Several times a week patients come into the office suprised that they have low back pain. They report an active lifestyle that involves exercise several times a week at the gym or outside. Some people can run 30 miles per week and develop back pain after sitting during a four hour car ride. Other people can lift massive amounts of weight of the gym, but injure themselves picking up their shoe off the ground.
It is a difficult concept to accept, but not all exercises are equal. Strenuous and repetitive exercise does not increase our functional abilities, nor does it enhance core and lumbar muscle stabilization of the spine. Big, strong weight lifters injure themselves picking up a one-pound shoe off the ground. It is not the weight of the shoe, but the functional ability of the spine to stabilize during the movement. While bending over our weight is shifting and forces are being spread throughout the spine. If the muscles do not properly engage to stabilize the spine, the joints can end up slipping and shearing across each other which damages the joints and ligaments (Visit Anatomy of Low Back Page).
The weightlifter obviously has enough strength to lift up his shoe, but his muscles were not properly paying attention. Not to mention that during a heavy lift the mind and body are engaged and thinking about lifting heavy weights, which triggers all of the back muscles to engage to protect the spine. During simple, routing activities our mind is not helping to engage our low back muscle stabilizers, leading to low back sprains.
The big, strong weight lifter is amazed at how functionally limited he is performing a few simple core stabilization exercises. The person has difficulty performing three sets of 10 of single leg bridging, and is completely unstable when trying to perform two-foot bridging on the exercise ball. It is more frustrating for this person when they see a much older and less physically-gifted patient performing much harder exercises than they can. It takes a few treatments for the person to conceptualize and understand that they have been increasing strength in muscles, but they have not been teaching the core stabilizers to properly function.
The core stabilization exercises teach them to use the correct muscles to stabilize the spine instead of overcompensating postural muscles. When trying to use the wrong muscles they fatigue quickly and are unable to maintain balance on the stability ball. With practice and the proper exercises, the same patients can very quickly advance through the core stabilization series to meet their therapeutic goals. The big, strong weight lifters find their daily stiffness and mild low back pain diminishes. They also have less stiffness and soreness first thing in the morning or with sitting at their work desk. Most importantly, their risk of severe sprains and lumbar disc injuries decreases.
They just assumed their chronic low back pain was due to age, not appreciating that the low back pain was due to shearing forces in their low back joints because the muscles were not properly stabilizing the lumbar spine.
Muscle strength and endurance exercise does not guarantee core stabilization in the low back. Performing the proper exercises and core stability activities improves functional spinal movements; therefore, reducing the likelihood of low back pain or severe spinal disc injuries.