Motion Stability's Blog


What Exercises Can Help to Alleviate My Lower Back Pain? by charlestlee

image source: lakeviewchiropractic.net

Brian Yee PT, MPhty, OCS, FAAOMPT

Usually low grade/oscillatory exercises can help alleviate low back pain. This includes stretches such as knees to chest, knees side to side/trunk rotation, prone press ups (like a Cobra position in yoga), pelvic tilts/clocks. Please consult with a qualified health practitioner to assess your causes of low back pain to then develop a proper exercise program.

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What are the treatment options for back pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

Accurate diagnosis of the sources of back pain will indicate the type of treatment you should receive. However, after structural reasons of back pain have been ruled out (such as a herniated disc), the majority of patients are diagnosed with ‘non-specific low back pain’. 

What we find clinically is that traditional interventions such as medications and injections, although perhaps needed and based on a physician’s recommendation, provide short-term relief.

There is growing research and clinical attention on trying to diagnose or sub-group ‘non-specific low back pain’. This can include movement dysfunction, fascial restrictions, muscle control dysfunction, myofascial trigger points, psychosocial variables, pelvic pain, nerve referred pain, or internal/systemic issues such as referred pain from internal organs or hormonal/vitamin deficiencies.

It is important to find a clinician that is able to differentially diagnose the various contributing factors of back pain, and then be able to provide effective treatment for those sources – and then coordinate with other practitioners that can address other needed areas. Especially in chronic low back pain management, a multi-disciplinary team of health practitioners is usually needed.



When Doing Squats, How Do I Avoid A Stiff Back? by charlestlee

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Brian Yee PT, MPhty, OCS, FAAOMPT

If your squatting is causing your low back to feel stiff it indicates that either your form, the amount of load or repetition, or the sequence of muscle contractions are incorrect and not safe for your back. With your form – there are many proper ways to squat, but people we see that have back pain or stiffness after lifting typically let the back arch or round too much. It may be the angle your squatting at, but it may also mean that your spine is more structurally unstable than you may think it is. Have a qualified practitioner observe your form to look for any inefficiencies.

In regards to load or repetition – even if your form is perfect eventually your back can wear out due to excessive weight or overdoing the number of times that you squat. I would recommend finding out the repetition, sets, or weight that you feel like you back just begins to stiffen. Next time you do squats, do less than that so your back does not stiffen. As you improve your form and the proper muscle sequence you should notice that you can increase your weight and repetitions gradually without worsening your back stiffness.

Most importantly – back stiffness can occur with squats due to improper muscle sequence. With a squat, the trunk and back muscles should all activate to provide stability to your spine. The muscles that should provide the most power and movement in the squat are your gluteal / buttock muscles. The primary joint that moves in the squat should be the hip – which is controlled by the glute muscles. But what we see are patients that use their knees or back more – causing the quadriceps or back muscles to be used more. This develops an improper sequence of muscle firing patterns and ultimately places more stress on your back as your form and coordination of movement is inefficient. You should contact a skilled health practitioner such as a Physical Therapist to assess the strength and control of your hip, back, and leg muscles if your back stiffens while squatting.



What Exercises for My Core Can Help Prevent Lower Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

First – generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles – such as rectus abdominis, obliques, paraspinal muscles. These muscles are designed for power and stability at higher loads. Core stability exercises should integrate the function of the ‘local’ and ‘global’ muscles in proper sequence.

Once that is established, any asymmetries of the muscles should be determined. In back pain patients, it is very common to have one side of the oblique muscles contracting properly while the other side does not. This causes an imbalance of forces on your trunk and can cause increased torque to your spine – eventually leading to back pain due to excessive torsional stresses in your daily function or sport.

Once the asymmetry is addressed, integration of muscles from above and below the core need to be assessed.  The old saying ‘the knee bone is connected to the hip bone’ goes too with the muscles in your body. Such lower leg muscles as the gluteal muscles in your hip or the latissimus dorsi in the mid back affect the way your core muscles in daily function and sport. People with back pain, typically have an improper tone and sequence of these muscles working together. Over time this places increased stress on the back – regardless of how strong your core is.

