This guest blog comes from Kevin Rindal, DC, CSCS, and owner of InHealth Seattle – our primary Seattle physical therapy partner! We’re proud to have a strong partnership with Dr. Rindal, who performs Active Release Technique, chiropractic, Graston/ASTYM, and many other rehabilitative services and procedures. I can’t recommend him highly enough, as we’ve discussed biomechanics and kinesiology at length about a variety of sports/activities, and Dr. Rindal is also my personal PT and Chiropractor (I have two herniated discs – L4 and L5 – and treatment at InHealth Seattle has all but eliminated the symptoms).
Have you ever wondered why some people experience lower back pain on a recurrent basis? As a baseball player it can be extremely limiting to your ability to throw, catch, run, and hit. Many athletes who initially come to our office for treatment have a history of one or more previous acute bouts of lower back pain, and are seeking treatment for another “flare-up.” Even though these individuals may not consistently experience lower back pain, between painful episodes, they are often heading down a path leading to chronic daily lower back pain.
Research has shown that pain and previous injuries can both inhibit proper muscle function. We see this manifested in chronic lower back pain patients in what is called the “feed forward mechanism.” Through the use of Electromyographic (EMG) studies, researchers have discovered that the deep stabilizing muscles of the lumbar spine, called the lumbar multifidii, are usually the first muscles to contract when the body is preparing for a quick response. An example of this is when an object, such as a baseball, is thrown in our direction; before the large muscle of the spine contract, in an effort to move the body to avoid the object that was thrown, the multifidii muscles will have already contracted to brace and support the spine. This action of the multifidii occurs without us even having to think about bracing our spine. However, in chronic lower back pain patients, this feed-forward mechanism is either delayed or absent. This fact is clinically relevant, as often we see acute flare-ups developing from a simple motion such as the quick jarring of the body in response to missing a step…thus, the multifidii’s inability to brace the spine in time resulting in excessive strain to the other spinal stabilizing structures.
A May 2009 study published in the scientific journal Pain1 used muscle EMG to evaluate 15 patients with recurrent, unilateral pain (pain on one side of the body), who were currently asymptomatic, and 19 healthy control subjects with no previous history of lower back pain. This group of researchers found that the patients with previous history of lower back pain did indeed demonstrate reduced function of the deep layers of the multifidus on the previously symptomatic side. This study confirms what many of us in the spinal rehabilitation fields have assumed for quite some time, namely, that deep seeded muscle dysfunction is present in low back pain sufferers, and retraining the function of these deep pelvic and lumbar stabilizers is essential to completely resolve a patient’s lumbar spinal dysfunction.
At InHealth Seattle, we emphasize “core stability” with each and every lower back pain patient, as well as the importance of continuing their home exercise program after the pain has resolved. Exercises such as “Kegels,” Pelvic Tilts, “Abdominal Hollowing,” “Plank,” “Side-Bridge,” and the “Bird Dog” are examples of exercise that activate the important deep layers of muscle that stabilize the spine, and can enhance your performance as a baseball player.
If you would like more information regarding this article, or exercises that you could perform as a preventative measure to fight chronic lower back pain, please contact Dr. Kevin Rindal at InHealth Seattle to schedule an appointment (206-315-7998).
1. MacDonald D, Moseley GL, Hodges PW. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain 2009;142(3): 183-188.
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