Over the past 5 - 10 years, an increased understanding of spinal anatomy and muscle function has led to a recognition of the important concept of “core stability,” in the prevention of lower back pain. There is now a general consensus that the deep trunk muscles (particularly transversus abdominis and multifidus) play an important role in spinal function. They are also essential in exercise programs which are designed to prevent recurrent lower back pain.
The ability to activate these muscles at the right time during everyday activities such as lifting, is important in the treatment of some types of lower back pain. A prescribed exercise program can become the appropriate environment within which skills can be practiced, perfected and automated, allowing for more dynamic movement. This is why Pilates style exercise programs have become so popular.
However it is very difficult to recommend specific exercises or activity regimes to help prevent lower back pain in everyone. Programs need to be individualized. Exercises that suit a particular individual will depend on a number of factors, including fitness level and individual training goals.
Research shows that, following an episode of spinal pain, the stabilising muscles of the lower back inevitably weaken and become unable to adequately support and protect the lumbar spine. This results in ongoing pain, slow recovery and a greater chance of re-injury. It is therefore necessary to modify physical activity and posture until the function of these muscles has improved sufficiently. This is why rehabilitation programs following lower back pain should aim to recover stabilising muscle function before commencing strengthening exercises.
Ideally, exercises should challenge muscles but not impose excessive loads on the lumbar joints. Another important point is that “endurance” is of greater protective value than “strength.” Doing more repetitions of slowly performed high quality exercise is better than exercising with quick movements and heavy loads, particularly in the initial stage.
To challenge the abdominal area, several variations of curl up and stomach ‘crunches’ should be performed, rather than full sit ups. No single abdominal exercise challenges all of the abdominal muscles.
Individuals with recurrent or prolonged lower back pain can easily slip into a de-conditioned state. This is why an exercise program needs a component of general aerobic and strengthening activity as well. Aerobic activities such as walking or swimming help activate the supporting muscles without putting too much stress on the joints. An individual strengthening program needs to target all the major muscle groups as well as putting extra emphasis on leg strength. Leg strength is important for developing a good lower back posture during normal daily activities such as lifting, etc. Good lower limb flexibility is also necessary to reduce excessive spinal motion. It is important that you work very carefully with your chiropractor to develop your own personal core stabilising rehabilitation exercise program. This is essential to prevent further problems.
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