Author: Dr. Scott Allin on 4 February 2020
Clients often come to me with low back discomfort or pain. How I treat low back pain depends on my assessment because often, the pain does not originate from the low back. Below are five common causes of discomfort, along with possible contributing factors.
Pelvic immobility means that muscles, bones, ligaments or cartilage within the pelvis has become stuck, and are not moving through their natural range of motion. This immobility could be caused by trauma to the area, or long periods of sedentary activity. Your low back and pelvis work together as a unit when you move. If your pelvis is less mobile, your back movements need to be exaggerated to complete the same movement, which puts additional strain on your back, predisposing your back to injury. During my pre-treatment assessment, I assess the pelvis to pinpoint joints that are moving with limited range of motion. Once I know the problem area, I use the appropriate interventions to make the low back and pelvis work as a cohesive functional unit. I may also recommend stretches or exercises to keep the area mobile.
When the muscles around the core are weak, the back muscles have to work harder to hold the person upright, thus causing tightening of the back muscles. Think of a radio tower with slack in the support cables, more strain will be placed on the tower itself to stay upright. Abdominal exercises are a great way to prevent low back pain. If you are new to abdominal exercises, start with abdominal hollows (tuck your bellybutton in towards your spine and hold for a few seconds, repeat until you are fatigued). Then progress to pelvic tilts (lay down face up keeping your tailbone on the ground and flatten your back against the ground and hold for a few seconds, repeat until you are fatigued). Then progress to bridging (Lay on the ground knees bent and feet flat on the floor. lift your hips off the ground to make a strait line from your thighs to your upper back and hold until you are fatigued. If you can maintain for 1 minute you are doing great!) Then progress to heel raising (Lay down face up keeping your tailbone on the ground lift, lift your heels just an inch off the ground and hold until you are fatigued. If you can maintain it for 30 seconds you are doing great!). Then progress to planks (Hold a pushup position with your body strait as a board, you have to maintain a posterior pelvic tilt or you are not targeting the correct area. If you can maintain good form for 1 minute, you are doing great!). There are lots more we can talk about but that is a good start. These exercises will vary depending your personal starting point and your needs.
Sometimes pain interpreted as low back pain can actually be coming from another area. Muscles and ligaments commonly do this but so do organs. Organ or visceral referral pain may be caused by trauma or infection. If you present with associated symptoms that suggest the presence of acute organ injury or infection, I will refer you to your physician for evaluation. If you have had an organ injury or infection in the past, the connective tissue that supports that area may have dysfunction that maintains the pain referral pattern. This connective tissue dysfunction can present as abdominal tensions.
Abdominal tensions refer to the tightening of the connective tissue in your abdominal cavity. If present, they can cause not only referred pain, but your back position and motion to have to compensate. I will assess the abdominal cavity and look for tensions between structures and if present, apply treatment in order to allow them to glide naturally. This allows the back to return to its proper position and uninhibited movements and removes the strain that can cause referred pain.
Local Musculo-Skeletal Pain
Sometimes, low back pain is, in fact, caused by stress on muscles and other structures in the low back. This discomfort may be caused by strains, sprains, overuse or poor posture. Each of these causes would call for a different treatment. Acute or very recent strains or sprains typically do not respond well to deep-tissue treatment because that tends to exaggerate the inflammatory state of the injury. However they may respond well to a lymphatic drainage treatment to flush out inflammation, which I also provide. For over use of muscles and pain caused from poor posture, I can provide interventions to the area of discomfort. After the treatment, I can also suggest tips to improve posture, improve the ergonomics of lifting and other activities or how to care for strains and sprains that will encourage a full recovery.
A pre-treatment assessment of the whole body provides you with the most appropriate treatment for your individual needs.
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