Lower Back Pain & How The Muscles Change
Lower back pain (LBP) is a prevalent issue that affects millions worldwide, leading to discomfort, reduced mobility, and a lower quality of life. At Optimize Chiropractic, we understand the complexities of LBP and the importance of a personalized approach to help individuals get out of pain and back to doing the activities they love.
One aspect of helping individuals recover from lower back pain is a thorough understanding of the musculature of the lower back and how these muscles change through the process of developing lower back pain. Getting individuals back to their favorite activities, whether it’s golf, lifting weights, cooking, or being able to walk through the grocery store without having to sit down to rest because of the pain, is key.
Everyone has different goals when it comes to getting out of pain, some goals are related to getting back to the activities they enjoy while others want to be able to sit through a day of work without having the constant nagging of pain. By understanding the muscles of the lower back and how they change throughout the process of pain we are able to cater our care to the individuals goals and help them manage the factors outside of our office to keep them moving forward and helping them return back to the activities they love.
The Anatomy and Function of Back Muscles
One of the main muscles that is repeatedly discussed as it relates to lower back pain are the multifidus muscles. The multifidus muscles are a group of deep, stabilizing muscles located along the spine, spanning from the sacrum(the bottom of the spine) to the axis (the second vertebra below the skull). They play a crucial role in maintaining spinal stability, posture, and movement. Let's explore the purpose and function of these muscles in greater detail.
Purpose:
1. Spinal stability: The primary purpose of the multifidus muscles is to provide segmental stability to the spine. They help to maintain the integrity of the spinal column by controlling vertebral movement and protecting against excessive rotation, flexion, and extension.
2. Proprioception: Multifidus muscles contain a high density of muscle spindles, which are sensory receptors that provide proprioceptive feedback. This feedback helps the central nervous system maintain awareness of the spine's position and movement, contributing to better postural control and balance.
3. Posture maintenance: The multifidus muscles work in conjunction with other core muscles to maintain proper spinal alignment and posture. They also help to prevent excessive motion of the spine.
Function:
1. Segmental stabilization: Each multifidus muscle spans 2-4 vertebral levels, allowing them to provide localized, segmental stabilization. When activated, they create compressive forces that help to stiffen and stabilize the spinal segments, reducing the risk of injury and excessive movement.
2. Eccentric control: The multifidus muscles act eccentrically during spinal flexion and rotation, meaning they contract while lengthening. This eccentric control helps to prevent excessive forward bending and twisting motions, which can be particularly damaging to the intervertebral discs and other spinal structures.
3. Coordination with other muscles: The multifidus muscles work synergistically with other core muscles, such as the transversus abdominis and pelvic floor muscles, to create a stable foundation for the spine. This coordinated muscle activity is essential for maintaining spinal stability during dynamic movements and activities.
4. Injury prevention: By providing segmental stability and controlling excessive motion, the multifidus muscles help to prevent spinal injuries, such as herniated discs, facet joint irritation, and ligament sprains.
A Muscle Awry
Multifidus muscle dysfunction has been linked to various spinal disorders, including chronic low back pain, herniated discs, and spondylolisthesis. Atrophy, weakness, or delayed activation of these muscles can lead to poor spinal stability and increased risk of injury. In individuals with low back pain, studies have shown that the multifidus muscles may exhibit decreased cross-sectional area, fatty infiltration, and altered activation patterns.
Targeted exercises, such as specific stabilization and motor control training can help to improve multifidus muscle function and reduce the risk of spinal injuries. These exercises often focus on isolating and strengthening the multifidus muscles while maintaining neutral spinal alignment and proper breathing patterns.
Changes to the Muscles During Low Back Pain
Acute Phase: In the initial stages of LBP, there are immediate changes in muscle structure and function. Acute pain and Painful stimulation (nociceptive stimulation) affect muscle activation patterns, leading to a reduction in the cross-sectional area (CSA) of the multifidus on the painful side. This stage often sees decreased multifidus activity and compensatory increases in other muscles like the erector spinae.
Subacute Phase: As LBP progresses to the subacute stage, muscle changes become more pronounced. Research shows increased adipose tissue and fibrosis within the muscles, especially in the multifidus. There is also a reduction in slow-twitch (type I) muscle fibers, driven by inflammatory cytokines such as tumor necrosis factor and interleukin-1β.