As you can tell, there is a lot to consider when training your core. To recommend a standard protocol of exercises to help your back is not specific enough. A proper assessment of your muscle control and movement patterns should be assessed by a qualified movement specialist – such as a Physical Therapist – to determine what the appropriate level and progression of exercises for proper stability and prevent back injury.



How Does Posture Affect Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT

The way you sit and stand significantly affects your back. Especially for prolonged duration, the tissues around the spine experience what clinicians call ‘creep phenomenon’.

Think of a cold piece of taffy. As you hold it, warm it up, and then hold it by its ends, it slowly stretches and lengthens. Very similarly, the tissues in the back can due the same thing. The fascia, muscles, nerve, joints all experience increased strain when the spine is statically held in one position for a long duration of time.

When you then place yourself in a poorly sitting or standing posture, that then accentuates the amount of tissue loading that is placed on the spine and its surrounding tissues. The ‘creep phenomenon’ is then accelerated and tissue breakdown and injury can occur quicker.

Correctly changing your postures can significantly place less stress on your spine.

Please consult with an appropriate practitioner to discuss proper ergonomics/postures.



How Can a Weak Core Lead to Back Pain? by charlestlee
Brian Yee PT, MPhty, OCS, FAAOMPT
According to Panjabi’s model, we can view spinal stabiilty based on 3 key elements:

1. Passive Structures: The spinal column itself and the ligaments, fascia and other static tissues that hold it together.

2. Active Structures: The muscles that surround the trunk and pelvis ‘actively’ contract to provide muscle support.

3. Cognitive / Motor Control: The brain has a way to coordinate how muscles will be used to anticipate how the spine is used with functional activities.

The passive structures and the spine itself is limited in its ability to stabilize the spine, especially in dynamic function or prolonged positions such as standing or sitting. The brain thus needs to coordinate the proper timing of muscle contractions and muscle forces to hold the spine together. Without proper muscle control and force the vertebrae of the spine will have increased shearing, torque or compression eventually leading to such things as vertebral degeneration, herniated discs, or other structural issues that may lead to back pain.

The notion of the ‘stronger you are – the better you’ll be’ needs to be carefully considered as it is more important to develop stability in the core that is efficient and properly coordinates with proper movements in your upper and lower body. There are many disciplines out there that teach movement patterning and stabilization, this can include pilates, yoga, functional movement training, feldenkrais, janda approach, and more. Each discipline has their specific methods, while there are also similarities. Please consult a qualified physical therapist or other health practitioner to learn more about proper movement training to stabilize your core.



How Is Rehabilitation Used to Treat Neck and Back Pain? by charlestlee

In Physical Therapy we treat neck and back pain by the following interventions:

1. Examination: Take a thorough subjective and physical examination to determine the causes and severity of pain. The examination helps determine what specific interventions need to be done. Each patient is unique in the medical history and interventions should also be individualized to the patient’s progress.

2. Reduce Pain: Especially in more severe pain complaints, it is important to reduce the symptoms to allow for the patient to simply feel less pain. This can include manual therapy to decrease muscle spasms, restricted joint mobility, or decrease nerve irritation. Modalities such as ultrasound, electrical stimulation and traction can also be used.

3. Restore Motion: As pain decreases, it is the goal for rehabilitation specialists to restore patients back to their functional activities. Mobility / range of motion is important to allow the patient to move again. Manual therapy, exercises including stretches and stability training, posture and gait/walking education are all necessary to improve the patient.

4. Improve Stability and Strength: In the neck and back there are key muscles that are designed to stabilize the spine, while others provide power and torque. In chronic pain conditions, it is important to improve the efficiency of muscle function rather than just ‘get people stronger’. Such muscles as the longus colli in the neck, shoulder blade / scapular stabilizers – such as the lower trapezius, or trunk stabilizers -including the transversus abdominis, multifidus, obliques, and gluteal muscles are all necessary to provide proper stability for dynamic function. Rehabilitation specialists have strategies to improve the stability of these muscles.

5. Function / Sports Specific Training: Once basic stability has been established, it is important to provide the patient the tools to return to full work, functional, and sports-related activities.