Spinal strengthening exercises

Spinal strengthening exercises

Do you get back pain? You are not alone…

Recent estimates of the global prevalence of low back pain in adults showed on average 23% get pain once a month.  It has been reported chronic back pain ranges from 10 to 20% of the population and rising. Approximately 90% of low back pain is nonspecific, defined as pain symptoms with no specific cause.

Studies of low back pain shows that a loss of motor control (a specific type of strength) is associated with the presence of chronic pain, and the body starts to move in less ideal ways in reaction to, or to avoid pain. The nervous system may get “hypersensitive”. Changes occur in the region of pain ANDin the brain. Low back pain is a complex issue that Physiotherapists are trained to treat and to teach people long term strategies to manage their low back function.

“Core Stability”  exercise– does it help Back Pain?  Core Stability is a widely misused term.

Motor control of the body is a dance of strength, awareness and skill. To prevent strains and injury, the body needs to have a skill-set for all the activities you do, an ability to balance stability and flexibility, to produce steadiness in a state of movement. Each client has a body with a unique history of training and injury. We all place different demands on our bodies too. A trained physiotherapist uses their observational and diagnostic skills to assess where and how “core stability” needs to be developed for each client for their optimal function.

What is core stability really?

The concept of core stability probably originated in Australia in the 1990‘s with the famous work of Dr Paul Hodges. Dr. Hodges showed that the Transversus Abdominis and Multifidis turn on before, or within 50 milliseconds of, the deltoid muscle when subjects raised their arm up ie. the body did some motor planning to prepare the body for the arm raising. In low back pain subjects, Dr. Hodges showed that this motor control planning (feedforward mechanism) was delayed in the Transversus Abdominis and Multifidis.

The exercise industry at large made some huge extrapolations from this research. The idea that slow or weak transversus abdominis muscles are responsible for lower back pain has had thousands if not millions of people training up their “TA”’s. Despite beliefs that core stabilisation exercises will “ wake up” a slower feedforward mechanism, studies have shown that TA training exercises do not in fact lead to abdominal muscles switching on “faster” in preparation for movement.

“Core stability” has been widely touted as a preventative/cure for chronic low back pain. Recent evidence from high quality randomised controlled trials have not shown core stability programs to be superior to other therapies such as general exercise. Clinical evidence does show that spinal stabilisation exercises for patients with low back pain may help to decrease pain and disability and also reduce the recurrence of pain.

How can Spinal Stabilisation exercises work?

Specific core, individually tailored stability programs can work for many people by:

-Changing fear patterns, building trust and security in movement

-Building self efficacy.. clients can reduce pain and improve their quality of life without reliance on passive treatment

-Breaking habits of motion. Moving in new patterns creates new ease and reduces stiffness

-Mechanoreception/Pain gating; this means: experiencing pain free movement in an area previously identified to have pain associated with it can “ break” the pattern of pain

– Improved blood circulation, reduced muscle spasm and improved muscular tone.

Why “core stability” exercises sometimes don’t work

There is evidence that lower back pain may sometimes be associated with increased co-contraction and hyperactivity of “core” trunk muscles, with an inability to relax the transversus abdominis and lumbar multifidus. TREATMENT NEEDS TO BE SPECIFIC FOR EACH INDIVIDUAL PERSON.

Some people ‘s bodies respond well to encouraging activation of TA and multifidus and some respond to learning to relax tight muscles. Neuromuscular retraining specific to each individual body is the way forward.

An experienced Physiotherapist can determine what is needed for your body.

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