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Pilates and back pain.

Pilates is a fantastic and relatively passive way to strengthen your core and improve posture.

Many physiotherapists and other health care practitioners swear by pilates as the cure to chronic back pain. In this articles we will address. 1. Why pilates is a common referral pathway for back pain sufferers and 2. Whether pilates is indeed the best exercise based pathway for chronic back pain sufferers.

1. Why pilates is a common referral pathway for back pain sufferers

The most common cause for chronic back pain is muscular weakness and imbalances. The vast majority of sufferers who seek seek treatment only receive limited, short term relief from their pain. Treatment typically focuses on the tight/ restricted joints and muscles of the lower back. However the restriction soon returns after treatment due to the lower back pain sufferer not having the postural strength to support the weight of his/ her body. This results in the lower back carrying much of the load, which quickly compromises the muscles and joints, which in turn creates painful tension.    

Pilates is dedicated to improving core strength and postural symmetry, which is one of the reasons why the vast majority of allied practitioners refer their chronic back patients to a pilates instructor. Another reason is due to the passive/ gentle nature of pilates. Most chronic back pain sufferers lack the stability and confidence to carry out exercises that incorporate resistance. Pilates caters well for these patients, due to initially focusing on holding one’s own body weight, then making it more challenging as gains/ improvements are experienced.

2. Is Pilates the best exercise based pathway for chronic back pain.

Our answer is mixed: Some chronic back pain sufferers respond well to pilates, however many do not.

• If you are responding well to pilates then that’s great, stick at it.

However:

• If you are not responding at all (after 3-6 months)
• If you responded well initially, however you improvements have plateaued out.  

Then we recommend looking to other exercise based rehabilitation programs dedicated to strengthening your back and the muscles that support it.

Some people do not respond well to passive resistance. Some back pain sufferers, are extremely weak in the major postural muscles that support the back, which results in them distributing weight forward of their midline. In order to address this, the major focus of the exercise program needs to correct the postural/ muscular imbalances.

Exercises that stretch/ elongate the tight dominate muscles of the body whilst simultaneously shorten and strengthen the weakened postural muscles of the body will in time restore neuromuscular symmetry. The focus is to take the excessive load of the back, and get the major postural muscles assisting everyday function and movement.

Functional compound movements are the best at achieving this, however it is absolutely imperative that you commence this rehabilitation approach with a back specialist who can:

• Teach you the correct technique
• Advise when it is safe to increase resistance
• Monitor your form each time the resistance is increased.

Pilates is initially quite difficult to pick up technique wise. Functional compound movements likewise are difficult to pick up, however if you are not responding to pilates, then we strongly recommend that you make this your next approach.

For more information of how to fix your chronic back pain through functional compound movement patterns, please contact us for more information.

Why do most practitioners treat the symptoms of back pain and not the underlying cause?

It is what we are taught at university. Regardless of whether you are a physio, chiro, osteo, myo, massage therapist you are trained to accurately diagnose the source of lower back pain, then trained in a unique (to your modality) set of techniques to alleviate the lower back symptoms.

There are two sides to chronic lower back pain:

1. Tight and restricted tissues that cause pain (symptoms)
2. Weakened postural muscles that comprise the structures of the lower back (underlying cause)

The problem with being solely trained as a practitioner is that years of conditioning and focus on the symptoms makes you blindsighted to the true underlying cause of back pain.

Think about it:

• A massage therapist or myotherapist massages soft tissues
• A chiropractor and osteopath manipulate joints.

It is their job! When back pain sufferers come along, they execute their years of training and clinical experience, focusing on freeing the pain and restriction present in the lower back.

This works fine for the acute back pain sufferers (less than 3 months), however for the chronic back pain sufferer (more than 3 months) all this results in, is short term temporary relief from their pain. The pattern continues – treatment – patient feels better for hours/ days after treatment – pain returns – repeat process.

The problem for the practitioner and more importantly the chronic lower back pain patient is that practitioners are not taught how to address patients who do not respond to their modalities techniques.

From experience the best health care practitioners are the ones who have had a particular condition themselves, exhausted all efforts within their modalities philosophy to fix themselves only to turn to alternative solutions. This leads to the practitioner striving to create a solution to their condition and forces them to think/ explore outside the box.

