CORE STABILITY & LOW BACK PAIN. Tim Ellis, Physiotherapist BA(Hons) BSc(Hons) MHlthSc(Hons) APA

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1 CORE STABILITY & LOW BACK PAIN Tim Ellis, Physiotherapist BA(Hons) BSc(Hons) MHlthSc(Hons) APA 1

2 Core Stability & Low Back Pain In this 8 page ebook, our Principal Physiotherapist, Tim Ellis, explains the truth about core stability and low back pain. This ebook will explain what we mean by the term core stability; how a weak core can cause low back pain, and what you can do today to get a stronger core. So how do I know I have poor core stability? Can you answer yes to two or more of these questions? QUESTION ONE Have you had a lower back injury in the past, that got better, but never quite went away? Tim Ellis, Physiotherapist Core Stability is the term used to describe the concept of muscular, or motor control around the lumbar spine and pelvis. If you have low back pain you may have poor core stability and there is a good chance that this may be contributing to your pain. QUESTION TWO When you are standing do you find yourself putting your hands on your hips, swaying your body weight forwards or from one hip to another? But don t worry you can learn to use your core muscles correctly Our physiotherapists and exercise practitioners work together to help you retrain good core stability. QUESTION THREE When you bend forwards do you put your hands on your thighs to support yourself? Make a commitment to yourself: start working on your core today. QUESTION FOUR Do you get backache after walking on hard surfaces, like polished marble floors at a shopping centre? QUESTION FIVE Do you find yourself shifting around uncomfortably in your seat after only five minutes? Then there is a good chance that you have poor core stability and that this is contributing to your back pain. 2

3 Okay, sounds like me tell me more So to summarise its not just about muscle strength, its about muscle timing and endurance The first thing to understand it that improving your core is not as simple as strengthening your back and tummy muscles. + + The core muscles need to fire up at the right time, in fact just before you move. + + The core muscles need to stay active through the entire movement. At Excel we understand that improving core stability takes work, patience and dedication. But we see great improvements in people who do that work. That s because when the core is working well, the spine is stabilised and protected. This in turn prevents pain and injury. We also understand the importance of working as a team selecting the right approach for the right patient. Everyone is different and everyone s programme is tailored to their lifestyle, activities and interests. Our multi-disciplinary team of practitioners work together, giving better long--term outcomes. + + The core then needs to stay switched on, at a low level even when you are sitting down. 4

4 So what benefits can I expect to see, and how long will it take? Everyone is different, but within 3 weeks you should notice: + + Better posture from improved muscle activity in the core + + Reduced frequency and severity of low back pain and discomfort + + Less stiffness and enhanced physical functioning in everyday activities And within 6 weeks you should notice: + + Improved performance during vigorous activity such as sport + + Reduced incidence of peripheral injury such as muscle strains and ankle sprains + + Improved pelvic floor function, with benefits for both men s and women s health And for those looking for a bit more detail here comes the science part. THE ABDOMINAL MUSCLES CAN BE CONSIDERED IN TWO KEY GROUPS 1. Postural Muscles These deeper muscles include the corset muscle, transversus abdominis. These muscles attach to the deep fascia that connects to the lumbar vertebrae. They provide stability by controlling intraabdominal pressure and supporting the vertical position of each vertebra. 2. Dynamic Muscles These include the six pack muscle, rectus abdominis, and the obliques. These are larger muscles that cross the pelvis and the thoracic cage in a vertical or transverse direction. They provide for stronger muscle contraction and are important in movement during vigorous activity such as sport. TRANVERSUS ABDOMINIS MULTIFIDUS PELVIC FLOOR AND DIAPHRAGM Tranversus abdominis (TA) is the deepest abdominal muscle, it is also known as the corset muscle because of the shape within the abdomen. When functioning well it stabilises the joints, ligaments, discs and nerves by drawing in the abdominal contents prior to movement. The spinal joints become stabilised and the ribs are pushed upwards away from the pelvis. Multifidus (MF) are very short muscles that run between just one or two vertebrae. These small muscles fine tune postural movements. They also support and protect the lumbar discs. After a disc injury these muscles become weak and it is essential to retrain the function of the multifidus. The pelvic floor muscles and diaphragm work in conjunction with the TA and MF. Retraining pelvic floor is an important component of retraining core stability to reduce low back pain. It is also a key component on women s health and men s health programmes. Improving pelvic floor function has been shown to improve incontinence, and is especially important post pregnancy and after any abdominal surgery, such as prostectomy. 6

5 Alright then, so where do I start? Real Time Ultrasound Retraining Very simply, we need to start at the beginning, to create a strong foundation - that s the pelvic floor, the lowest part of the core. Real Time Ultrasound (RTUS) guidance is the only truly accurate and reliable way of assessing the function of the pelvic floor, and we have this equipment in our practice. Your physiotherapist will then add some more complex exercise and increase the complexity of your programme. We guide you through five stages of re-training core stability: 1. Learning to activate the core muscles (pelvic floor first) in an easy position, using RTUS 2. Progressing to more challenging positions that test your ability to hold a contraction while moving a limb 3. Then we start lengthening and stretching the tight larger muscles (like hamstrings or hip flexors) that may be compensating for the weak core Here at Excel, we use Real Time Ultrasound (RTUS) to assess and help you improve the function of your core muscles. With RTUS you can compare what you think you are contracting with what you are actually contracting! This is the key to successful re--training, giving us accurate feedback about your progress. Retraining in this manner helps you quickly learn the correct contraction pattern. This may be used initially to introduce the concept of core stability. You will not need RTUS guidance at every visit but at regular intervals during your retraining to monitor your progress. RTUS is similar technology to hat used to see a baby in the womb. 4. Next we focus on improving the function in larger stability muscles around the hip, like gluteus medius 5. Finally we provide you with a long-term strategy to maintain these improvements this may include a Yoga, Pilates or Tai Chi class, all of which are available with our experienced instructors at Excel Physiotherapy and Wellness. Remember, we work as a multi-disciplinary team, with one aim in mind, helping you to push your health forwards. If you have any questions about this article or would like to make an appointment with one of our experienced practitioners at Excel Physiotherapy and Wellness just phone or info@excelphysio.com.au. The co-contraction of MF and TA during these exercises is key to achieving core stability. Selectively contracting some muscles while relaxing others can be difficult concept and Real Time Ultrasound can show you on screen the muscle that are actually contracting 8

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