By Glenn Cranham – 5S Sports Rehabilitator.
Low back pain can be defined as pain, muscle tension, or stiffness localised below the ribs and above the lower gluteal folds, with or without leg pain (Sciatica) (Van der Heijden, 1991).
Back pain is a very common condition, with up to 33% of the UK adult population suffering at some time. In addition, approximately half the UK adult population (49%) report low back pain for at least 24 hours, at some point in the course of a year and an estimated 4 out of 5 adults will suffer back pain at some point in their life.
‘Non-specific lower back pain’ (NSLBP) is the most common form of back pain – about 19 in every 20 cases of sudden onset low back pain can be placed in this category. In many cases, the cause may be a simple sprain of a ligament or a strain of a muscle, or alternatively there may be a minor irritation of an intervertebral disc or facet joint.
However, in these cases, it is almost impossible to accurately distinguish the main source of pain. The pain itself is mechanical in nature and therefore, generally changes with posture and activity. The pain is often quite localised, but in some cases can extend to the buttocks or thighs and can vary from mild to very uncomfortable.
Functional Movement, Recruitment and Alignment
From a functional perspective, it is highly evident that there is faulty recruitment of muscles affecting the lower back, in individuals with low back pain. Evidence has highlighted a
decrease in activation of many muscles such as the Gluteus Maximus, Medius and Minimus (muscles of the bottom); as well as an increase in activation of other muscles including the external oblique, rectus abdominals and hamstrings.
As we sit down more and more we develop compensatory movement patterns which lead to altered muscle recruitment patterns and control of the spine and pelvis. This altered and delayed activation pattern in the gluteals, and overactive hamstrings has been described as ‘gluteal amnesia’.
The term gluteal ‘amnesia’ was described by Stuart McGill in 2002 during observations of groups of men with chronic low back pain. It was observed during squatting type movements that those exhibiting this pattern appear to accomplish the basic motion of hip extension by emphasising the back extensors and the hamstrings. Fundamentally, these individuals had forgotten how to recruit and use their gluteals which resulted in an exaggerated loading of the low back muscles; this high level of erector spinae activation (muscles in the low back) effectively ‘crushed’ the lumbar spine.
It should be noted that any amount of squatting will not resolve this situation; rather it will reinforce this established motor pattern (bad habit). What should be focused on instead, is a strategy to address the mobility and muscle imbalances, so that the gluteals regain optimal function and work to spare the back.
If you suffer from any issues relating to the lower back/pelvis, please contact the 5S clinic for more information. We can create a bespoke programme to optimise your hip and back function, and rid your back of pain for good.