In thinking of low back pain, the visual comes to mind: a person half-bent holding onto their back for dear life.
Many of us have had low back pain and during the acute stage of your last episode you may remember feeling seriously limited or even powerless. Feelings of discomfort and hardship are some of the reasons why low back pain is the primary cause of emergency treatment in patients (1).
More than 80 percent of people have had at least one episode of low back pain in their lives, and in the last three months up to a quarter of adults suffered from low back pain (2,3) Low back pain is more common then most people think!
In addition, chronic low back pain is considered to be the second most common type of disability in the world and one of the most common reasons for adults to see a family physician (4).
In the past, during a flare-up of low back pain, patients were told to "take it easy”. Their family practitioner may have recommended bed rest, hoping that reducing movement would help calm muscle spasms and ease pain to more tolerable levels.
Nevertheless, things have changed. Specific exercises, gentle stretches, and other ways to remain active throughout the healing phase are advised by chiropractors in Victoria BC. Complete bedrest and limiting full activities is typically to be avoided.
And why the change?
The justification is partially the way our backs and bodies are anatomically. Our backs have two types of muscles: superficial muscles (or surface muscles) and deep muscles.
To execute movements like bending and twisting, superficial muscles are used. Exercise that brings tension on the muscles strengthens these muscles. Think of the person who lifts weights at the gym: they build and develop these superficial muscles.
On the other hand, deep muscles help strengthen the spine and maintain posture. Physical exercise helps keep them in shape, such as yoga, cycling, running, and more.
Bending over to pick something off the floor is a classic scenario.
In your lower back, you can hear a "pop" followed by pain and muscle tightness. You're bent down, unable to stand upright fully, and suddenly your life hurts no matter what you do. You go to bed and lie there, unable to move because pain is occurring with any movement. Since you can't get out of bed, you call into work. For a week, under the guise of 'waiting it out,' you remain largely sedentary and inactive.
The deep muscles in the back will weaken when a person goes on a long bed rest, and begin to lose mass and strength. This is a mechanism referred to as muscle atrophy (6). As the pain subsides and the person begins to feel better, normal life is slowly resumed. The body has to recruit bending, rotating, superficial muscles to help support the back in order to do this. While they can function to get you moving, superficial muscles are NOT well-adapted for this! Such superficial muscles can tire more quickly, resulting in normal movement or motor function being compromised.
This can bring abnormal stress on spinal structures such as joints, muscles, nerves as well as joints and muscles in other areas of the body, raising the risk of further injury to the musculoskeletal system.
There are particular exercises that help to strengthen the stabilizing muscles close to the spine, which lie deep in our bodies. Victoria Chiropractors regularly recommend exercise to treat an acute flare-up of low back pain and can advise general exercises to boost the overall health, such as swimming or walking.
Some unique exercises are particularly useful for patients recovering from an intervertebral disc injury, known as McKenzie exercises (4).
"McKenzie exercises" is a concept for conservative treatment of low back pain, they have become a staple of rehabilitation your chiropractor in Victoria BC should be trained in. They require basic exercises with very significant effects on the low back pain of a patient. They are named after the physical therapist who first started using them, Robin McKenzie.
After a comprehensive review by a chiropractor in Victoria BC, McKenzie exercises are meant to be used. McKenzie actually refers to a form of mechanical diagnosis and a set of clinical exercises recommended on the basis of the specific diagnosis. The activities I'll be teaching here are only one McKenzie exercise procedure.
It is the most widely practiced protocol; it will not benefit every patient with low back pain, however. Even, this is not a replacement for a mechanical test. Instead, it is a guide for acute pain patients seeking relief before clinical treatment is received. It is always best to have your condition assessed by a Victoria chiropractor near you.
McKenzie exercises in their most simple form are most successful for patients suffering from intervertebral disc injuries. Disc injuries can cause a range of low back symptoms, ranging from extreme back pain to lower limb pain. These exercises can decrease the severity of the pain and eliminate it completely in some patients.
The disc material will also protrude posteriorly when you feel a disc bulge or herniation. Although other forms of disc injuries occur, these are the most common. In today's population, injuries to discs are extremely common and play a role in the majority of low back pain. Many who are seeking medical attention for these injuries will be advised that rest or surgery are their choices. While surgery is required in certain serious cases, the body has the ability to naturally resorb the disk. In order to help the body, resorb this disc, McKenzie exercises are a mechanical technique that patients can use.
Extension exercises by McKenzie work because they force the spine to go into an extended position (this means a "arched" back position when referring to the lumbar spine). In fact, this arch will cause the two vertebrae to close at the back over the disc. In fact, this "closing" of the disc space will allow the protruding disc material to retract back into the spine and alleviate many of the lumbar spine disc injury-related symptoms. This is known as a “vacuum phenomena”.
There are a few things you can pay attention to before doing these exercises:
It is normal to feel pain during the workout when performing the exercises. The pain intensity will also begin to decrease after several repetitions. These exercises will not be right for you if you do the exercises and the pain gets worse and remains worse.
Pain should not be worse than a 4/10.
These exercises can also help reduce those symptoms if you have symptoms in your lower extremity. Pay attention to the severity of the pain in your leg when you do repetitions.
Was it improving? Does the pain move as far as it was when you started? If any one of these happens, further sets and repetitions should be beneficial. For you, these exercises might be right.
It should be remembered that even though the lower extremity symptoms tend to change or move to the low back, it is not unusual to have increased pain in the lower back at the same time. It seems counterintuitive, but when the pain in your leg is improving, increased back pain isn't necessarily a bad sign.
Usually, when there is radiating pain in the lower extremity, the leg pain must be removed first to get rid of the pain completely (from the leg AND back). We also see the pain tracing up the leg towards the back becoming more pronounced, albeit over a smaller surface area, when doing these exercises. The smaller the pain area, regardless of severity, the closer you are to finally abolishing it. This is know as centralizing, and is a good sign.
How do you complete these exercises?
There are two options: In a standing or prone (on your stomach) position, you can begin these exercises. You place your hands at the base of your spine as you stand and push your hips forward. The aim is to drive your hips over or past your toes. Take the stretch to the pain point or until you can't go on and repeat it.
The other option is on the ground. Keep your hips on the floor while you are on your stomach and put your hands up to your chest as if you were doing a push up. Without raising your hips, bring your chest up, go as far as you can. If you can only move a few inches due to pain that is alright. Through these exercises, let each repetition gradually develop your range.
3 sets of 10 to 15 repetitions, is a good place to start to see if this is the best exercise for your low back condition. If the pain rises after three sets take a break and try again later on. Do more repetitions to see if you can establish permanent improvement or even slight improvement in pain or range of motion. These exercises can not only help alleviate overall pain for many patients, but are also useful for reducing flare-ups.
This are just one of several different kinds of McKenzie directional exercises. A different direction or progression of exercises can be needed depending on what is causing your pain. If you are on your own, this is a fantastic place to start, but note - it is strongly recommended to get a proper examination from a chiropractor in Victoria to decide exactly which exercises can treat your particular illness.
Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.
“Back pain fact sheet.” (2014). National Institute of Neurological Disorders and Stroke. Retrieved March 2020 from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530.
Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.
Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.
Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.
Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.
“Low back pain.” (2020). American Academy of Family Physicians. Retrieved from https://familydoctor.org/condition/low-back-pain
Dr. Mike Hadbavny
Chiropractor, Sports Sciences Resident RCCSS(C)
If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of chiropractic care in Victoria, BC. Contact us today.