There are many terrific stories of health care practitioners who have gone on such journeys, healed their bodies then shifted their focus to helping chronic patients do the same. Back pain is no different, there are great books that go into such stories and more importantly they provide a how to – process to fix chronic back pain. Not surprisingly all such books mention that more needs to be done that just standard physio, chiro, massage, with the attention focused around restoring strength and symmetry to the body.

If you are suffering from chronic lower back pain and have tried many different modalities and practitioners without a long term solution to your pain, don’t be alarmed, you are not alone. Search for books and success stories from practitioners who have fixed their own back pain and follow their guidance. Please search through our website to find articles from such authors.

8 in every 10 Australians will suffer from back pain throughout their life

80% of Australians will suffer Lower Back Pain – Find out why

As a society we fail to move. From a young age, we are spending vast hours of the day bent over an iphone, ipad or parked at a desk focusing in on the screen of our PC.

Gone are the days where we spent every light hour of the day, on push bikes or in the courtyard playing ball sports. Video and computer games are par for the course nowadays.

With a bit of luck we mature into young adolescents and shift some of our focus away from video games and onto our studies. The demands and pressure placed on young kids is growing by the year, with hours and hours per week spent fixed to a desk studying away in the pursuit of making competitive grades.

As we mature into young adults, more of the same awaits us with university demands continuing to ensure a sedentary life. For most this only worsens as we enter the workforce, spending long hours in fixed positions as we make our impression on our new employers.

In attempt to zone out and unwind from work we head straight home to sit in from of the TV tuning into one of the many netflix series that entertain and distract us from the daily pressures.

When do we move?

Simply put, for most Australians we do not!!  We sit all day at work, we sit all evening at home, then we lay all night as we sleep.     

Muscles support our postural structure. Muscles support our back.  

Ironically the muscle group the plays the most significant role in supporting our back is the the group we spent the most time resting on – Our backsides (gluteal muscle group)

So if we are never using this muscle group because we are always sitting on it – would it not be natural for this muscle group to become weak, to noticeably atrophy away.

Back pain is a billion dollar industry, with money pouring into doctors surgeries and physiotherapy clinic all of the country each year. Not to mention the mega dollars spent on pain relief, all heading to the big pharma companies.

Millions of pointless dollars pour into research on why so many people suffer from ongoing back pain. However, there is no mystery as to why 8 in every 10 Australians will suffer from back pain. We become weak in the very areas integral to supporting our backs due to the lack of time and focus on activities that use our bodies functionally.  

If a mere fraction of the money and effort was spent on the research and promotion of simple non time consuming exercises that counteract our modern day inactivity then the percentage of australians who suffer from back pain will instantly plummet.

For more information on exercises and movement patterns to prevent and avoid back pain please refer to one of the useful links on our site.

Think Postural strength and symmetry NOT core strength to fix chronic back pain.

Find out the correct strengthening techniques to fix chronic lower back pain

Far too great an emphasis is placed on ‘core’ strengthening programs to address chronic back pain. The core is an ambiguous term referring to deep trunk muscles, with the majority of practitioners and personal trainers holding differing views on the specific muscles that fall in the core group.

Let’s look at the most common muscles believe to make up the ‘core’:

• Pelvic floor muscles
• Transverse abdominis
• Multifidus

In comparison to the major muscles that support the pelvis and back, the above ‘core’ muscles pale in significance.  

Yes they are muscles that provide stability to the pelvis, the trunk and the spine – however no amount of strength to these muscles will override and counteract weak non functional postural muscles.

Lets now look at just one of the major muscles of the body that support our posture:

• Gluteus maximus

The gluteus maximus is the largest muscle in the human body. It is large and powerful because it plays the role of keeping the trunk of the body in an erect posture. It is the chief antigravity muscle that aids in walking up a flight of stairs.

In essence if the back pain sufferer has a non functional and weak gluteus maximus muscles, no amount of ‘core strength’ will compensate for the lack of foundation and stability this creates.

It is like asking someone to stand on one leg, then try and push someone over who is standing on two legs. Or like placing a solid beam on top of a loose pile of bricks, and wondering why the beam is unstable.