Chronic Phase: Chronic LBP is characterized by extensive muscle atrophy, fatty infiltration, and fibrosis, particularly in the multifidus muscle. These changes are often bilateral and result from long-term disuse, altered movement patterns, and deconditioning. Functional impairments, such as reduced deep multifidus activation and increased superficial muscle activation, compromise spine control and elevate the risk of recurrent LBP.
“This stage often sees decreased multifidus activity”
“Research shows increased adipose tissue and fibrosis within the muscles, especially in the multifidus. There is also a reduction in slow-twitch (type I) muscle fibers…”
“Chronic LBP is characterized by extensive muscle atrophy, fatty infiltration, and fibrosis, particularly in the multifidus muscle.”
A Reoccurring Theme: Weaker Muscles With Less Control
One common theme in lower back pain, as you’ve read above, is the decrease in strength and motor control of the muscles of the spine.
One of the largest issues with lower back pain and specifically lower back pain turning into chronic back pain is movement. Many times when someone has lower back pain they are told to pause activity and rest. While this is sometimes necessary in the beginning, specifically if the back is continuously spasming, this stopping of activity can lead to more pain and dysfunction if it goes on for too long. For instance muscles need to be used to maintain their function and when muscles are stopped from being used they get weaker and smaller faster. This is why movement is crucial in the process of healing for lower back pain. Rather than stopping all movements choosing to do small movements that don’t cause an increase in pain and allow the pain to subside after the movements is a key aspect of helping the healing process increase.
Our Approach at Optimize Chiropractic
At Optimize Chiropractic, we use a detailed understanding of these muscle changes to create personalized treatment plans. Here's how we do it:
1. Comprehensive Assessment:
We begin with a thorough assessment of your structure and function. We analyze your ability to control movement, your ability to balance, your range of motion, and delve into the functional movement and limitations of the hips and lower back.
This assessment helps us understand the extent of changes and tailor our approach accordingly.
2. Early Intervention:
For acute LBP, early intervention is crucial. We employ gentle, precise adjustments to help reduce tension and stress that is often occurring in individuals with lower back pain, we then incorporate movements and exercises to help restore function and strength of the lower back muscle. These exercises help overcome muscle inhibition and prevent early atrophy, setting the stage for recovery.
3. Targeted Rehabilitation:
We introduce targeted rehabilitation exercises throughout the process of recovery. A golfer trying to regain their swing speed after a back injury is going to need a little bit different training than a gardener that is looking to be able to garden for a few hours everyday. While there is always some overlap with training and strengthening there are also specific movements that need to be taken into account when helping an individual return to their favorite activities.
4. Progressive Resistance Training:
As we move past pain resistance training becomes essential. We design programs that gradually increase load to rebuild muscle strength and endurance. This phase focuses on reversing muscle atrophy and reducing fatty infiltration, ensuring long-term spine health and stability. For the majority of our patients they are able to get out of pain and return to their activities a lot faster than they realized in the beginning. However, for many of our patients what they were or rather weren't;t doing outside of the office is what caused or contributed to the pain and dysfunction in the first place. This is why for many of our patients they choose to continue to work with us after their pain has gone to increase their strength and mobility as they age and to help reduce their risk of future injury.
5. The Whole Picture:
One key aspect of lower back pain is understanding that LBP is multifactorial and the LBP can be influenced by more than just the alignment, muscle strength, and motor control. This is why throughout the process we are constantly sharing with our patients information about how the body processes pain, how the brain plays a role in pain, stress reduction techniques and a lot more. We are complicated people with complicated lives and we’re here to help you not only recover but also have the tools to take an active role in your recovery and healing process in order to help you get back to the activities you love.
At Optimize Chiropractic, we are committed to helping you get back to the activities you love and helping make back pain a thing of the past.
By understanding the intricate changes in back muscle structure and function at different stages of LBP, we develop effective, personalized treatment plans catered to you and your personal goals. If you're struggling with LBP, schedule your complimentary consultation with us to find out how we can help. Click the button below to schedule. As always if you have any questions feel free to reach out to me at drcoffman@optimizecolumbus.com. I hope you enjoyed this blog and hope you have a great day!