Thirty two percent of people between 25 and 34 years old complain of chronic pain, and more people miss work because of chronic lower back pain (LBP) than for any other reason. Moreover, 38 percent of all people will experience LBP at some point during the year. The most common cause of lower back pain is spinal instability.
If an injury is sustained and the lumbar spine becomes unstable, it is important to regain that stability in order to recover from the injury. If these steps aren’t taken, the result of the injury (spinal instability) will become the cause of your long-term, chronic pain. It becomes a little bit of a “the chicken or the egg” scenario, but in either case, the lower back is fragile, and we want to keep that eggshell in one piece!
Suffering from lower back pain severely limits a person’s ability to function throughout the day and perform routine tasks. Even something as simple as standing up from a chair can be a painful process. A healthy person will stand up and sit down approximately 60 times in the average work day. As someone who recovered from severe lower back pain, the LBP sufferer will get up for only three reasons: to get food, to use the restroom, and if the building is on fire. Given the relatively low demand of each task, it’s easy to see how important spinal stability is in daily life, even if you have never considered it before.
Unfortunately, spinal stability isn’t the only thing that is lost following injury. Spinal proprioception and balance are also impaired in chronic LBP sufferers. These are essential in relaying information back to the brain for motor-processing strategies and to anticipate change. Efficient movement requires a complex network of systems—it’s much more than having adequate strength to move around. Until all of these deficits are addressed and proper muscle recruitment patterns are re-established, there will still be an increased risk of re-injury. If these things aren’t addressed, spinal instability will increase until the person displays abnormal postural reactions, and this will result in the inability to perform normal activities due to loss of balance.
Balance is the ability to maintain the body’s center of mass within the base of support. If balance is impaired, the person will fall over when the center of mass is outside the base of support. To prevent falls in daily life and in sports, there are two balance control strategies that can be implemented. Proactive balance control is a person’s ability to modify their body positioning prior to a destabilizing movement in order to avoid instability. Reactive balance control is the ability to recover body positioning after an unexpected perturbation. Both are implemented in various conditions but are equally important to functioning in daily life. Both of these strategies can be implemented with a balance board trainer. To avoid purchasing multiple products, choose the best balance exercise board to maximize your training and declutter your workout space.
Maintaining dynamic balance while exerting external forces forms the base of performing activities of daily life and sports. This is one of the first things lost when the lumbar spine (low back) is unstable. Spinal stabilization is required to exert external forces throughout static and dynamic balance. You can’t have distal mobilization without proximal stabilization. Thus, the goal of core stability exercise programs should be to enable performance of required activities while keeping the spine stabilized.
In order to stabilize the lumbar spine, the focus of training should be on the abdominals, paraspinals, and glutes—it isn’t enough to strengthen these muscles, they must also fire in the correct sequence. Muscle recruitment patterns are required to attain and maintain stability of the low back and to prevent injury throughout the body. Poor recruitment patterns or “muscle imbalances” are improper sequencing of muscle activation in a movement and can lead to injury. In running, for example, if the hamstrings activate before the erector spinae muscles do, that person is at an eight times greater risk of sustaining a hamstring injury. Thankfully, there are ways to improve muscle performance.
In muscle imbalances, the postural muscles get tight and phasic muscles (muscles that produce movement) get weak. In order to correct the imbalance the tight muscles must be stretched and the weak muscles must be strengthened. Endurance training has been shown to effectively increase stability by properly recruiting muscles of the lumbopelvic region. Furthermore, these muscles are found to have greater endurance in rock climbers. Rock climbing walls have grown in popularity and availability in many gyms. Under proper supervision it could be a great way to recreationally improve your conditioning and prevent future injury.
If you’d like to do some safe and effective exercises at home to improve your LBP or to generally increase your lumbar spine stability try these with the TherRex™ Balance Exercise Board. Remember, as the movement becomes more complex greater lumbar stabilization is required.
TherRex Bridge with Ball Squeeze
In supine on your TherRex™ Balance Exercise Board lift your hips up and at the top hold for 5 seconds to squeeze the ball between your knees.
Lay supine and bend your hips and knees to 90 degrees. Maintain your balance and lift your shoulders up off the board.
Put one forearm on the balance board and with one leg on top of the other lift your hips up until your body straight. Place your other arm along your trunk or in the air to increase difficulty.
Mount the TherRex™ Balance Exercise Board on your hands and knees, maintain your balance as you tighten your abdomen and raise one arm out in front of you or one leg out behind you. Progress this exercise by raising one arm and the opposite leg at the same time.
Click here for a complete low back pain recovery program and get back to pain free activity.
Chad Franche, PT, DPT
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