Low Back Pain - Treatment considerations

The Low Back

The low back (lumbar spine) is perhaps the most dysfunctional and weakest musculoskeletal link in the body. It is one of the leading reasons for visits to the emergency room. And anyone who has had a bout of back pain will tell you it affects everything they do throughout the day. It is active in nearly every functional activity of the body and its proper function is integral to most of our movements in every day life.
Interestingly, the low back is rarely the first to move. If you take a swing in golf, first your arms move, then your upper back, and then your low back moves then hips. If you step forward and bend down to pick something up, first your foot moves then your leg and hip then your sacroiliac joint and then your low back moves. This is a very important point, because the low back relies on proper communication from the rest of the body in order to function properly. Thus, any therapy for low back pain should integrate the rest of the body and promote proper communication between the low back and the upper and lower body.
What does communication to the low back mean? It means the ability to transfer triplane (sagittal, frontal and transverse) motion into triplane stability. The low back is designed to move really well in the front to back motions (sagittal plane); it has some movement in the side to side (frontal plane motion) and very little motion in rotation (transverse plane). The limitation in rotation allows the lumbar spine to be stable enough to transfer rotational motion between the upper and lower body. As a practitioner I consider how the body functions in its transformational zones between two stages of motion. The load and the unload. Loading is the preparation for a movement. The unload is performance of a specific movement. Let’s look at an example.
I recently treated a person who was training for her first marathon that was to take place in 3 weeks. She had been having right low back pain for the last 2 months of her training and had just recently started to get right knee pain and swelling. She was unable to run or even go from sitting to standing without pain.
I started her evaluation by observing her walk. I immediately noticed that she walked on the outside of her right foot, her right foot turned out more than the left and her heel came off the ground early. My next step was to get more specific and see how her right foot moved in all three planes of motion and when she was doing a balance reach exercise she lacked balance in the frontal and transverse planes. In response to this unbalance she said, “I do remember spraining my ankle about a year ago”. Next I assessed her hip function on the TrueStretch which allowed for a stable environment to look at triplane motion. It quickly became evident that she lacked sagittal, and more importantly, transverse plane motion of her right hip. “Yeah, but what does this have to do with my back”, she asked me. Next I set out to re-gain motion in her right ankle and hip by facilitating these motions in a pain-free range of motion and then I followed up with triplane functional lunges to activate some sleeping muscles. Within one and a half weeks, this patient was back to pain-free running.
Although the patient’s original complaint was right low back pain and knee pain, I believe the true cause of pain and dysfunction was rooted in the foot/ankle and hip. Since the low back only has a nominal amount of rotation to begin with, there is not much it can do to compensate for lack of motion in other parts of the body. Therefore those restricted parts of the body must be evaluated and treated in order to have a truly successful and lasting resolution of back pain.