Overcoming All Types of Low Back Pain & Sciatica Flare-Ups Quickly : 5 Part Series
by onsite, April 2, 2017
PART 1: CALM DOWN THE NERVOUS SYSTEM
To start, I want to make it clear that I am a huge believer that no back pain is created equal. Specifically speaking, no two back injuries should be treated in exactly the same manner. This is because there are hundreds of different combinations of factors that can contribute to causing low back problems. Trying to place a back injury into a box and providing an exercise routine or treatment program solely based off of a medical diagnosis or the findings of an X-ray or MRI is a lazy, out dated, non-effective way to deal with back injuries. Although every back injury needs to be treated on a case-by-case basis, there are some things that MUST happen with every back injury in order for the individual to resume function in the quickest and safest manner possible.
After an acute injury resulting in even mild tissue damage, your brain gets a warning signal from sensory receptors in the tissue that was damaged. This warning of a threat causes your brain to do everything it can to protect the tissues or area of injury. This response is important in the short term to ensure that you don’t continue to damage tissue or perform a movement that will cause further injury. However, if this increased level of hypersensitivity continues in the neuromuscular system, it makes it very difficult to regain normal movements and function. In this case, pushing through the pain is definitely not recommended. The photo to the right demonstrates a patient a few days after an acute low back pain flare up. We can see the muscles on each side of the spine are spasming and very tense — even in a relaxed lying position with the patient’s pelvis supported — the patient’s nervous system is so irritated that the muscles are staying contracted.
Take for example a simple movement like getting up out of your car. This is often a very painful transitional movement for patients dealing with acute low back pain. It forces the core to activate while the hip and spine is moving through various positions. Initially after an injury, the brain may perceive this movement as threatening – and send extra juice forcing muscles in the back to aggressively contract rather than the appropriate core musculature. Over time, the patient may learn to compensate during a a simple daily movement like this to avoid pain. Now the patient is in a situation where every time they get in or out of the car they’re using an abnormal muscle activation pattern.
SO WHAT DO WE DO TO CHANGE THIS NEURAL HYPERSENSITIVITY?
One of the best ways to calm down the nervous system is to perform what we call diaphragmatic breathing. This simply involves getting into a comfortable, non-threatening position and breathing through the stomach and not the chest. The video below is an example of 90/90 Breathing, which is a great way to calm down muscles in the back and get your nervous system to CHILL OUT! Many patient’s make the mistake of attempting to aggressively stretch low back muscles when tight. When we have excessive tone in a muscle (essentially the muscle is staying turned on all the time because the nervous system is over-active) performing stretching techniques to these tissues will often create more tone and tightness in the muscle. The muscle isn’t short it’s just staying contracted – so we don’t want to stretch it. Instead, regaining a normal breathing pattern and getting our brain to start sending juice t0 the anterior core/breathing musculature is very helpful in decreasing muscle guarding in the low back.
Unless the patient is dealing with a very mild injury – some manual therapy techniques from a Physical Therapist or Chiropractor will be very beneficial in helping the nervous system relax back to it’s normal state. In my experience with low back injuries, trigger point release dry needling followed by active release massage and/or functional wet cupping is a game changing combination. Chiropractic Adjustments are often effective as well in specific types of low back pain. These treatments can desensitize the nervous system around the spasming or over-active muscles, increase blood flow to the area for tissue healing, and improve activation of smaller postural muscles (most notably the deep multifidi) that often get dominated by the larger superficial muscle spasms. Patient’s may be able to overcome a low back injury without these manual treatments, but it will take much longer and the recovery may not reach the same level. Meaning that although the patient isn’t having as much pain – they still may not be utilizing appropriate muscle activation in the low back likely resulting in subsequent flare-ups in the near future.
TDN of Deep Multifidi in Low Back
Check out the upcoming posts in this five-part series continuing tomorrow with PART 2: RE-INTEGRATING NON-THREATENING MOVEMENTS
OnSite-PT is now accepting patients at the following Cleveland Area locations:
- Chagrin Falls
- Bedford Heights
- Olmsted Falls
If you’re in the Cleveland area and having problems give us a call. Those of you in the Wayne/Holmes County area check out Revive Physical Therapy & Wellness or Optimum Performance!
www.onsite-pt.com DrJames@OnSite-PT.com (330) 231-0987