THE CORE OF THE PROBLEM

Posted by SportsMed NQ, 27 July 2015

We are now half way through 2015 and this month I got another year older. Most days I don’t feel like it but there are days when the kids are up during the night and I’m working long hours that I feel every day of my 46 years! These are the days when I realise how important it is for me to maintain my own health and fitness.  My core strength and posture is important to me as around 85% of my day is spent with patients who are struggling with bad back pain.

Research has shown that 80% of Australians will have back pain at some stage in their life of which 90% will resolve in 6 weeks.  The major statistic is that 60-80% of these people will have a reoccurrence within 12 months.  This has an impact on your ability to generate your greatest asset – your income, but also on your own quality of life.  Back pain patients crave normality, to be able to do normal activities like getting in and out of the car pain free and to be able to bend down to put on their shoes.

What happens in people with no back pain is their core muscles activate prior to movement to stabilise the lower back. In patients who have lower back pain, activated stability muscles are delayed and this does not recover over time and will cause wastage of these core muscles. This can start after just 1 episode of back pain! So every time we bend to put our socks on or lift our bags, these stabilising muscles are not functioning properly, causing increased load on the lower back.  Over time these stability muscles get weaker, so people find they aggravate their backs easier and episodes are more intense.  So how do we train these stability muscles known as transverse abdominis (TA) and multifidus (core muscles).

RTUSIt is important to use a Real Time Ultrasound in the retraining of these muscles.   This is similar to ultrasound used on pregnant women to look at their baby.  This machine shows you visually the layers of your core muscles as you use them as instructed by your physio. I would say that up to 80% of people that think they are doing core stability exercises correctly are in fact not, when shown on ultrasound.

This is a scary fact, especially when many people are doing pilates/yoga with back pain and in fact at times this may be making the problem worse. I am a strong advocate for pilates/yoga, but if you have had back pain you want to make sure you are getting maximum benefit from the class.  Therefore, it is important that you understand how to activate your core muscles correctly.

The other main problem is people do exercise classes at too high a level for their level of stability.  As you strengthen, your threshold will increase before you aggravate your back.  Real Time Ultrasound is used to assess rate of progression of exercise.  Back pain patients also need to be assessed for joint stiffness and muscle length changes to target an effective exercise program.

Written by Paul Parker for DUO Magazine, June Issue 2015Paul-Parker-2

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