Monday 12 December 2011

Novel movements for the low back

A day in the life of a physiotherapist –  Low Back

After talking about how I relieved my own neck pain with novel movements last week, I thought I would touch on some novel movements for the low back.

We can use the exact same strategy that I used for my neck in order to regain rotation through the back.  Remember that usually throughout the day, we move the top part on the bottom part.  When rotating our back, we move the upper trunk on the lower trunk (picture swinging a baseball bat or shooting in hockey).  Our nervous system recognizes this movement very quickly because it is a movement that we do all of the time.  If our brain thinks that moving into a rotated position is threatening, it might protect against that movement by producing pain or by turning on muscles that stop you from getting into that position. In order to get into the same rotated position without our brain protecting against this motion, we want to try a novel way of getting there.  Rotating from below is one option. 

Watch the video below and try it for yourself:
1)   In standing turn your body as far as you can and see how far you can see in that direction
2)   Lie on your back and keep your knees together. 
3)   Slowly and carefully rotate your knees from one side to the other while breathing in a controlled way
4)   After you have completed about 10 repetitions, retest the rotating in standing see if the movement is changed.

More commonly in low back pain, bending forward or bending back is the movement that hurts or is limited rather than rotating.  In this case, we want to find a novel way to flex (bend forward) or extend (bend backward) the low back without the brain producing pain or turning on muscles to stop you from getting into that position.

See the video below for a novel flexion and extension movement of the lower back. Once again, the results will be more dramatic if your nervous system is protecting against this movement, but most people will experience a significant gain in range of motion after performing this exercise.  Don’t take my word for it, try it yourself!

1)   Bend forward or bend back up to the point that you start to feel discomfort.  Remember how far you get.
2)   Get onto your hands and knees
3)   Slowly flex and extend your lower back while breathing in a slow and controlled way.  Do this by thinking about which direction your tailbone is pointing.  Point your tailbone up towards the ceiling as you extend and point your tailbone down towards the floor as you flex your back.
4)   After performing about 10 repetitions, stand back up and retest bending forward or bending back and see if the movement changes.

[Insert video: flexion or extension of the low back]

There are a couple of reasons that flexing and extending is easier in this position than it is in standing.
1)   Gravity is now perpendicular to our low back rather than parallel to our low back
·        Changing the direction of gravity relative to the back changes the movement enough that our brain does not recognize it as quickly
·        Our brain therefore doesn’t protect against the movement as quickly
2)   Our knees and hips are now flexed
·        When standing, we have more stretch or tension through the nervous tissue that crosses our back
·        Bending the knees and hips puts these tissues in relaxed position
·        When we bend forward or back, we can move further into the position before these sensitive tissues send signals of that may be protected against by the brain

There are lots of ways to perform novel movements to regain a painful or limited movement.  Moving from below or flexing and extending while on your hands and knees are just two examples.  Your physiotherapist can provide you with other strategies to get moving again.

*Note: this movement strategy is an effective option for your typical work to hard the day before or get up in the morning stiff low back pain. If your low back pain is associated with a traumatic event, prevents you from performing your daily activities, or persists for an extended period, I would recommend seeing a physiotherapy for a thorough assessment.

References:
1)   Blinkenstaff C (2011). Edgework for the neck. Available at: www.blog.forwardmotionpt.com
2)   Butler D, Moseley GL (2002). Explain Pain. Noi Group Puclications. Adelaide, Australia.