As stupid as these examples sound, this is the exact approach that so many therapists and trainers recommend to their patients suffering from back pain. People dedicate hours upon hours focusing on core stability exercises, whilst completely ignoring the major muscles such as the gluteus maximus.  

Whilst the muscles we outlined earlier in this article, defined as core muscles hold their importance, it is imperative to understand that effective functional compound exercises that target the major postural muscles of the body, also strengthen these core muscles.

In fact they do so in a functional manner, they replicate everyday human movement.

Lower Back Pain Symptoms, Diagnosis, and Treatment

The vast majority of doctors and practitioners alike focus on purely the symptoms of lower back pain. They base both their diagnosis and treatment plan purely on what the symptoms are telling them whilst completely overlooking the underlying cause.

This is the main reason why the majority of people who present to their doctor or practitioner with acute back pain, do not respond to treatment and medication and end up going on to be chronic back pain sufferers (defined as having back pain for greater than 3 months).

This is also the main reason why up to 40% of back pain patients who go undergo back surgery recover from surgery feeling no better if not worse than before they went under the knife.

In order to address both the symptoms and the cause of back pain, providing initial pain relief then lasting relief it is important that we look at what needs to be covered in both the diagnosis and the treatment plan.  

The symptoms of lower back pain that result in direct pain:

1. Pain derived from compromised, restricted joints such as SIJ (sacroiliac joint) and facet joints.
2. Pain derived from compromised, tight muscles of the lower back such as; the intrinsic muscles that support and stabilise the spine and the quadratus lumborum muscles
3. Pain derived from nerve impingement. Either through direct contact by a herniated disc, or from inflammatory pressure.
4. Pain derived from inflammation present in and around the structures of the lower back
5. Pain derived from solidified connective tissue (fascia) that is either present to protect the back or has been built up over a period of time.

The symptoms of lower back pain that may or may not result in direct pain:

1. Intervertebral disc issues; such as herniations (bulge) and ruptures.
2. Degenerative changes to the vertebral structures (wear and tear)
3. Foraminal stenosis (narrowing of bone pathways.)

 It is important to diagnose which of the above symptoms is causing back pain, however it is imperative that a more holistic view is taken in the diagnosis of what caused the symptoms in the first place.

Typical underlying causes that bring on lower back symptoms.

1. Postural weaknesses that place excessive load on the structures of the lower back
2. Postural alignment issues that create an excessive lordotic curve to the lumbar spine which comprises the way the muscles, joints and intervertebral discs function.
3. Protective, compensatory patterns that tighten and fatigue the lower back muscles.

Therefore the lower back pain diagnosis must cover

1. The exact symptoms of the lower back producing pain and restricting function.
2. The exact cause of what has brought on the symptoms

In turn the treatment plan must address both the cause and the symptoms of back pain.

1. Treatment techniques need to be engaged to reduce pain, inflammation and restricted movement.
2. The rehabilitation plan must look to lengthen the tight and shortened muscles creating excess tension on the lower back
3. The rehabilitation plan must focus on strengthening the weak and lengthen postural muscles integral to supporting the lower back and pelvis.

By focusing in on both the symptoms and cause of lower back pain, can eliminate repetitive lower back flare ups and give back pain sufferers the confidence to carry out daily actions without the fear of putting their lower back out.

Why is lower back pain considered one of the hardest conditions to address?   

Many practitioners dread the complexity of a chronic lower back sufferer attending their clinic. If time hasn’t healed the patient’s condition, if many other practitioners have attempted, yet failed to provide lasting relief then how are they going to be able to help?

Some practitioners work to a formula, if they cannot help after 4 sessions or after a certain amount of  weeks then they will tell the back pain sufferer that their treatment approach is most likely not going to help them. The majority of practitioners who have difficulty treating lower back pain, try different approaches trying to find a solution to their patients pain, with the process often taking many months if not years until the patient seeks treatment elsewhere.

The lower back is a complex part of the human anatomy. There are many different structures that make up and support the lower back and any number of these structures can be the source of pain for the back pain patient. Identifying the source of the pain, and how best to treat it is one of  the most difficult tasks for practitioner treating chronic back pain sufferers.

