Back pain and injury are very prevalent in our society, both in the athletic and sedentary population. While the cause (athletic injury or basic sprain/strain from bending over too quickly in the more sedentary population) may be obvious, the long-term effects of back injury may be less so.
Many have sought treatment for back pain and have experienced various treatment approaches, from manipulation to massage, and a seemingly random assortment of “core strengthening” exercises in between. The fact is that back pain tends to dissipate over time, regardless of the treatment. Additionally, recurring back pain and/or injury is common. So why does anyone go to their physician, chiropractor or physical therapist, as opposed to just waiting it out?
As it turns out, current physical therapy literature has uncovered interesting data. By measuring trunk muscle activity through EMG (electromyography), research by Cholwecki and others has demonstrated that those with recent history (<6 months prior) of back pain/injury have altered trunk neuromuscular activity when compared to those without history of pain. In this case, those with previous (not current) back pain were compared to those without any history of low back pain. Those with prior pain used many more global (or superficial) trunk muscles to resist forces on the spine, as compared to those without history of back injury. There was also a significant delay in the appropriate contraction and relaxation of those trunk muscles. Other studies have demonstrated that there is a significant delay in recruitment of deep core muscles (which the spine relies on to prevent serious injury to the discs, nerves and ligaments of the spine) when torque is applied to the spine after an episode of back pain. Additionally, there tends to be an overuse of superficial trunk and leg muscles in these cases, which contributes to hamstring and paraspinal (back muscle) tightness. This is because, given the reduced activity of the deep core muscles, the brain has adopted these muscles as stabilizers instead of movers of the trunk (which causes excessive force on the spine and increased risk for re-injury).
In a nutshell, following an episode of back pain or injury, the spine begins to rely on improper muscular support during activity, thereby increasing risk for re-injury or progressive injury.
These facts imply that the significance of physical therapist intervention in the restoration of deep core muscle activity, breath control (diaphragmatic breathing) and movement correction is remarkable.
A Direct Performance Physical Therapy evaluation includes a complete functional movement assessment. Based on these findings, areas of improper muscle activity or even reduced mobility will be addressed with appropriate interventions, in order to reduce the client’s potential for re-injury.
