Dr Andrew Crellin – West Warwick, RI
Back pain is everywhere. You can’t talk to a friend, a family member or a stranger who hasn’t had some experience with back pain. Pain comes in all different varieties and expressions. With every complaint comes a story. And why not, the physical and emotional scars can be long lasting.
It wasn’t so long ago your doctor would prescribe heat treatments and a week of bed rest for your troubles. Sometimes this would actually work, as the “condition” ran its course. More times than not, it didn’t. Back pain continues to be enigmatic for many, especially chronic back pain. There was a time when many who “treated” low back pain (LBP) or insured those who had LBP, thought that 90% of patients seen in general practice would be (or should be) pain free in 3 months. Recent studies prove this to be a false notion. One year after initially seeking care, 82% of patients reported having back pain in the prior month. Hey if this was straight forward there would be one answer, one profession. You don’t see a lot of competition for dentists do you?
Many times as practitioners we focus on the acute pain and dysfunction the patient presents with. We try to reduce the swelling, restore range of motion and eliminate the pain. Laser like focus on this is appropriate and important. We call this acute care. But once this is under control, the search begins for the under lying reasons the problem presented itself in the first place. In addition, one must anticipate problems that may develop in the future.
One of the most commonly overlooked problems that can lead to chronicity of LBP is the concept of muscle imbalance. This refers to the tendency of some muscles to become shortened and tight and others (usually on the opposite side) to become weak and inhibited. These patterns are predictable and are well documented. It is the strong anti gravity postural muscles that tighten and by virtue of some complicated neurology (Sherrington’s law of reciprocal inhibition), the opposite muscles on the other side of the joint become weak. Simply strengthening the weak muscles will not work in restoring function. The neurologic input to these weak muscles is partially shut down by the tight muscles on the other side of the joint. Therefore before undergoing a strengthening program one must address the tight muscles that are inhibiting the weak ones.
OK before we go on, go back and re read that last paragraph.
Common causes of muscle imbalances include overuse patterns, trauma, inadequate postures and sedentary lifestyle. These changes can affect central nervous system motor programming, which perpetuates the muscle imbalance through aberrant movement patterns.
And there you have it, a self sustaining chronic condition.
So the first thing we need to do is recognize which muscles are in play. How many times have you heard that you have to have a strong “core” to eliminate your back pain. No doubt. It will surely help. But studies show that if you try to strengthen your abdominals with sit ups, you tighten your erector spinae muscles . Tight erector spinae muscles in the low back shut down the abdominal muscles on the other side. Making it virtually impossible to strengthen your abs with tight low back muscles. Therefore if you have a tight, painful low back you need to deal with that before you start strengthening your abs. These muscle relationships (agonist/antagonist) are seen throughout the body. In the upper back it is often observed that the muscles in the chest are tight. Everything we do is in front us. Computer, driving, cooking working at a bench. These all lead to our shoulders rounding forward and shortening. The pecs, deltoid and anterior neck muscles all tighten. Consequently the traps and the rotator cuff muscles on the opposite side elongate and weaken. If you have neck and upper back pain you must first stretch the front of your chest then strengthen the posterior aspect.
One more example is the knee. Hamstrings tighten. Quads and gluts weaken. Therefore stretch hams, then strengthen gluts and quads. These patterns are known and should be addressed in any long term (and short term for that matter) rehabilitation program. I recommend you talk to your chiropractor, physical therapist or personal trainer about these issues if you are having trouble recovering from an injury.
Dr. Andrew Crellin is a chiropractic physician and physical therapist with more 30 years of experience treating sports injuries. His office is located at 328 Cowesett Ave. West Warwick, R.I. and can reached at 821-6091