Motion Stability's Blog


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.

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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.