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Best Exercise for Chronic Low Back Pain

The ‘main’ spine muscle, the multifidus M. can have a low cross-sectional area (thinness) in people with back pain or following spinal surgery. Turning to muscle stabilisation (core) exercises have no effect (1) in restoring thickness. Static holding of arms in front of the body have been found to be a restorative exercise (1). Reminiscent of an old Qi Gong exercise, handed down for at least 500 years.

 

 

Instability of the spine occurs when there is a loss of muscular control changing the spine’s ‘neutral zone’ (2). Ankle pressure increases can occur as the brain ignores a thin multifidus muscle to reference postural control, (3) leading to a lack of muscle control of the spine (4). Using ankle muscles rather than spinal muscles for postural centring means you are not using your spinal muscles.

‘If you don’t use it you lose it and if your brain can’t see it you can’t free it.’

 

Identifying Heel Tension and multifidus muscle activity are just part of Lee’s chiropractic physical examination.

Research into back extension exercises to investigate modified positions and improved muscle activity has resulted in advocacy for the prone arch position (5) (laying on your front and arching upwards) exercise. However, if you have back pain this position could well aggravate any inflammation of the spinal joints.

Lee knows that when we are in pain the way the brain can coordinate and re-learn muscle use changes further, which could be why there is no best exercise for back pain (6).

References:

  1. Danneels LA et al (2001) Effects of Three Different Training Modalities on The Cross-Sectional Area of The Lumbar Multifidus. BJSM 35 (3) 186
  2. Punjabi M (1992) The Stabilising System of The Spine. Part 1 Function, Dysfunction, Adaptation and Enhancement. J Spinal Disord 5 383-9
  3. Brumagne S et al (2008) Persons with Recurrent Low Back Pain Exhibit a Rigid Postural Control Strategy Eu Spine J 17 1177-1184
  4. Russo M et al (2018) Muscle Control and Non-Specific Chronic Low Back Pain. Neuromodulation. 21 (1) 1-9
  5. Ng J and Richardson C (1994) EMG Study of Erector Spinae and Multifidus in Two Isometric Back Extension Exercises. Australian Physiotherapy 40 (2) 115-121
  6. Owen P et al (2019) Which Specific Modes of Exercise are Most Effective for Treating Low Back Pain? Network Meta-Analysis BJSM 54 (21) 1279-1287
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