The Core: It’s a Matter of Control
In February, we discussed how low back pain (LBP) is the second most common reason a person sees a physician. Almost everyone experiences a bout of LBP at some point in their life. Once you have, you’re more likely to experience it again.
The overwhelming majority of LBP cases are uncomplicated and can be successfully treated with physical therapy, reducing the need for costly and invasive tests and procedures. Even those who have suffered from recurring episodes of LBP or have had surgery in the past are well served by seeing a physical therapist.
There are a number of things that may cause one’s first experience of LBP- bending, lifting, twisting, an accident, or even child-birth. In many cases, LBP can occur for no apparent reason.
Once a person experiences LBP, the core muscles become imbalanced. If one does not regain control, the system will continue to be imbalanced, even if the pain goes away. This is why back pain will often recur.
What’s “the Core” got to do with it?
There are two basic types of muscles that make up the core- superficial and deep. The superficial stomach and back muscles are responsible moving the trunk and pelvis (i.e., bending or twisting). The deep stomach and back muscles attach directly to the spine and control small motions between the vertebrae. They function to stabilize and protect the spine.
When functioning correctly, the deep muscles contract independently of the superficial ones. They contract a split second before someone moves their arm or leg, and with all directions of trunk bending and twisting.
In people who have a history of LBP, the deep muscles no longer contract in anticipation of movement, nor do they contract with all directions of trunk motion. Their stabilizing action is lost. The superficial muscles become overactive, trying to compensate for the inactivity of the deep muscles. Since the superficial muscles do not attach directly to the spine, they do not have the ability to stabilize it.
Take control!
Without restoring proper muscle control, LBP most likely will recur. Exercise methods such as Pilates, yoga, and traditional exercises (i.e., sit-ups) do not restore normal motor control.
Motor Control Training (MCT) relies upon a skilled physical therapist, who will use visual and tactile cues to aid the patient in identifying the specific muscles that are problematic. The patient will get the muscles working properly again by learning to control them related to simple postures and then continue to more challenging activities. The goal is for patients to learn how to control the muscles that support the spine while performing movements that previously caused pain.
As you can imagine, it can be difficult to explain how a deep abdominal muscle contraction should feel, and you certainly can’t see a deep muscle…or can you?
Ultrasound imaging is the tool that physical therapists use to provide biofeedback of the deep stomach and back muscles. It allows therapist and patient to view these muscles contracting and relaxing during motor control exercise training.
In a landmark study of MCT for people experiencing a first time bout of LBP, people who received this training were twelve times less likely over a two- to – three year period, to suffer a recurrence of LBP than those who did not receive this training. People who received this training restored normal back muscle size within a few weeks, while months later people who did not receive this training still had decreased back muscle size.
Low back pain has been referred to as an international health crisis. As of 2009, its treatment cost in America alone was estimated to be $86 billion per year.
Because the restoration of motor control is so important in preventing the recurrence of low back pain, MCT can be an invaluable tool, complementing fitness programs, chiropractic care, and massage therapy.