Recurrent Lower Back Pain and the Core

 
 
 
Pain in the lower back has become a common complaint. We hear everyone from 11-year old children to 80-year old grandparents complain of lower back pain. A survey conducted by the Back Society of Singapore shows that 1 out of every 5 Singaporeans suffer from either a back or neck pain. The same study indicates that 1 out of 10 Singaporeans experienced such pain at least once a month. That is a very high incidence rate.

 
 
What are the effects of this pain?
  • Restriction of movement
  • Restriction of functionality and participation in recreational sporting activities
  • Reduced participation in social, community and family events
  • An awareness of the fragility of the back
  • Feelings of being old

While the pain can be physically debilitating, it can have an even more profound effect on the mental and emotional well-being of the individual. An inability to physically keep up with one’s peers may result in feelings of inadequacy. Depression is often seen as a “complication” of a chronic pain (pain that lasts for more than 3 months). Thus the saying
 
 
 
 
 
 
 
 
 
 
“You are only as young as your spine is flexible.”
- Joseph Pilates

What prolongs an acute lower back pain and makes it chronic?
We all have our tool kits to manage back pain – Yoko Yoko, stretches, tui na. Most of these remedies address lower back spasms. Reduction in pain is considered good; and a reason to return to functional and recreational activities with full vigour. Until the next attack of lower back pain.

So here’s the interesting thing about lower back pain – every time the body experiences such pain, the core muscles “switch off” a little and they just don’t switch back on. Even when the pain disappears. We lift, carry and run and the pain reappears. A vicious cycle of pain and no pain is started off. This is when an acute pain becomes a chronic pain.
 
 
What do the core muscles have to do with breaking this cycle?

The core muscles are situated between the diaphragm (breathing muscle that separates the ribs from the abdomen) and the pelvic floor. These muscles
  • Stabilise the lower back and pelvis
  • Even transmission of weight from the upper body to the lower body, thus preventing this weight from getting “stuck” in the lower back

Training these core muscles to activate at the right time and in the correct ratio will thus form a strong foundation for efficient movements; thus breaking the pain cycle.

What is effective core training?
Core muscles (Diaphragm, Pelvic Floor, Transversus Abdominus, Multifidus) are always working. If they didn’t work, we would just be a pile of bones. Thus they don’t need to be “switched on.” These muscles need to be trained to vary their levels of activation based on the load that is being placed on the trunk.
Thus core training would involve the following in different functional activities:
  • Teaching the Pelvic Floor to switch on JUST before the Transversus Abdominus and Multifidus
  • Teaching the Pelvic Floor how to respond to the Diaphragm

What is effective core strengthening?
Loading a core that has been taught to activate in a timely manner and in the right ratios for all functional activities.

How do we stop lower back pain from recurring?
By doing specific core training exercises before rushing into core strengthening exercises.