Stop blaming your Back. Maybe it’s your front??? (Read til the end to find out why)

Back pain is one of the most common reasons people coming into the clinic or seek medical and allied health care for. In fact 1 in 6 people will be suffering right now. That’s around 4 million Australians!

Back pain is also a poorly understood injury, especially in the medical world. If you go to a doctor they are likely to do very little assessment and you are likely to be sent for scans and given anti-inflammatories and pain killers. If you’re lucky the scan may say something like bulging disc or degeneration but for many the scans come back with nothing. Just a note here that bulging discs don’t usually cause back pain unless they are pressing on a nerve which will then cause more sciatica symptoms like shooting, electricity pain down your leg. And degeneration just means age related wear and tear and this doesn’t always cause pain.

So if your scans don't conclusively show anything then what is wrong?

In many cases the back is sore because it is trying to do all of the work. Just let that sink in, because this is one of the most important pieces of information in this whole article. The back isn’t sore because it’s injured. It’s actually working hard. It’s like when you're lifting something heavy with 4 other people and you feel like you’re carrying all of the weight and the others aren't carrying anything. In the case of your back, the muscles of the lower back such as the Quadratus Lumborum and the Erector Spinae as well as the spinal ligaments and joints are doing all of the work. So they become overused and painful. There’s your back pain. So then you come into the clinic and we work on your back muscles and give them some love, releasing the painful trigger points, getting more blood into the ligaments and taking pressure off the joints and increasing synovial fluid into the joints. Then you feel amazing afterwards and think your back pain is solved. But remember those exercises we gave you. They are the things that will help prevent the injuries coming back. So a few months later when you start getting pain in the back again remember it's the lower back that is overworking and becoming strained. So we need to get all of the other muscles helping out to stop the lower back getting overworked.

So who are the freeloader muscles not helping out?

Well the list is long and it can be different for each person depending on their lifestyle and how much exercise they do.

Glutes - These 3 muscles stabilise the pelvis and prevent the spine from being unstable. Exercises like glute bridges, hip thrusters, crab walks and clams can help these. More advanced exercises like deadlift and squats can also if performed correctly but yo should always learn advanced exercises with a personal trainer or exercise physiologist as you can easily injure yourself.

Hamstings - The hamstrings also help to stabilise the pelvis. Exercises like hamstring curls

Obliques - These are part of the core that wrap around the front to the back. Exercises like side planks and paloff press and wloodchps are great for these muscles.

Abdominals - the old abba dabbas. These muscles are important for holding us up and are the opposing muscles to the poor overworked back muscles. Exercises like planks, crunches, pull downs and leg lifts are a few. Note that normal sit ups can aggravate back pain if it is acute.

Adductors - The forgotten muscles of the body. Few people exercises these muscles. The are important stabilisers of the hips and are weak in most people. Unless you are a horse rider, do martial arts or specifically strengthen them you will likely have weak muscles here.

Hip flexors - these muscles can be tight or weak or both. Exercises like leg lifts, banded leg lifts, mountain climbers and dead bugs.

Transversus Abdomens - these are the deep muscles that wrap around like a corset and squeeze out a number 2 or flatulence. These are some of the muscles we squeeze when bracing.

Latissimus Dorsi - the lats aren't always seen as a lower back muscle but they definitely are. The Lats attach from the thoraco lumbar fascia Pelvic floor - this group of muscles helps hold all of our reproductive and abdominal contents from going south, so this is the base of our core. Exercises like squeezing as if you are cutting of the stream of urine can help to strengthen this group.

So what to do?

The first thing we recommend is Stuart McGill’s Big 3. The McGill Curl up, the side plank and the birddog. These are easy to get some of the muscles helping out the back. You can do these every day.

And then depending on your unique areas of weakness you can incorporate some of the other exercises above.

The other thing to consider is the mobility of your hips and thoracic spine so that all of the movement isn’t going through our lower backs. We see this a lot in office workers who are locked into the same position for long periods of time and have poor posture for extended periods of time.

The best thing to do if you have lower back pain is to have an assessment to see what is going on for you and get advice that is targeted to you. Guess work can leave you trying to figure it out on your own, which ultimately you want to understand this to understand your back. But to take the guess work out of it it’s best to get professional help from someone who understands lower back injuries. We are here to help you.

Oh and the reason the articles title says Maybe it’s your front is that the muscles of the abdomen and the Hipflexors can be tight and weak and can be the cause of your back pain.

Another note is that some lower back injuries can be very serious and require medical intervention. Scans such as MRI are very useful to get an idea of what is going on inside the spine. If there is a severe disc bulge pressing on nerves then this will require a different approach to treatment as you may not be able to do a lot of the exercises and require more hands on treatment.

References

https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems-1