Lower Back injuries
Lower back stiffness first thing in the morning?
Unable to sleep with your back pain?
Stiff when getting up from sitting?At Fix Physio, we understand that lower back pain can be one of the most debilitating injuries that you can have. As your lower back is situated centrally in your body it is involved in the majority of activities that we do daily- from walking & sitting, to rolling over in bed, picking up your children and even sometimes just coughing or sneezing.At Fix Physio we know that the sooner you commence the appropriate physio treatment, the sooner that you’re back to normal, pain free life. We’ve seen the disc bulges, dealt with the pre & post pregnancy back ache, fixed up the sciatica and stabilised the rotated pelvis.
The science part….The lower back or Lumbar spine as it medically known is the lowest portion of our spine. It comprises 5 bony Lumbar vertebrae aptly named Lumbar 1 (L1) to Lumbar 5 (L5).
Lumbar Facet joints
Each Lumbar vertebrae articulates with the vertebrae above and below by a left and right sided facet joint. These facet joints are covered with a thin layer of cartilage. Due to day to day stresses, poor postures, repetitive movements or trauma, these joints commonly suffer from wear and tear or Osteoarthritis (OA) as it is medically known which can cause symptoms of pain and restricted movement.Reproduction of true facet joint symptoms are generally occur during Lumbar extension (leaning backwards) & Lumbar side flexion towards painful facet joint (side bend) but this classic presentation can be complicated by several other factors.
Lumbar discsThe Lumbar vertebrae are separated by jelly like structures called intervertebral discs. These discs act as shock absorbers and allow the vertebrae to move segmentally rather than just as one block. Unfortunately discs are prone to injury and typically dehydrate (disc dessication) as we age therefore providing less shock absorbance and cushioning.Intervertebral Discs 1 Diagram Intervertebral Discs 2 DiagramFurthermore, discs can suffer from bulging (layman term is a “slipped disc”), protrusions and extrusions which typically result in the patient unable to straighten up or being bent over to one side or a combination of the two. Disc bulges/ protrusions/ extrusions etc can also lead to sciatic symptoms- see below section on sciatica.
Sciatica and Lumbar nerve injury
Sciatica is where a person experiences a feeling of pain, tightness, pins & needles or numbness anywhere along the length of the sciatic nerve. The sciatic nerve departs the Lumbar spine at the lowest Lumbar level and travels down through the buttock into the back of the thigh and knee. At the level of the knee it splits into 2 branches- one down the calf into the sole of the foot and the other down the front of the shin into the foot. Symptoms can be present at any section of this nerves pathway and occasionally in severe cases the whole length of the nerve from lower back to the foot is affected.
Sciatica is experienced if the sciatic nerve is compressed near its exit from the spine. This typically occurs if there is a bulging disc, irritation of the facet joint or muscle spasm (particularly in the piriformis muscle= piriformis syndrome). The aim of physiotherapy treatment is to normalise whatever structure is compressing the sciatic nerve to alleviate this pressure through manual and exercise therapy.
Sacroiliac joint dysfunction
The Sacroiliac joint or SIJ as it is often referred to is where the central sacrum bone of the pelvis meets the wing type bones of the ilium. This joint is situated in the “dimples” that most people have at the top of their buttock creases. People with SIJ dysfunction can find certain Lumbar movements painful as well as single leg activities such as stairs and high impact activities such as hopping and landing from a jump as in netball.
The SIJ transmits load from the legs to the Lumbar spine and as such this joint can go out of position or be unstable which leads to pain. SIJ instability is more common if a person is hypermobile (greater than average range of movement) in their lower back and hips, if they have weak core stability and gluteal muscles and if they are pregnant or post pregnancy due to hormone relaxin being released during pregnancy which results in their ligaments becoming more lax.
Physiotherapy treatment of SIJ dysfunction includes core stability and glutes strengthening and occasionally requires a support belt initially particularly during pregnancy.
Typical muscle weakness of the Lumbar spineEverybody has two different types of muscles in their body: a. Movement muscles b. Stability muscles
a. Movement musclesMovement muscles are more superficial in the body, they switch on when they are needed and switch off when they are not needed. They are fast twitch in nature and as such are designed for more explosive types of movements.
b. Stability musclesStability muscles sit deep inside the body close to the joint that they stabilise. They should be working constantly with our breathing and they are slow twitch in nature therefore work to maintain our posture.Around the Lumbar spine and pelvis, the stabilising muscles are called core stability muscles. The core stability muscles are made up of:Diaphragm Pelvic Floor Transverse Abdominis Multifidus
However, when an injury of any type occurs in the lower back or pelvis, it is the core stability muscles which are inhibited by pain and therefore switch off. When these stabilisers switch off, the brain automatically goes to the fast twitch movement muscles to try and stabilise the spine. Unfortunately, these movement muscles are not designed for posture or endurance and so fatigue pretty quickly trying to do this job. Muscle spasm of these movement muscles ensues and so the cycle of pain continues.
The final factor to mention is that once stability muscles have been inhibited by pain they stay at this level of weakness unless they are retrained even after the injury has resolved. This explains why people often get recurrent low back, neck, shoulder etc pain.
Real Time Ultrasound (RTUS)
Do you struggle to switch on your core stability muscles properly?
Not sure what your physio/ trainer/ yoga instructor means when they say “switch on your pelvic floor”?
Does it feel like your not doing anything when you try to pull in your lower tummy?HELP IS AT HAND!!!
At Fix Physio, we are using cutting edge technology to assess and retrain the core stability muscles of Pelvic Floor and Transverse Abdominis. RTUS uses sound waves to visualise muscles and how they are switching on in real time just like we look at babies in the womb during pregnancy. The benefit of this is that the patient gets that visual feedback from the RTUS and this has been shown to improve overall contraction of this difficult muscle group to isolate.