The National Institutes of Health states that back pain is the #2 reason for people to go to see their physician, outranked only by visits for symptoms of the cold and flu. Chances are, most Americans will have at least one episode of back pain and some of us are plagued with chronic pain. The causes of back pain are varied. Certainly the back is a pain referral site for medical conditions such as kidney infections, certain cancers, gynecologic disorders, and pancreatitis. More commonly however, back pain comes from musculoskeletal issues often derived from muscle imbalances, fascial restrictions, and torsions within our bodies causing abnormal stress on our bones, ligaments, and neural structures. Structurally, the low back area consists of the 5 bones of the lumbar spine and the discs between them, the sacrum or tailbone, and the pelvis. The areas in which the sacrum meets the pelvic bones on either side are known as the sacroiliac joints (SI joints). All of this area is prone to compression due to prolonged sitting, abnormal forces when lifting heavy objects, and less than perfect posture. With this compression, our joint surfaces are not as free to move in an anatomically ideal position setting them up for arthritis, disc disorders, and pain. Muscularly, there are a huge number of muscles that attach into the pelvis. Muscles from the back, pelvic floor, and legs all have origins and insertions into the pelvis. If even one group of muscles is tight, it can change the shift of the whole system and cause quite a few changes even remotely to the pelvis. There are differences in the male and female pelvis. The female pelvis is wider than the male pelvis and the joint surfaces of the SI joints are flatter. In addition, to prepare for childbirth, women secrete a hormone called Relaxin to help soften the ligaments of the pelvis to accommodate for the child's delivery. Levels of Relaxin are elevated with each menstrual cycle and therefore the ligaments that hold the SI joint can be more lax. The laxity of the ligaments combined with the flattened joint surfaces can lead to instability of the SI joint with resulting pain. SI pain is not limited to problems of instability. Sometimes one or both sacroiliac joints are hypomobile, not moving enough. Your therapist often will look for the quality and quantity of sacral motion with special tests during your assessment. When things are not moving as they should, and the body still needs to move, it will choose the path of least resistance moving more than normal at another joint such as the back or hip. Our muscles and soft tissue also work to compensate for joint issues. Our bodies are wonderful machines that continue to work and function even in non-ideal situations! Over time however, these compensations and imbalances can ultimately lead to too much strain on our system. One of the results of soft tissue compensation is torsion, or rotation, of our bony structures. Rotations and upslips of the pelvic bones, and pull on the individual spinal segments not only set us up for pain in these areas, but also changes the orientation and forces put on the joints above and below the back. The complicated thing about back pain is that it is never the same for everyone. What works for your friend to relieve pain may not work for you. For example, herniated disc injuries are usually aggravated by being in flexed positions such as sitting or bending over. Stenosis, or narrowing of the spinal canal, however is aggravated by standing but feels much better in flexed positions. For self treatment, one of the most important things to notice is what positions seem to aggravate your symptoms, and which positions seem to make them better! By placing yourself in the position of comfort, the tissues may be able to relax enough to give you some relief to continue with your day. Other helpful options to relieve back pain: Ice. The properties of cold can reduce the inflammatory process and give relief. A good rule of thumb is to place ice directly on the skin for about 20 minutes. Ice at first feels cold, then burning, then aching, before finally the tissue becomes numb. It is important to go through all 4 stages! Give yourself about an hour before repeating the process. Lie with feet elevated on a chair or with a pillow under your knees. Use this opportunity to focus on your breathing and notice any areas in your body that draw your attention. Stretching, Again, listen to your body for area of tension and trust your intuition. Common culprits include the hamstrings, piriformis, psoas muscle, quadriceps, and the muscles on either side of your spine. Use your yellow ball! Use about a 4 inch ball in your belly searching for areas that are hot, hard or tender. After you find a spot keep it there for at least 2 minutes as your breathe into the tissue and let your body soften over the ball. This helps soften the soft tissue on the front of your body that pulls the lumbar spine forward and compresses it. Staying fit. Continuing to move (although working in a pain free or minimal pain range) is helpful in getting the joint structures moving again and regaining normal joint lubrication. In addition, working on core strength - lower abdominals, paraspinal musculature, and etc - can help provide correct support to the structures of the low back and SI joint areas. Yoga and Pilates are two great ways to achieve this. Notice your posture. Sometimes even subtle changes in the way we sit, stand, and move can make BIG changes in the way we feel. Attend Kristi's Self Treatment class. This class is an excellent opportunity to gain valuable body awareness and Myofascial stretching techniques. It also empowers you to take an active role in your self care. One of my favorite parts about working at HOPT is the time we are able to spend with you one-on-one to address your individual treatment needs. No two individuals are ever the same and therefore we do not give "cookbook" recipes for treatments. We look forward to working with each of you to improve your health and function and getting you back to your most productive life. Written by Erin Arnold, PT
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