Low Back Pain

At my office in Asheville, I see many people with low back pain and there are many elements that contribute to it. The anatomical component to back pain is important of course; however, there are other elements to back pain such as physiological, psychological, nutritional and biochemical elements that could be playing a role as well. For example, our gut is innervated by the same nerves as our low back, so an inflamed gut due to IBS, bloating, blood sugar dysregulation could cause low back pain.

If low back pain creeps up on you at the end of the day, you are most likely using more of your outer unit muscles to stabilize your spine, which fatigue more quickly. An example of these muscles would be your lattissimus dorsi muscle and gluteus maximus muscles which are important muscles, but a strong outer unit is only effective when it is supported by a strong inner unit. When this happens you tend to shift your position often as you fatigue in one position you move to the next and this goes on throughout the day. Outer unit adaptation is a functional compensation which is not optimal for our spines. We ideally want to use our inner unit muscles to hold ourselves up which are the transverse abdominis (TVA ) in conjunction with the multifidus, diaphragm, and pelvic floor muscles. They are our spinal stabilizer muscles that can handle postural load and fatigue later than sooner. Unfortunately, pain or irritation will inhibit or stop our inner unit muscles from firing and stabilizing us. There are forces that effect our spines, these are known as shear force which occur when one vertebrae is  sliding forward or backward on the vertebrae below it; compressive force which occurs when the vertebrae are “pressed” or compressed together; torsion force occurs when one vertebrae is rotating on top of the one below it.  When our spinal stabilizer muscles are not working there is more shear, compression and torsion thru our joints which overtime create wear and tear and an increase propensity to injury.

Postural distortions and muscle imbalances can create low back pain. For example an anterior tilt of the pelvis unlocks the sacroiliac joints and makes it more prone to injury or wear and tear. Or a posterior tilt of the pelvis locks the sacroiliac joint and tightens the ligaments.

Dysfunctional motor control could also be causing your low back pain. For example, if your rectus abdominis muscle is overactive and overpowering your transverse abdominis muscle this could load your discs and set you up for more risk of disc injury. Or if your quads are working harder than your glutes and hamstrings this will create an anterior pelvic tilt which will create more wear and tear thru your facet joints.

Faulty breathing patterns can contribute to low back pain. Our diaphragm attaches to L2 & L3. When we breathe incorrectly it pulls on L2 & L3 and decompresses L4 &L5 creating instability of the spine which in turn can cause injury.

Trigger points in muscles such as the Quadratus Lumborum, Psoas, Iliacus, Gluteus Medius and Piriformis can refer pain to the low back.

Chronic emotional stress leads to cortisol dysfunction and inflammation as well as muscle tension and reduced blood flow. All of this can manifest in the low back so it is essential to recognize this, and take steps to reduce chronic stress in your life.

Remember your spine has evolved to handle significant loads and your body can heal in the right environment. Low back pain does not have to overcome your life.

Tips on helping with your low back pain:

-Reactivating your inner unit muscles. A good exercise example of this is the bird dog. Our spines and bodies need proper movement to thrive.

-Working with a massage therapist to release the outer unit muscles, and/or trigger points and getting the inner unit muscles to fire better.

-Working with your nutrition to heal inflammation of the gut and implementing an anti-inflammatory diet.

- Getting out in nature, to relieve emotional and physical stress.