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    Will strengthening my abs prevent lower back pain?

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    I have been suffering from lower back pain for several years now and I was recently told that if I strengthen my core this will help ease the pain. What specific exercises should I be doing? Regular sit ups tend to hurt my neck.

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    Jason Tomlinson

    Personal Trainer

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    I am a qualified Fitness Specialist and am a second year Podiatry student. I have an interest in musculoskeletal rehab, running and nutrition recommendations. I ... View Profile
    Hi there,

    There are a few ways to tackle lower back pain. I'll assume you have an increased arch in your lower back which is the main cause of the pain. Weak core muscles can contribute to the problem, as can tight hip flexor muscles which are pulling your pelvis down which is leading the curve. A tight back can also be part of back pain. 

    I don't like giving sit up's or crunches to people with lower back pain, as in order to do the movement you have to turn your hip flexors on which, in turn, is going to cause them to become tight if not stretched regularly and make the pain worse.

    I would suggest the following things:

    1. Stretch your hip flexors - I have a stretch for that on my website here http://www.jtwellbeing.com/p/stretches.html (stretch #8)

    2. Stretch your lat muscle -  I have a stretch for that on my website here http://www.jtwellbeing.com/p/stretches.html (stretch #1)

    3. Work on transversus abdominis activation. This is the main core muscle that offers stability and one I would try and activate then strengthen. There are different levels of progression this but the first one is to:

    1. Lay down on a bed
    2. Feel for the sides of your hip bones and move in 1-2cm and keep a finger there
    3. Breathe in and squeeze your pelvic floor muscles
    3. Breathe out but keep your pelvic floor muscles drawn and stomach squeezed/tensed. Hold for 10-15 seconds initially or until you feel the muscle stop working/tensing.

    There is research to say that if your abdominal muscles are switched on then the transversus muscle is likely to be also, but I think it's good to focus on it specifically. 

    Here is a good video that might help if you're stuck feeling for the muscle as it isn't the easiest muscle to feel for. http://www.youtube.com/watch?v=dgIhzlp474A

    I wont go into detail about working other muscles that are weak because I think that the stretching and core activation is a great place to start. 

    If you do feel severe pain or it doesn't get better I think it would be good to see a physio so they can assess it.

    I hope this helps!

    Jason
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    Neil Synnott Pro

    Exercise Physiologist · Physiotherapist

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    I am qualified as a PHYSIOTHERAPIST and ACCREDITED EXERCISE PHYSIOLOGIST. I primarily use the McKENZIE METHOD for assessment and management of musculoskeletal pain disorders. The ... View Profile
    • Traralgon, VIC 03 5174 6865
    Hi,

    Low back pain can be a difficult problem to treat. Low back pain is a very personal and individualised problem… thus an individualised management program is advisable! Assessment and management with a physiotherapist is advised.

    People with low back pain need to consider and work on two things… spinal mobility and spinal muscular conditioning (control, endurance, strength).

    If spinal mobility has not been suffiecently assessed and managed, spinal muscular conditioning will be more difficult and slower to progress. So just working on abdominal strength is not enough to help prevent low back pain episodes.

    With regard to spinal mobility, people often display a direction preference for movement. When moving in the preferred direction (usually lumbar extension with and without a bias) the spine moves freer and local and other pains are often improved. When moving in the non-preferred direction (often lumbar flexion) the spine stiffens and local and other pains are worse. So finding your preferred direction is very important for spinal mobility and management of low back pain. A credentialled McKenzie physiotherapist is advised for this aspect of managing low back pain. Check out www.mckenziemdt.org.au for a therapist near you.

    With regard to spinal muscle conditioning, transverse abdominis and lumbar multifidus are two very important muscles to activate. Once you know how to activate transverse abdominis and lumbar multifidus, challenging these muscles with low intensity functional exercises is important. When transverse abdominis and lumbar multifidus are functioning well, continued exercise management with a personal trainer (fortnightly sessions) is advised to monitor form and technique.

    Any questions, I am happy to discuss.

    Regards, Neil

     
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    Melissa Desira

    Osteopath
    Director, Osteopath & Real Time Ultrasound Specialist. With a Bachelor of Biomedical Science and a Masters of Health Science in Osteopathy, coupled with over 10 ... View Profile
    Hi
    in addition to Neil and Jason's responses, a good way of ensuring you are correctly activating your core - (TA, Pelvic floor & multifidus)-  a fantastic method is seeing a therapist that uses real time ultrasound. This way you can visualize if your core is truly switching on and a valuable teaching tool, if you are having difficulty.

    if you have any questions on this or would like to know more- please contact me
    Cheers
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    Joel Laing

