I have been a chiropractor for almost 20 years. From day one I realized how I fit into a person’s health care team. I didn’t have all the answers and I wasn’t the end-all. Chiropractic adjustments were necessary to improve spinal function, reduce nerve irritation, and reduce muscle tightness at the spine.
I have referred my patients for massage, acupuncture and physical therapy to help get them out of pain. Early on in my career, if the Team couldn’t get a patient out of pain in their lower back we knew they would have the pain for their lifetime. Unfortunately, there were a lot of patients we couldn’t help.
Thank goodness for research. Studies have correlated lower back pain with atrophy of the multifidus. Even more than disc herniations and degeneration. The multifidus is a small muscle that attaches one spinal bone to another. It is one of the primary stabilizers of the spine and is the only muscle that crosses the sacroiliac joint. You can see atrophy on an MRI – the muscle shows up dark and fat(atrophied muscle) shows up as white. I started looking at the MRI’s I already had on patients and out of the 35 I looked at all had atrophy. Some were severe, which matched their pain complaints and my findings.
As we move the small ligaments of the spine get stretched. As they are stretched they begin to fire, which tells the multifidii to contract and stabilize. If the multifidii are weak and atrophied they are unable to contract appropriately. This leads to microtearing of the small ligaments that attach spinous process to spinous process and transverse process to transverse process. Over time this leads to a loss of stability. Think of running on a sprained ankle, same idea. The ligaments are overstretched and there is no muscular support. This microscopic damage also leads to chronic inflammation at the spine.
The multifidus is supposed to kick in with the first 5-15 degrees of forward bending. A person gets back pain with the bending of the muscles are not functioning. Many of my patients complain of back pain when they are brushing their teeth, chopping vegetables and doing the dishes. All of these occur within the first 15 degrees of bending. These are the patients that have to do multifidus retraining.
The multifidus and the transverse abdominus contract before any other muscles when we move.
Isolation exercises are no longer recommended for stability retraining. Functional full body motions which incorporate the multifidus, transverse abdominus, arms and legs are recommended. Bracing your abdominals, as if you were going to take a punch, while you exercise gives you the functional stability you need.
Strength is the ability of a muscle to generate a force. Power is the ability to rapidly generate a maximum force. Endurance is the ability to maintain a sustained submaximal contraction or repetitive cyclic contraction. It is endurance we are looking for with multifidus stability. It doesn’t matter if the muscle is strong for one contraction, it needs to have endurance. It needs to be able to have staying power to support the spine under continuous loads.
One of the best exercises I know to improve strength and endurance in the multifidus is the kettlebell swing. The swing is extremely stabilizing for the lower back. It was the first exercise I learned when I started kettlebell training and it was the one that got me out of my chronic lower back pain. The swing is initiated from the hips, the abdominals are braced and the back is kept flat so the back is protected at all times. As the kettlebell swings between the legs the glutes then contract, the knees pull up and your hips jut forward.
I have had many emails saying kettlebell workouts look too intense for people with lower back pain. If done correctly it is only stabilizing and strengthening. I have seen many videos that scare me. The technique is wrong. The motion comes from the lower back and not the hips. Doing this move over and over incorrectly can cause strain on the lower back leading to injury. I recommend all people who are interested in starting kettlbell training get several sessions of personal training with a RKC trainer. The RKC system is the only system that understands the importance of hip initiation, bracing and endurance.
Yours In Health!
Dr. Wendy
