past we have talked about poor strength and poor activation of the spinal and pelvis stablisers, we have identified exercises and approaches that can help with these so you can always compliment this post with a quick trawl back through previous blogs:
What we have not fully looked at before is understanding why the postures, resulting from any weakness in these muscles, give rise to certain problems.
What problems can arise from weak back muscles?
The answer to that is…many! But, let’s start with the anterior pelvic tilt. This is so common these days that almost everybody is displaying one. Here is a rough and ready way you can check for yourself if you have an anterior pelvic tilt. Roll up your shirt so you can see your midriff and then stand side on to a mirror. Now look at he way the waist band of your trousers, shorts, underwear or leggings sits. In most people the waist band will sit on and therefore follow a horizontal line across the Iliac Crest of the pelvis. If you have an anterior tilt then the waist band will slope downwards, i.e. higher at the back and lower at the front. There are very few garments designed to sit like this on purpose so it is relatively indicative that you may indeed have an anterior pelvic tilt ad this can be a cause of Back Pain.
An anterior tilt is indicative of poor pelvic stabilisation and of overly tight hip flexors, often from significant amounts of sitting, but what back pain does it bring with it and why?
So, what back pain problems can an anterior pelvic tilt cause?
Well our spinal column is designed to load in compression, or put another way with one vertebra directly stacking on top of another. The first problem that an anterior pelvic tilt creates, is an exaggerated curve in the lower spine area which results in the vertebra sitting at a sloping angle. This sloping angle increase sheer forces in the spine whilst reducing the natural compression force.
This results in back pain, as the muscles of the back desperately try to control these unnatural forces in a way they were never designed to do. Not only can you experience pain from incorrect and overuse of the back muscles, but also the pain and sensation that the brain experiences is unfamiliar. So the brain can over react to this sensations, and what might normally be a mild pain can be completely misinterpreted by the brain as complete agony.
What other back problems can an anteriorly tilted pelvis create?
The second thing this increased curvature of the spine does is bring the transverse processes, the side of the vertebrae, closer together. This in turn has three undesirable effects:
- The bones of the spine create small holes between the vertebrae and nerves use these holes to exit the safety of the spine. If the vertebrae sit closer together, these holes sit closer together, so effectively become smaller. This can compress the nerves as they leave the spine, giving referred ‘sciatic’ pain into the backside or the leg.
- It brings the facet joint closer together which can lead to osteoarthritis. The facet joints are the point of the spine that has bone of one vertebrae sitting on the bone of the next vertebrae, separated by cartilage. This is why we are able to have bending and twisting movements within our spine. Additional pressure through theses joint can give rise to pain and in the longer term osteoarthritis.
- The muscles that span from the pelvis to the spine and to the ribs shorten. These muscles lower you forward and then pull you back upright. Such as when bending over to open a low drawer. This shortened position leaves them very tight and therefore, vulnerable to muscle strains. Additionally, it also means that when you do bend forward, say to wash up, the muscles come under almost immediate strain and can make everyday actions almost impossible due to the resulting back pain
Now, that’s an awful lot of things, just because your pelvis has tilted. Physiotherapists and Sports Therapists can, however, straighten the pelvis out using soft tissue work and give exercises to strengthen the muscles that support a neutral pelvis position. This can help to stop it recurring in the future.
I have been told I have Posterior pelvic tilt!
Indeed this can occur too, and as a whole, the global effect on the spine is similar to that of an anterior pelvic tilt. The spinal column moves away from loading in its natural compressive state.
Locally, however, the resulting issues can be quite different. In this position the holes for the nerves and the facet joints are actually opening up. It sounds great given what we just said about the anterior tilt closing them down. But, a posterior pelvis tilt results in a flattening of the natural lumbar (lower back) curve and with that comes a rather unpleasant secondary issue:
The intervertebral discs begin to bulge backwards. This can weaken them and result in anything from a bulging disc that presses on the nerve in certain positions, to a fully prolapsed disc. This is traditionally, but incorrectly, referred to as a ‘Slipped Disc” and leads to severe back pain.
Can my pelvis tilt sideways?
It certainly can and it can also horizontally rotate out of position too. Funnily enough the end result of this and of any pelvic misalignment is an uneven loading of the spine away from it natural position which will affect either, disks, nerve or joints…are you noticing a theme here?
Could my back pain be a slipped disk?
That is, of course, what everybody worries about when back pain hits, especially if there is referred pain into the leg. Well, we only need to look at all of the issues we have highlighted above and how a simple misalignment can easily give rise to pain that easy to mistake for, or assume is this kind of injury or many other back injuries. So, in many cases, no, you probably have not slipped a disk but this is where getting the issue looked at becomes important.
There are a number of tests that can identify and differentiate between the causes of similar feeling types of back pain. But, if your pelvis does not sit level (remember the looking in the mirror trick we mentioned earlier?) Then have this checked before you start to worry too much about something that just may not be there.
Take a look at how we treat back pain here.
For more information on Back pain, please see this website.