We need our lower back in order to carry out most daily activities, in fact the only time our lower back gets to rest is often times when we are lying down in bed. This makes resting an injured back, or a recently treated lower back very challenging, which is another factor in the complexity of addressing a lower back complaint.  

The most common complaint amongst chronic back pain sufferers about treatment received from practitioners is that it only provides temporary relief from their pain. They feel much better in the hours/ days post treatment, with a greater range of movement and reduced pain only for the pain and restriction to return soon after their appointment.

The frustration for both the patient and practitioner is why the pain continues to return, why the pain areas shift around and why the MRI scans do not show a significant cause for the ongoing condition.

From experience in both seeing many practitioners as a back pain sufferer, then as a practitioner who has mentored other practitioners who want to specialise in chronic back pain, my observation has been that the vast majority of practitioners focus on the symptoms of back pain and completely overlook the underlying cause.  

Practitioners treat the symptoms that cause pain,  which makes the back pain patient feel better temporarily, only for the pain to return. This pattern continues with both the back pain sufferer and the practitioner aware of why it occurs.

If the body is not strong enough to support its own weight – then there will be significant biomechanical changes to compensate for this weakness. The most common underlying cause of back pain is muscular imbalances that compromise the structures of the lower back. The symptoms are the pain or damage that occurs to the structures of the lower back, and if you keep treating the symptoms and overlook the muscular imbalances then you will continue the same pattern of short term symptomatic relief.

Granted, lower back injuries are complicated in comparison to other regions of the human body. However correct postural analysis will clearly outline that the structures of the lower back are compromised resulting in pain and dysfunction.

Addressing the postural imbalances in conjunction with treating the symptoms will provide chronic lower back pain sufferers both temporary relief and a lasting solution to their pain.

Why do most practitioners treat the symptoms of back pain and not the underlying cause?

It is what we are taught at university. Regardless of whether you are a physio, chiro, osteo, myo, massage therapist you are trained to accurately diagnose the source of lower back pain, then trained in a unique (to your modality) set of techniques to alleviate the lower back symptoms.

There are two sides to chronic lower back pain

1. Tight and restricted tissues that cause pain (symptoms)
2. Weakened postural muscles that comprise the structures of the lower back (underlying cause)

The problem with being solely trained as a practitioner is that years of conditioning and focus on the symptoms makes you blindsighted to the true underlying cause of back pain

Think about it:

• A massage therapist or myotherapist massages soft tissues
• A chiropractor and osteopath manipulate joints.

It is their job! When back pain sufferers come along, they execute their years of training and clinical experience, focusing on freeing the pain and restriction present in the lower back.

This works fine for the acute back pain sufferers (less than 3 months), however for the chronic back pain sufferer (more than 3 months) all this results in, is short term temporary relief from their pain. The pattern continues – treatment – patient feels better for hours/ days after treatment – pain returns – repeat process.

The problem for the practitioner and more importantly the chronic lower back pain patient is that practitioners are not taught how to address patients who do not respond to their modalities techniques.

From experience the best health care practitioners are the ones who have had a particular condition themselves, exhausted all efforts within their modalities philosophy to fix themselves only to turn to alternative solutions. This leads to the practitioner striving to create a solution to their condition and forces them to think/ explore outside the box.

There are many terrific stories of health care practitioners who have gone on such journeys, healed their bodies then shifted their focus to helping chronic patients do the same. Back pain is no different, there are great books that go into such stories and more importantly they provide a how to – process to fix chronic back pain. Not surprisingly all such books mention that more needs to be done that just standard physio, chiro, massage, with the attention focused around restoring strength and symmetry to the body.

If you are suffering from chronic lower back pain and have tried many different modalities and practitioners without a long term solution to your pain, don’t be alarmed, you are not alone. Search for books and success stories from practitioners who have fixed their own back pain and follow their guidance. Please search through our website to find articles from such authors.