    Physiotherapist

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    I am a McKenzie Method specialised physiotherapist. Using the McKenzie Method I predominantly treat low back and neck problems, although we do treat all parts ... View Profile
    Many physiotherapists, Exercise Physiologist and other Allied Health Practitioners place a strong emphasis on strength and rehabilitation programs. They recognize that core stability and muscle retraining can be important, especially when the nature of your job or sport involves heavy or repetitive loading.One of the Frequently Asked Questions by patients who come to our clinic for the first time is “Why am I not better?? I have been taught a strength program or core stability program for my back by another health professional and my back is just the same or worse”There are 2 critical things that make all the difference with Rehabilitation Programs that are frequently not well done by many health professionals.
    • The underlying joint problem (eg disc in the lower back, or labrum in the shoulder or hip) is not resolved first
    • The exercises are not specific for your particular problem
    With the McKenzie Method we first correct the underlying joint issue. This instantly improves muscle function even before strengthening takes place! Failure to correct the underlying joint issue does not allow normal functioning of the joint, causing pain inhibition and alters muscle function. Retraining the muscle in this instances leads to poor results and a failure to improve pain!With the underlying joint issue sorted out (within 2-3 sessions) the muscle function often rapidly and dramatically improves. The key then is ensuring exercises are performed in the direction your problem needs, which is central to the McKenzie exercises.eg. Doing crunches for the low back (with a reasonable view of strengthening the core) causes repeated flexion to occur, the most common direction that worsens disc problems in the low back!Specific Rehabilitation Programs also need to befunctional, as research clearly shows that exercises need to be performed in positions that replicate your work or sporting environment for best results!
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    Sandra McFaul

    Physiotherapist
    Do you suffer from chronic lower back pain or neck pain? Based in SYDNEY, Sandra is 1 of ONLY 15 Physiotherapists in Australia with ADVANCED ... View Profile
    Joel makes very good points.  You need to do pain relieving exercises first.  Once the pain is releived with that then strengthening the area allow you to get back to what you love to do.

    Unfortunately, I also see lots of people who “think” they are doing the right thing, but in fact it is not helping matters.  Like Joel mentioned, doing crunches is strengthening the abs but it is a felxion exercise - the exercises or movement that does the most harm.

    The McKenzie Method is a targeted assessment and treatment tool that can be used for any musculoskeletal problem.
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    Dr Andrew Lim

    Chiropractor

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    Andrew has a Masters in Chiropractic and his interest in Sports Chiropractic has led him to treat many athletes from junior to elite levels in ... View Profile
    The ‘Ab’ muscles are just one part of the entire ‘core’ group of muscles. The ‘core’ muscles form a wall around the abdominal cavity that help stabilize and protect not only the lower back and spine, but also all the abdominal organs. I will also include some of the hip and upper back muscles in the core muscles group as there are muscle in these regions which reinforce the lower spine and pelvis, the foundation of the core.
    I suggest you speak to a qualified physical therapist to specifically diagnose your condition, and prescribe exercises for you that are suitable to your condition, as you have mentioned, there may be some exercise that are not suited for you. Sit-ups and crunches have been thought to be more damaging for the spine than beneficial if performed incorrectly.
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    Dr Matthew Stevens

    Chiropractor
    Passionate about health and education, I specialise in spinal and sports related injuries, looking not just at the injuries themselves but the complex dysfunctions which ... View Profile
    One point which has been touched on but not really discussed is that low back pain is rarely a 'strength' issue but rather a ‘control’ issue. As such ‘strength’ exercises are not particularly beneficial. Exercises you want to perform are ones that require controlled co-activation of all the varying muscles which stabilise and move the low back. These exercises are generally similar to pilates exercises. Since we are talking about control here it is vitally important that correct technique is maintained and as such professional supervision is required to prescribe exercises at a level that whilst still challenging, are able to be performed correctly.
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    Dr Bryan Hornby

    Chiropractor
    Chiropractor, Author, Teacher - Dr Bryan Hornby has clinical experience across 5 states of Australia, in both the rural and city locations and focuses on ... View Profile
    Good question!
    When people think of ‘strengthening the back’, they often think of doing sit ups.  
    This common myth is simply not true! And harmful for your back.
    A traditional sit up places enormous amounts of stress on the discs, joints, and surrounding tissues and should be avoided at all costs (simply read the research e.g. Low Back Disorders - Stuart McGill).  Each time you do a sit up, it places as much force as American/Canadian Work Health and Safety Taskforce says to avoid at all costs.  Each sit up is pushing you right up to the unsafe limit!

    With any back pain, first priority is to normalize the biomechanics!! (make sure the joints are working properly and in the correct order - as other have mentioned here “control issues”).  In my opinion, you cannot start strengthening without fixing this mechanics first; it simply makes no sense. And to do that, chiropractor is first choice.
    THEN, and only then, you can start strengthening/rehab on the lower back - which physiotherapy would be good.  Inline with the other professionals opinions about exercise, back endurance exercises for transverse abdominus, gluteals, etc are a good start (such as dead bug, back bridge, bird dog, etc).  And a final note, everyone is individual so a tailored treatment plan is needed.  
    Hope that helps clear up some of the myth on sit ups/back strengthening!  


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