Back Injury: Understanding The Importance of Stabilization And The Role It Plays In Back Rehabilitation

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Welcome to the Back Pain Solutions Podcast – Back Injury: Understanding The Importance of Stabilization And The Role It Plays In Back Rehabilitation

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Introducing Back Injury: Understanding The Importance of Stabilization And The Role It Plays In Back Rehabilitation

One of the fundamental issues with the back-pain epidemic is the sedentary nature of the lives that we lead. A lack of conditioning of the key muscles throughout the core is leading to micro-movements in the spine leading to injury, and pain. Micro-movements occur due to a lack of stability throughout the spine which needs to be resolved if any underlying tissue damage is to be resolved because otherwise these micro-movements continue and the underlying tissue damage cannot heal. Stability is often overlooked as much of the advice often recommends a flexibility-based approach to treat back pain. But how can introducing flexibility-based movement be healthy for a back that is moving too much?!!!

In this fourth episode of this four-part series we introduce the concept of spinal stabilisation and the role this plays in back recovery. We discuss a progressive approach to building safe movement before applying key principles to more complex exercises! You will learn that only a small amount of time is required to implement key principles each day but how repetition is important to rehabilitation success. You will learn how micro movement in the low back needs to be controlled by recruiting key muscles whilst understanding that these muscles must be recruited safely!

Some of the things you’ll discover…

• What is meant by spinal stabilisation?
• How do you stabilise the injured area?
• The mistakes most people make when trying to resolve their back pain
• How the nervous system works to protect your spine
• Why your back often feels tight when experiencing back pain
• The importance of stabilising between the hips and the shoulders
• Exercises that enhance stabilisation and which exercises negatively impact your back health
• Why it’s crucial to understand the concept of stabilisation

Show Highlights

The importance of building up exercise to ensure it provides stability in the long term. How repetitive training builds up ‘neurological’ memory which allows you to execute exercises subconsciously meaning that you’re performing movements safely, without having to think about the movements you make all the time. This helps build long term resilience to recurring injury but allows you to perform activities of daily living and even sporting endeavours safely as well as efficiently.

Interview Transcription

Unknown Speaker 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain. Back Pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better black health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.

Jacob Steyn 0:28
Welcome back to the back pain solutions podcast everybody. It’s Jacob here today doing a solo and I’m going to continue with the series of four episodes that I started out explaining and what is meant with building tolerance. So today is the fourth episode of the series of four. And we started out with the intro, talking about what is meant with building tolerance and why it is necessary to consider this topic when we were recovering from low back pain. Then, in the second episode we discussed why and what is meant with the sensitizing and why this is so important. And in the third episode we discussed and looked at what is meant with spinal hygiene or good movement. And today we’re going to look at what is meant with the final topic thing, a very important topic that we need to consider to regain the capacity to heal from a low back injury. And this is stabilization or how to stabilize the injured area.

So let’s start off first and look at what most people would do if they have low back pain. Typically, the person would think that it’s making a lot of sense to actually go and stretch my low back when I have pain and stiffness. We do this because we don’t realize, in fact, what is the cause of this stiffness. I’ve mentioned in a previous episode of the series that the stiffness doesn’t just appear, it’s actually an as a result of the injury, and it’s driven by the brain. So the nervous system will cause this stiffness as a result of the injury. Now, if we think a little bit further, this actually means that the muscle tightness and stiffness is a reaction to try and protect the injured area. So I usually say to my patients, if I have a knee injury, and it’s sore and tender, would I go and stretch that knee in all different directions? And the answer is, obviously, no, because we can clearly see that there’s an injured knee, maybe there’s some swelling, we’re very certain that it’s the joint. That’s the problem because it’s such a big joint. And so the idea of actually going and stretching the knee joint is just something that we would never consider. And that’s how we have to look at the back.

So we know from the research that the back muscles will not cramp up for any other reason, but to try and protect the low back. And when we mean or what we talk about the low back, we’re referring specifically to the spine. So we’re referring to the joints and the tissues around the spinal joints of the, say, the big joint, the desk or the small joints, the facet joints at the back of the spine. Sowe’ve gone through the steps of desensitizing the area, we figured out what is causing the pain trigger. So we now focus on moving well and try not to look up those pain triggers in order to allow the injury to heal. And then we have to consider very much the aspect of stabilizing the area so that we can allow the healing to occur. So all these three points, first desensitizing. Secondly, moving Well, you know, considering spinal hygiene and thirdly, stabilizing the low back spine or the core to allow the healing. These are interchangeable. And what I mean by that is they are they they overlap so much that we have to think of all three of these points, and not just one if we do only one or maybe two. We’re never going to reach our goal if we only stabilize but we keep looking up that pain trigger and we keep setting off the injury over and over and over. And so, getting the immune system to respond with more swelling, we can stabilize as much as we want, but we’re going to be our own worst enemy. So we have to think a little bit further than just one piece of information. And we have to go and look at the whole picture. And so that’s why I put together these three aspects of building tolerance.

So, when we look at stabilization of the low back, we have to understand that the low back is really made for I would put it for as a center point from which we move. So we like to talk of the core, there’s many names for it, but the low back is really the center of the core. And the core finds itself between the shoulders and the hips. Now the shoulders and the hips. They are ball and socket joints, and everything in between. That is of course the spine. And what I’d like to refer to it as a tunnel of muscles. So we have this tube running from the front to the side to the back to the side again into the front tube of muscle from the shoulders through the hips. And if we want to be effective moving from those hips and shoulders, those ball and socket joints, we need to be able to stiffen everything between the shoulders and the hips. With minimal movement, we can direct the force driven from a hip or from a shoulder in terms of speed, strength and accuracy to a much greater effect than when we have a very loose core. And we try to create that same effect. So that’s the whole idea of stabilization of the core of the low back.

