PART 3 of 4: Inadequate back strength: the main reason for chronic back pain
Last week we discussed decreased back strength as a cause of chronic back pain. This week, let’s focus on unbalanced strengthening, meaning building of some muscles asymmetrically without performing adequate stretching and flexibility.
While strengthening usually results in the shortening of muscles, flexibility lengthens them again to maintain balance. Flexibility and balanced strengthening are critical to any treatment program for the spine. If you were to only strengthen the “mirror muscles” in the front that people see (specifically, the pectoral muscles in the chest and biceps in the arms), then your shoulders would rotate forward as a result of the shortening of these muscles. Consequently, you could end up with shoulder pain from increased irritation of the rotator cuff. Also, the nerves and blood vessels going down the arm could get compressed due to the shortened muscles, causing arm pain and numbness (also called “thoracic outlet syndrome”). The forward leaning posture could also lead to disc herniations in the neck and low back, or chronic pain from irritation of the overtaxed muscles and tendons. That’s why it is so important to stretch those front muscles after strengthening them. In this way, you maintain correct posture and balance.
Another example of how muscle tightness can result in injury is the iliopsoas muscle. This is a muscle group that lifts up the hip. Since this muscle is a primary “fight or flight muscle,” it is affected by stress. As you can imagine, the first thing you would do when running away from danger is to flex your hip and pull your leg towards your chest to initiate running. As a result, this muscle can hold a lot of emotionally charged tension.
Prolonged sitting—at a desk or driving in a car, for example—also shortens this muscle. Any time it becomes tight, it rotates the pelvis forward and in turn results in increasing the curvature of the low back. As a result, a person can begin to experience an ache in the lower back, which can spread throughout the back and hips. It can even cause pain as you rise up out of a seated position or stand upright too quickly. (This is also why patients with a tight iliopsoas muscle frequently experience pain in the second half of a sit-up.)
In the diagram below, on the left is a normal spine. On the right, when the iliopsoas muscle becomes tight and shortened, notice how the lower spine becomes “hyperlordotic” and the upper spine becomes “hyperkyphotic”, both of which can cause extra strain on joints and soft tissues and as a result, pain.
To avoid this kind of pain, it’s important that any strengthening program identifies tightness where it is present and adequately stretches out the iliopsoas, the hamstrings, and the adductor muscles of the hip. The same is true for the upper trunk; the front chest muscles must be stretched out well and the shoulder blades lowered and brought together. (You can do this at home with a simple door stretch by extending your arms as you walk through it. Continue to walk forward until you feel a stretch within the chest.)
There are multiple deviations that can commonly occur to your posture. Each deviation results in corresponding imbalanced muscle activity (either over- or underactive muscles) or tight soft tissues such as tendons or muscles. Each deviation can therefore be addressed by specific strengthening exercises and stretches. The description of each of these can be found at www. takebackcontrol.com or www.bodybuilding. com/fun/posture-power-how-to-correct-yourbody- alignment.html.
Sometimes We Need Sustained, Supervised “Medical Exercise”
Many of the asymmetries of strength can be addressed by becoming more aware of your body, educating yourself on common problems, and performing regular, proper exercise and stretching. Sometimes, however, the asymmetries become advanced or difficult to identify. It may be hard to identify an issue since you have been doing it the same way for years. Also, sports involving asymmetric motions such as tennis and golf result in significant asymmetric changes in the body that often go unrecognized. Muscles are stronger on one side, and there are multiple tendons and joints which have different lengths and range of motion on the different sides.This is why a trained professional such as a physical therapist or certified athletic trainer can be very helpful. At our SpineZone clinics, we have physical therapists perform an initial evaluation and take posture pictures before starting treatment. We identify and focus on any asymmetries, and take follow-up posture pictures to compare the effects of treatment. I have been very pleasantly surprised at the number of patients who have been able to avoid surgery with this process despite years of bad habits and suffering from severe spinal conditions.