Invasion of The Glass Trees…
(Or why my job is harder than ever)
My job is to help people solve the problem of their lower back pain.
The biggest part of this (in the initial stages at least) is to identify and remove the the mechanical causes of pain and damage…aggravators / pain triggers.
I class them into two categories:
Active aggravators are the easiest to identify and remove as they usually give instant pain feedback when encountered…think sneezing or the catch you get when standing up suddenly out of a bad chair.
Passive aggravtors are more insidious in their nature as they don’t usually give instant feedback, but instead will slowly deplete your back’s bank account and start to inhibit the muscles you need to protect the back – lateral stabilisers and glutes are two of the most common to be affected.
Now this could be sitting for long hours without lumbar support and letting your lower back slip into flexion (if you are flexion intolerant – those with disc bulges, herniations and sciatica will fit into this camp)
Again…fairly obvious once you understand the rules of the game for your back (which is made clear with McGill style provocation testing.)
Even when people do a great job of avoiding active aggravators and passive aggravtors…they can still have tight, fragile backs.
The Glass Tree…
I quite often get clients who claim they are managing aggravators and doing the exercises, but seem to be getting stuck with progress – either in the exercises or pain levels – sometimes both)
Let me paint two typical scenarios.
Scenario 1: A client does a grand job of managing aggravators and getting the exercises done each day. On the weekend they spend their time resting and doing as little as possible.
They will say something like “My back was great during the week, but after the weekend it felt grouchy again.”
I’ll ask what did you do on the weekend?
“Nothing” comes the reply.
Scenario 2: A client does a good job at avoiding movements and postures that they know aggravate the injury every day of the week,
They put their best effort into the exercises every day…but the bank account never seems to grow.
Here I’ll ask “What are your strategies to avoid your aggravators?”
The answer will be some variation of being so afraid to aggravate the back, they almost completely limit all movement all together.
For example, if flexion is an issue…they will opt to stand or sit absolutely rigid for hours on end to avoid flexion.
Stiff and Fragile…
In both instances the client is spending excessive amounts of time not moving at all.
Remember your body has two systems to maintain posture.
It can either utilise your muscles, which gives great stability and robustness at the cost of energy expenditure.
Or it can let your posture relax and hang most of you weight off of your connective tissue. Which give great energy efficiency at the expenditure of inhibiting muscles and leaving you stiff and fragile.
The solution to managing aggravators is better movement, NOT less movement.
One tell-tale sign this is happening is having small, feeble multifidus musculature.
Multifidus is a very important component when it comes to core stiffness, particularly segmental stiffness in the lumbar area.
Multifidus is very prone to atrophy (wasting away) in those with lower back issues due to the Glass Tree pattern of behaviour.
(But bear in mind…this is just one of components in a system that will be feeble in someone who does very little movement.)
In fact, this is one reason why (in most cases) I can get someone with a manual job a far quicker positive result with their back pain versus someone with an office/low movement based job.
The first thing to do is to develop and engrain movement habits that spare the back, but still promote you actually moving.
For example using some degree of hip-hinge (think Romanian Deadlift type movement) versus just trying to flex from the spine itself.
Our goal is distribute work evenly between the hips, lower back and core… NOT to try and take away all work by never moving again.
The second step is to build capacity for movement by…you guessed it…moving more.
The golden rule here is to avoid your movement aggravators while you gradually build capacity so that you safely add more activites in over time.
For some, CONSISTENTLY breaking up the working day with 2-3 x 15 minute walks WITH GOOD TECHNIQUE is going to make a massive difference.
Notice the “consistently” and “good technique” points there.
These movement habits will then go hand-in-hand with a tailored rehab program designed to strengthen the underlying weaknesses you are prone to.
As skill and bank balance grow, you’ll be able to add more movement skills to give you more options to help spare the back; and more exercises to help build work capacity further.
The Less I Move The Worse I Feel…
Whether you realise it or not, your back is only responding to how well your are using it.
Completely limiting movement is making the choice to encourage it to become stiff and brittle, much like a glass tree.
So move more and work on moving well.