So we have to go to exercises which are going to enhance this stiffening effect between the shoulders and now I can assure you doing setups or Russian twists, or Superman, and then I’m referring to the Superman where you line your tummy, flat arms above your head, and you raise your arms and you raise your legs. In other words, you make a sort of reverse crunch with your low back muscles are not going to provide you with the stabilizing effect that we are looking for. In fact, that’s most likely, most definitely going to put more pressure through an injured tissue in the spine. And this is going to take you further from home. So the typical exercises we’d be looking at when we want to stabilize, like I said, is going towards stiffening everything between the shoulders and the hips. And so we want to work with the idea of anti rotation, anti flexion anti extension in the low back. In other words, when I push something I’ll be pushing from my hips and not through my spine, so I’m not going to twist or turn through my spine, I’m going to lock my shoulders on my hips. And I’m going to push off through my hip with either my glutes or my legs. And so this is the broad concept of stabilizing the core when we approach it through exercises. But if we have an injury, we need to go back and we have to start from the ground up. So we have to make the exercises very simple and basic. So we get the communication between the brain and these muscles that provide us the stabilization function well, before we go towards extreme exercises, we really challenge the anti rotation or anti flexion anti extension aspect. So the best exercise I would usually refer to is the bird dog. In other words on the hands and knees we start off maybe only raising a hand progressing to arm and leg. And then if we want to, we go to only leg because we have more compression through the spine when we only raise the leg. If you don’t know this exercise, you can look it up online. There’s many examples of it, or when it comes to the small nuances of how to do it correctly, I can obviously not guarantee the video that you’re going to see is going to make the standard but that’s a very, very important exercise. From this exercise we’ll build out with more plank variations, side plank variations, Sorenson hold everything that’s going to target the core on the front and the side and on the back without bending through the spine. In other words, we’re going to challenge the stiffness between the shoulders and the hips.

So we have to consider that if we have a disco injury and we have limited tolerance for compression. In other words, if we would put weight on our shoulders, and we have a disc injury and we have limited tolerance, we might already feel pain or discomfort with only that weight on our shoulders. I imagine the weight on our shoulders is pressing down towards the hips. In a similar fashion, we have compression between the shoulders and the hips, when we would contract our core in the correct way. So when I mean in the correct way, I mean the the bracing technique that we teach, which basically, is what we get from the research is where we create compression by bracing the core. So if you brace the core correctly, use the lats and all these muscles that run between the shoulders and the hips you will actually cause compression in the spine. And this compression is needed because it’s difference the spine. The only problem is if you have a disc injury or any endplate disco, sometimes faster joint injury, the tissues will already be irritated with minimal compression. In other words, if you would only stand embrace or even maybe do a bird dog, which has minimal compression, but just enough compression to already set off the injury, then we have to take a step back and we have to start with minimal compression exercises. This is where the key lies. If you go too fast, and you step over that line, and you start to challenge your injured body part with too much compression or too much shear force or too much torsion then we’re going to flare up that part of the injury, again, we’re going to cause that injury to come back or not get better and so that’s why it’s so crucial to understand the whole concept of stabilization. And that when we take the right steps, small steps, often we will build tolerance instead of removing the tolerance that we are aiming to move towards.

So I hope that’s clear for everybody. What is meant with stabilizing the spine we want to work with just enough stabilization through the exercises. And we want to do these exercises, depending on your situation regularly throughout the day, because the stabilization exercises will provide you with stabilizing effect around the spine for three, four up to five hours after doing them. And that obviously, increases or creates this possibility of healing. In other words, you’re going to be less likely to look up a pain trigger at the injury site because you’re going to be protected because of the criminal, the better communication between the brain and the muscles by doing these exercises from doing them two three times a day.

So if we think of stabilization, we usually start with isolated exercises. And with isolated exercises, I mean, very quite often single joint movement exercises. And we will build that up gradually, usually starting from floor exercises, to standing exercises where we move towards complex movements. First we have to establish good movement in the isolated movements that we start with on the floor. And then we can take those movements having gained theneural drive, the mental capacity to enable that movement to be to be done with good form. And then we will apply that to complex movements. And so, I’ve just mentioned the idea of doing these exercises two or three times a day. If you have a busy schedule like a lot of us, then my suggestion is, together with the desensitizing exercises, schedule your stabilization exercises in two to three times a day in your agenda. So it’s there, you can see it, it’s a good idea to start off with these exercises before work. It’s going to help you through the morning, maybe during the beginning of the afternoon, and if you have time, another time in the evening and quite often these stabilization exercises will not take you more than 10 minutes. If you’re efficient, no longer than five minutes.

Just the last note I want to make is that and I may I may have mentioned it already. Well, we don’t want to do or we want to be careful with stabilization exercises the first 30 to 45 minutes in the morning when we’ve just woken up, and we still have possible swelling around that injured area and the low back. And when we’ve woken up and we went from horizontal lying to vertical standing, we get a lot of pressure on the swelling. And so the first 30 to 45 minutes, we want to move, pump away the swelling and we we have more freedom of movement and less sensitivity in the low back. We will have an ideal moment to start doing the exercises.

So hope that’s clear for everybody. What is meant with stabilization as part of this approach to build tolerance? And I would suggest that if you’ve listened to all four episodes, and you’re curious about what exactly to do, and you want to know more about this concept, then listen to all four episodes again, because there’s a lot of thought provoking ideas, which might sound very simple and it may or may make a lot of sense. But the idea is for you to understand this and to go and apply it and to make use of the information.

Thank you for listening and like always, please head over to iTunes, give us a rating. And if you’d like to go to the website, and download the free ebook, and see what that can do for you if you’ve had chronic low back pain. Thanks for listening. Bye.

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