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Where does LBP come from?

Where could back pain come from?

Saul Yudelowitz Bsc (Hons)

In this article only 6 basic points are discussed, there are many more! It is an extract taken from a presentation to the medical fraternity, if you have any questions please feel free to contact us.

All movement starts off with contraction of the core muscles. From here the energy travels down the thigh into the foot via the leg. If the foot is set in correct biomechanical alignment the energy will bounce off the floor and begin traveling back up the body. The bounce of energy off the floor is also dependent on the foot initiating the movement. This results in the lower extremity driving the pelvis, which transmits the energy from the trunk to the contralateral upper extremity. This also requires that the abdominals contract to transfer the energy. Due the numerous abdominal exercises that are not functional the lower back absorbs a good amount of the returning energy and can result in degenerative joint or disc disease to name a few conditions that result in back pain. As a manual therapist when writing a diagnosis for a patient the medical norm is to base this on the tissue causing symptoms however if a patient does not move correctly due to a dysfunctional core should the diagnosis read: Dysfunctional core maintained by poor foot biomechanics predisposed by degenerative disc disease……….When you exercise always use your abdominals just as you would in life, how often do you lie on your back and lift your legs up off the floor?

The are two types of movements that the human body can do in the broad sense of biomechanics.
1. Open chain and
2. Closed chain
Most bottom up patterns or ascending patterns as in the above example are closed chain movements and most top down or descending patterns are closed chain movements. There are exceptions to the rule. A close chain movement that would be descending is the pull up, a fantastic exercise however an open chain exercise that is descending would be bench press, a common dysfunctional exercise seen in the gym. One of the big problems that could contribute to lower back pain is the fact that most people do not train relative to movement. A definition of open and closed chain could be stated simply as…
Open chain movement occurs when power is put through the body and the body remain stationary and the object is
moved eg bench press
Closed chain movement occurs when the power is put through the body and the body moves eg running on the earth.
Running on a treadmill is an open chain exercise as you are teaching the body to run to stand still. If you run on the earth, as you run a building does not move towards you. Due to the earth having more mass than you when you press off the earth you move so this is closed chain. When exercising always use appropriate open or closed chain exercises for the movement that you do in life!

The body is designed to place the central nervous system over the pelvis so when you move your head position will determine where your pelvis goes. The central nervous system includes the spinal cord and so when movement occurs that allows the head to move into a position that places the spine in a compromised position the lower back will take the mechanical load so that the central nervous system is protected. When you exercise always consider where your head position is………

Stretching, well it does upset me to see that the few people who stretch most often are doing it incorrectly. This is easy to explain in the following way. If you stretch a muscle that effects the lower back when it is contracting and you do not consider the position of the lower back when you are stretching you are possibly damaging your lower back.

The articulation between the sacrum and the last lumbar vertebra determines the biomechanics of the rest of the spine. If the L/S junction is flexed then there will need to be an area of hyperextension, this area of compensation is typically where the joints of the spine degenerate however with hyperflexion this is an area where the discs degenerate. It is common to find clinically patients that have a flexed L/S junction extend their spine in the Thoracic area of the spine, which in neutral should be flexed!

The amount of lumbar extension will determine the degree of scapula/thoracic movement that can be achieved and therefore directly affect shoulder movement. The lower back also has a close influence of the mechanics of the cervical spine movement and can thus contribute to degenerative joint disease of the cervical spine. Degenerative disc disease of the cervical spine is not a common finding clinically. This effect is reciprocally related so if you sit with protracted shoulders it is likely that you will flex the lumbar spine, which could lead to degenerative disc disease.

The information contained in this Newsletter was prepared from medical and scientific sources which are referenced and are believed to be accurate and reliable. The information herein should not be used to treat or to prevent any medical condition unless it is used with the full knowledge, compliance and agreement of your personal physician or other licensed health care professional. Readers are strongly advised to seek the advice of their personal health care professional(s) before proceeding with any changes in any health care program.

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