Low Back Pain and Dysfunction… Back Pain Part 2

You can derive a few clues about the source of general dysfunction or even pain related to kinetic chain dysfunction just by looking at an individual’s static posture. The way a person stands(or sits) while in a rested state in many cases can begin reveal which areas of the core are weak and which areas may be overactive(tight). The two main systems that determine static posture is the skeletal system and the muscular system (the nervous system is also important but it is the resting length of the muscles and their attachment to the bones that we are focusing on for our purposes). The skeletal system is the framework of your body. The muscular system is, for all intents and purposes, a series of pulleys and levers that moves that frame around by pulling on the attachment points at the joints and on the bone through the shortening and lengtheningen (flexion and extension) of individual muscles or muscle groups causing them to make simple and complex movements to occur. When “at rest” (static posture), there is a default length that the musculature should maintain. When it’s not, it is the initial cause of many postural problems.

posturegood

Here is what is considered good posture. The spine is stabilized by strong abdominal complex; the pelvis is in a neutral position, as is the neck and shoulders. The reason this is an ideal posture is because the muscles are at an ideal resting length and don’t pull the bones they are attached to out of their natural position.

posture1 (2)

Here are various common dysfunctional static posture positions. These dysfunctions are the result of various muscle imbalances throughout the kinetic chain. Nearly all of these imbalances originate in the core musculature. The core musculature extends from the neck to the pelvic floor.

Lower back pain, in most cases, is caused by the pelvis being rotated out of its neutral position into an anteriorly or posteriorly rotated state. The dysfunction of an anterior rotated pelvis(commonly called an anterior pelvic tilt) is one of the most common dysfunctions in the low back and a major cause of back pain. Though it involves many muscles, the central causes of it are: Weak Posterior Chain(gluteus maximus, medius and hamstrings), weak abdominals, tight hip flexors(TFL, rectus femoris and sartorius) and tight back extensors. What I want to point out here is what is almost always the rule when it comes to muscle imbalances: when there is a tight or overactive muscle, there is an antagonistic muscle that is weak or underactive. For instance, as I stated above, with an anterior pelvic tilt, the posterior chain is weak and underactive. To compensate for the weak and underactive glutes and hamstrings, the TFL(tensor fascia latae) and the quadriceps(rectus femoris and sartorius) become tight and overactive to compensate. This causes the overactive muscles(hip flexor complex) to shorten, the posterior chain(glutes and hamstrings) to lengthen. Combined with an abdominal complex that is too weak to keep the lower back in its most stable position, the pelvis is then pull back into an anteriorly rotated position.

pelvic tilt

When looking at the anterior pelvic tilt, several things jump out about the posture. The first noticeable difference is the low back is in extension at rest. The tight low back extensors has pulled the pelvis back which has in turn lengthened the hamstrings. The tight hip extensors have weakened and lengthened the abdominals. On a related note, many people feel their hamstrings are “tight” and feel like they need to be stretched. In most cases the hamstrings are lengthened like a rubber band that is being stretched. In these cases, do not stretch your hamstrings- that causes more harm than good-instead, work to get the pelvis back to normal position.

Though the core musculature, particularly the hip complex, is made up of many different large and small muscles and muscle groups, these muscles move in synergistic ways making strategies to correct the imbalances less complicated. The basic approach to correct dysfunction is to activate and strengthen the weak and lengthened musculature while inhibiting and stretching the overactive and tight muscles. In the case of an anterior pelvic tilt, the posterior chain needs and abdominals need to be activated and strengthened while the hip flexors and back extensors need to be inhibited and lengthened.

Inhibiting Overactive and Tight Muscles

Now that we’ve taken an abbreviated look at the possible causes and physiology behind an anterior pelvic tilt, we’ll look at a protocol on how to correct it. The first step is to inhibit the muscle. Muscle inhibition is a fairly new idea with recent studies mostly being in the last ten years and look very promising. The basic idea of muscle inhibition- in this case we’re talking the use of self-myofascial release (which literally means self-massage) with foam-rolling and other self-massage techniques- is an offshoot from traditional massage therapy. One of the techniques of massage therapy is using autogenic inhibition to release knots in the muscle. To make a long story short, Those shortened and overactive muscles are that way because, in most cases, being in the shortened state has caused the muscle to spasm and form knots therefore shortening the muscle. Think of it as the overall length of a rope being shortened because of knots being made in it. Autogenic inhibition is the technique that by applying pressure on the shortened muscles for a length of time, these knots eventually release themselves allowing the muscle an opportunity to lengthen back to its proper length.

So in the case of an anterior pelvic tilt, as we discussed before, the muscles that are most likely overactive and tight reside in the hip flexors and the lower back extensors. Therefore the muscles we should be trying to inhibit(and later lengthen) are in those areas. Here are some videos demonstrating how to use a foam roller (you should get one of these) to

Inhibiting overactive and tight muscles

Lower back:

Hip flexors:

Stretching the tight muscles

Now that we have performed some self-massage to untangle those knots in those muscle fibers, we’re going to stretch them to return them to their normal length.

Hip Flexors:

Concentrate on the basic hip flexor stretch that is first shown. Experiment with the variations after the basic stretch is mastered.

Lower Back:

I generally don’t recommend stretches to acutely target the lower back because it’s an area that is easily injured. The combination of foam rolling to release the knots and stretching out the hip flexors while strengthening the weak areas of the core will naturally provide relief to the lower back.

Strengthening of Weak and Underactive Muscles

Abdominals:

If you aren’t used to planks start by holding them for 10 seconds with 10 seconds rest between. Do this for 5 sets. When that becomes tolerable go up to 20 seconds. When that becomes tolerable, go to 30- do this all the way up to 90 seconds. Once your time starts increasing, you can back off of the sets. After you’re at a minute, only do one plank and hold and just keep increasing time.

I went back and forth on whether to put crunches as an exercise because the way most people do crunches is totally wrong. So do them exactly as described here and DO NOT grap the back of your head and pull or flex your upper back. Just contract your abdominals.

Activating Glutes and Hamstrings:

Hold the Bridge at the top for 10 seconds and then slowly lower. Repeat five times.

This is a basic strategy guide to dealing with low back pain originating from an anterior pelvic tilt. There are other exercises that can be used to focus more acutely on the muscles involved, however, they should be performed under the supervision of a certified trainer or physical therapist.

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About dmartin1977

NASM Certified Personal Trainer, Corrective Exercise Specialist and a nutrition geek with an interest in fat loss and maintenance.
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