Musculoskeletal pain can be an important protective mechanism that acts as a warning signal that not all is functioning well in the system – rather like the dashboard alert light reminding you that your car needs a service.
In general, modern medicine tends to look for a structural cause for back pain eg ‘having a slipped disc’ helps to explain the pain. If one can’t be found, there is usually no real understanding as to why the pain is there.
The cause of back pain
Mostly, back pain is linked to how our skeleton works to do the job it is well designed to do: to move easily via well balanced muscle control as nature intended. When this does not happen, unhealthy stresses and strains are inflicted on our skeletal structures and pains begin to appear. Eventually, ‘structural lesions’ may well develop – disc prolapse, hip arthritis and so on.
Controlling the subtle movements between each vertebra and those of the spine as a whole is a complex achievement – a delicate balancing act by the muscles enabled by our nervous system. There are a lot of nerves around the joints of the spine which can be adversely affected when the spine is not well controlled by the muscle system – a local joint/nerve problem can have wide reaching effects – the whole nervous system can begin to suffer further and muscle activity can get even further out of balance.
What is the ‘right’ exercise?
Many ‘mythconceptions’ abound as to what is the ‘right exercise’ for back pain. People are often told they should touch their toes; ‘do weights’ to get strong; that strong ‘abs’ will fix your back and more recently that ‘core stability’ is the answer.
But what is usually delivered as a core stability program is often far from the mark (see article Unraveling Core Stability). Many of the people we see in our practice are victims of these approaches and require considerable help to unlearn their bad habits of muscle use.
Contemporary back pain research tells us that some more deeply placed back muscles don’t readily perform while other muscles over-perform. Strength is not the basic problem but rather poor muscle control! It is actually your brain rather than your brawn which needs to be challenged; to organise the muscles to work as team players to provide balanced control around the joints, so that you have more efficient posture and movement patterns as you perform the simple movements involved in most activities of daily living.
However, many exercise and gym programs emphasize working for ‘strength’ in specific muscles – your ‘abs’ or ‘pecs’ for instance. This is not necessarily functionally useful, increases the imbalanced muscle activity and further jeopardizes spinal health.
Muscles that work too much and are too strong become tight and don’t allow parts of the spine to move properly. Your posture and the quality of your movement control begin to suffer – you start to ‘feel stiff’ and/or ‘feel weak’. This is a common problem – you may have noticed that a lot of people are ‘stretching’ – and need to keep doing so.
Worse, because ‘stretching’ is generally poorly taught and supervised, further problems can arise as various ‘weak links’ in the chain of spinal joints are subjected to further stress and strain.
It’s possible this is even creating or perpetuating your back problem without you realising it.
Moving better will mean feeling better
If the muscles of the spine are used in a proper balanced way, you not only look good, you feel good, have plenty of energy and suppleness, and control and strength naturally occur. And you don’t have pain.
This means that exercise regimes for back pain should not address single muscles or involve strength or effort but instead provide the opportunity to develop important ‘key’ patterns of spinal movement control.
We have developed the Key Moves™ programme of therapeutic exercises and movement classes which aim to provide more appropriate exercise therapy for back pain in a supervised, small group learning environment.
It’s also likely that you will feel that your whole musculoskeletal wellbeing is enhanced!
For more information see Back pain overtreated by surgery.