Prevention and Treatment for Back Pain: Lumbar Stabilization/Core Strengthening


If you have back pain you are not alone! According to a 2012 survey by the American Physical Therapy Association (APTA), 61 percent of Americans said they have experienced low back pain, and of those 69 percent felt it has affected their daily lives.1 Back pain is one of our society’s most common medical problems often resulting in disability.

Although research has demonstrated that physical therapy can be as effective as surgery for decreasing back pain, back pain is often over-treated with narcotics or unhelpful imaging scans that lead to higher costs.1-8

The good news is that most cases of low back pain are not serious and will respond well to conservative treatments of physical therapy.

If you are having low back pain right now and the pain has lasted more than a day or two make an appointment to see your physical therapist. Your physical therapist can help you improve or restore mobility and reduce low back pain.

Your physical therapist will complete a thorough examination. Once the examination is complete, your physical therapist will evaluate the results, identify the factors that have contributed to your specific back problem, and design an individualized treatment plan for your specific back problem.

Treatments may include:

  • Use of ice or heat treatments or electrical stimulation to help relieve pain

  • Manual therapy, joint mobilization, to improve the mobility of joints and soft tissues

  • Core strengthening and lumbar stabilization exercise instruction including specific strengthening and flexibility exercises

  • Education about proper posture and how you can take better care of your back

  • Training for proper lifting, bending, and sitting; for doing chores both at work and in the home; and for proper sleeping positions

  • Assistance in creating a safe and effective physical activity program to improve your overall health1

Prevention: Lumbar Stabilization Exercises

Physical therapists play an important role not only in treating persistent or recurrent low back pain, but also in preventing it and reducing your risk of having it come back.1

Preventing and Treating Back Pain: Core Strengthening/Lumbar Stabilization

Lumbar spine (low back) stability is largely dependent on the supporting abdominal and low back musculature.

The lumbar multifidi are the deepest layer of muscles of the back. They attach from the vertebral arches to the spinous processes. Each multifidi connects 1-3 vertebrae, (the vertebrae are the bones of the spine) controlling movement between the vertebrae.9

The transverse abdominus is the deepest of the abdominal muscles and is also a stabilizer of the spine. Support by this muscle is considered to be the most important of the abdominal muscle and has also been found to be in a weakened state in those who have chronic back pain or problems. Its normal action along with the action of the lumbar multifidus muscles function together to form a deep internal corset that acts to stabilize the spine during movement.9

The abdominal muscles provide the initial stabilizing support through their ability to generate pressure within the abdomen which is exerted posteriorly on the spine, thus providing an anterior support column (from the front of the spine). The low back muscles stabilize the spine from the back and lead to posterior support.9

Simply stated, the spine and discs are surrounded by muscles, and the stronger these specific muscles are, the less stress is placed on the discs and joints of the spine. Lumbar stabilization exercises help a patient to develop a ‘belt’ of muscle around their spine.9

What Does a Lumbar Stabilization Program Involve?

Lumbar stabilization is an active form of exercise used in physical therapy. It is a regimen of exercises where a physical therapist with help the patient to find and maintain her/his “neutral spine” position. The back and abdominal muscles are then exercised to teach the spine how to stay in this position. During exercise training, the therapist will carefully observe and provide correction to ensure the patient develops proper technique that then can be used at home, office, or recreation.2-6

The first step in the lumbar stabilization exercise process is to find the position of the spine considered neutral. As awareness of the neutral position is demonstrated, isolated transverse abdominus contraction is then initiated. This muscle is trained by simply pulling your navel into your spine, and/or exhaling thoroughly, while maintaining the neutral spine position.2-6

The Neutral spine:

  • It decreases tension on the spine-related ligaments and joints

  • It allows the various forces acting on the discs and vertebrae to be distributed in a more balanced manner

  • It keeps the patient’s posture near his/her “center”, enabling the patient to react more quickly (either forward or backward) when necessary

  • It provides the greatest functional stability with axial loading

Lumbar stabilization is a multi-component program and involves education/training, strength, flexibility, and endurance. Performed on an ongoing basis, these exercises can help keep the back strong and well positioned.2-6

Once learned, the lumbar stabilization exercise program is designed to train the muscles to maintain this neutral spine position subconsciously, quickly and automatically.2-6

Health and strength start with the core. Lumbar Stabilization exercise will help you build a more stable, powerful abdomen and lower back to improve fitness, straighten posture and provide a foundation for an active daily life.

The exercises need to be performed consistently to maintain strength and flexibility in the spine. This can be difficult for patients to do at home. GroupHab Physical Therapy offers lumbar stabilization exercise classes lead by knowledgeable and encouraging Physical Therapist.

References:

  1. Move Forward: Physical therapist guide to back pain. APTA website. http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=d0456c65-7906-4453-b334-d9780612bdd3#.VMaAKC4sxag. American Physical Therapy Association. Created June 2011. Accessed Jan 6th 2015.

  2. Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013; 59(2):105-13.

  3. Barnett F, Gilleard W. The use of lumbar spinal stabilization techniques during the performance of abdominal strengthening exercise variations. J Sports Med Phys Fitness. 2005; 45(1):38-43.

  4. San Juan J, G., Yaggie JA, Levy SS, Mooney V, al e. Effects of pelvic stabilization with lumbar muscle activities during dynamic exercise. Journal of Strength and Conditioning Research. 2005; 19(4):903-7.

  5. Kolbe MJ, Beekhuizen K. Lumbar stabilization: An evidence-based approach for the athlete with low back pain. Strength and Conditioning Journal. 2007;29(2):26-38

  6. Chou R, Qaseem A, Snow V, Casey D, et al. Clinical Guidelines: Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.Ann Intern Med. 2007;147:478-491.

  7. Fritz JM, Cleland JA, Childs JD. Subgrouping Patients with Low Back Pain: Evolution of a Classification Approach to Physical Therapy. J Orthop Sports Phys Ther. 2007; 37; 290-302.

  8. Roh JS, Teng AL, Yoo JU, Davis J, et al. Degenerative disorders of the lumbar and cervical spine.Orthop Clin North Am. 2005: 36:255-262.

  9. Beattie PF. Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology, and lumbar magnetic resonance imaging findings. J Orthop Sports Phys Ther. 2008; 38:329–340.

  10. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shebelle P. Clinical Guidelines: Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147:478-491.

  11. Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine. 2006; 31; 2541–2549.


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