Why does my back pain keep coming back
Lower back pain is a common injury. It is estimated that 60-80% of the adult population will experience it sometime in their life and 6% of the population have back pain at any one time – unfortunately, that means most of you should read this! It can be debilitating, stopping you from simple things such as running, hanging out the washing or picking up the kids. Some people will tell you that it can be fixed with some R&R but then why does the pain keep returning? Firstly, it helps if you understand the spine:
Anatomy of the spine
Each of the bones of the back (vertebrae) are connected by intervertebral discs. These discs consist of harder, fibrous outer rings (annulus fibrosus) with a gelatinous centre (nucleus pulposus). The discs allow movement between the segments as well as absorb forces from gravity and the ground when walking and running.
The vertebrae are also connected by facet (zygopophaseal) joints. These joints help to hold the segments together while allowing movement in all directions.
Multifidus is a deep, small muscle of the back. It connects one vertebra to the one directly above it. Multifidus provides stabilisation between the vertebrae and a small amount of movement at each level.
The effects of back pain
Back pain may be caused by the discs or joints, as well as a number of other, more specific conditions. Ruling out any structural damage (e.g. vertebral fracture, disc herniation, spinal canal stenosis) there are elements that are common through all back pain.
Recent research has found that the muscles in the back alter their size, strength and function after an episode of back pain.
The Multifidus decreases in size and the recruitment of the muscles around the back changes; abdominals decrease their output while back muscles have to work relatively harder. These changes mean certain muscles become fatigued more quickly and there is a change of load on the spine over time, thus decreasing overall spine health and leading to ongoing injury!
Although your back may feel better after a few weeks, the Multifidus muscle does not recover spontaneously, even after your back pain is gone. The recurrence rate of back pain within one year is around 84% when no rehabilitation is undertaken. This drops to 30% when patient-specific exercises are performed.
What can I do about it?
A program of specific exercises allows the multifidus muscle to recover more rapidly and more completely, returning the spine to its pre-injury load. The deep abdominals also need to be “re-programmed” along with the other muscles that act on the spine, pelvis and legs. It’s not as simple as doing a “plank”, squatting or other “core” exercises that are often bandied around these days. Because spinal strength isn’t about practising rigidity and just having strong muscles. It’s all about controlled efficient movement, dynamic stability and functional, automatic “motor control”. In order to achieve a result that ticks all these boxes, a skilled Physiotherapist is needed who may need a combination of Diagnostic Ultrasound, Clinical Exercise-based core stabilisation, a Whole Body Vibration Therapy program or specific functional rehabilitation exercises.
No two bodies or back injuries are alike, hence the need for an individually tailored approach. This is how you stop your BACK pain from coming BACK!
Nathan Rickard – Physiotherapist and Practice Director, Back In Motion Hawthorn and Aspendale Gardens
References:
Walker et al (2004) Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther 27(4):238-44
Hides et al (2008) Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 13(1):43-9
D’hooge et al (2013) Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J Electro & Kinesio 23(1):173-81
Hides et al (1996) Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First‐Episode Low Back Pain. Spine 21(23):2763-9
Hides et al (2001) Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. Spine 26(11):243-8