How To Strengthen Your Back

If you have been suffering from chronic lower back pain, you would feel weak, unsupported and unbalanced. What leads to chronic back pain is a lack of synergy with all of your muscles, especially the ones designed to support your back when you move and lift objects. As your back pain sets in, you brace yourself further to compensate for the weakness, however now more so to prevent pain when moving and lifting. The pattern worsens, certain muscles take over and become more dominant in a bid to protect the lower back, whilst other muscles integral to the support of the lower back become weak and atrophied.

Chronic back pain is more than just weakness to the lower back muscles. Many long term sufferers feel weak and attempt to strengthen their back only to make their lower back pain symptoms even worse.

The key to strengthening your back is to strengthen the muscles that support your back through functional compound movements. The key is to maintain correct and fluent movement throughout the exercise and to keep rep ranges low to avoid fatigue to an already weakened posture. Most people lack the patience to stick with a dedicated program to restore postural symmetry to their body. They either start too heavy and pull up sore and cease the program or they expect instant relief from their pain and give up a few short weeks into the program.

The key to strengthening your back is consistency and slow steady incremental increase to the resistance. Stay consistent, maintain fluid movement, keep increasing the resistance as the exercise becomes easier and the results will come.

Functional movements are difficult to master, so if you are going to attempt them by yourself then you are going to have to be patient. There is terrific self help available on the internet, with fitness instructors showing you how to master functional movements. If you have the resources available seek out a competent and experienced strength and conditioning coach to take you from A to B.

If you are suffering from chronic back pain, strengthening your back and the muscles that support your back is hands down the most effective way to end your back pain and ensure it never returns. You may also contact our back massage clinic in RIchmond.

Some people suffering from chronic back pain are so tight and restricted through their hips and lower back region that no matter how much practice they are not able to get their body into the positions required to carry out functional movements. If you fall under this category, do not give up hoe of permanently ending your back pain, you just need to be more resourceful. You will need to combine deep tissue therapy to your hips and lower back with functional movements. The most effective way is to go for a deep tissue treatment to open your hips and lower back, then attempt functional movements in the proceeding days when the tenderness has worn off, however whilst the freedom of movement from the therapy is still present.

What causes the lower back to go into spasm?

What causes back spasm

Lower back injuries are widely misunderstood in the health industry amongst doctors, practitioners even specialists. Is it any wonder that when patients injure their back, when their back goes into painful spasm they are told conflicting information by almost each and every doctor and practitioner they visit seeking quality advice and help.

In this article our aim is to provide clarity over the root underlying cause for why the lower back goes into spasm so people are informed and can prevent recurrences.

A lower back spasm is a protective mechanism designed to prevent further damage to the spine and intervertebral structures. When too great a load is placed on the lower back, due to overuse, lack of rest or most commonly due to postural weaknesses that have accumulated over a period of time.

Let’s look at the swelling that occurs post spraining an ankle and the similarities of a lower back spasm.

When you roll your ankle, the area swells for two main reasons:

1. Inflammatory cells are rushing to the ankle joint to commence the healing process
2. The extra fluid braces the ankle joint preventing movement that could do further damage.

When your lower back spasms:

1. An unconscious contraction of the lower back and gluteal muscles brace the lower back region preventing movement that could do further damage.
2. In the event of damage to the disc or facet joints, inflammatory cells with rush to the area to commence the healing process.

The problem with a lower back spasms is that, unlike an ankle where you can sit and rest it or walk on crutches, it is very difficult to find a pain free position.

A lower back spasm will on average last for 2-3 days, however can drag out over a 2-3 week period when damage to the disc has occurred, or when neural pathways are interfered with. The pain gradually subsides as the muscles ease from their painful contracted state. Most people are left with a residual discomfort that typically responds to massage, physiotherapy and chiropractic manipulation in the weeks that follow.

 If you experience a one off lower back spasm as a result of over fatiguing your back, seek treatment initially (although pain relief results will be limited during the spasm). Rest through the spasm then continue treatment to alleviate residual pain.

If you are experiencing repeat spasms, it is imperative to seek treatment that addresses the underlying cause of why your body is going into protection mode. Postural weaknesses and imbalances need to be addressed to ensure your lower back and hips are not carrying the load to the point of fatigue. Good quality postural strength work will make you feel much stronger and supported throughout the day.  A strong and balanced posture will remove the vulnerable feeling that you could experience another spasm at any time.