Saturday, February 7, 2009

Simple Back Exercises - Introduction

By Jonathan Blood Smyth

Back pain is extremely common and costly both in terms of financial requirements and personally in terms of pain, suffering, loss of functional abilities and loss of the ability to work. While there are very large numbers of treatments for back pain available, few of them work well or work for any length of time and much of the management of our low back pain is up to ourselves. One of the important aspects of self maintenance is to keep up an exercise programme of some kind, including aerobic or gym exercises, core stability work and range of motion for the lumbar spine.

To function normally in our daily activities we need our joints to perform through their normal full ranges, a requirement which does not make itself obvious until we have a problem. This is clearly illustrated by taking the shoulder as an example. The shoulder is an extremely mobile joint which allows us to put our hands in useful positions whilst our eyes are able to watch, requiring large movements of the arm behind the neck, behind the back and above the head. Illnesses and injuries can alter the joint by damaging the surfaces, causing laxity of a ligament or contracture of a joint from the healing process. Contracture involves the tightening up of ligamentous structures around a joint, limiting available movement.

To function normally in our daily activities we need our joints to perform through their normal full ranges, a requirement which does not make itself obvious until we have a problem. This is clearly illustrated by taking the shoulder as an example. The shoulder is an extremely mobile joint which allows us to put our hands in useful positions whilst our eyes are able to watch, requiring large movements of the arm behind the neck, behind the back and above the head. Illnesses and injuries can alter the joint by damaging the surfaces, causing laxity of a ligament or contracture of a joint from the healing process. Contracture involves the tightening up of ligamentous structures around a joint, limiting available movement.



After a back injury or episode of low back pain we often hold our backs stiff to prevent excessive forces being transmitted through the joints. This is acceptable in the initial period because it reduces our pain and allows the irritated joints to settle down so we can start moving more normally again. However if we keep this up after the acutely painful period we can heal up or stiffen in the guarded position, leading to a hidden loss of movement. This may not give us any functional difficulties as the other joints in the back allow us to move as we want to but it exposes us to abnormal movement patterns and re-injury risk.

Stiff joints cause alteration in muscle activation and joint movements, changing the way the complex interplay between muscle patterning and stability work in the spine. The coordinated weight bearing and movement functions of the spinal system are altered by the dysfunctional patterns of joint activity, leading to difficulties with pain and loss of function over time. If the joint stiffness remains there is a risk that the next time a movement is attempted the joint will be stretched to or beyond its stiff limit and could be re-injured. This is a good reason to try and loosen up these restrictions.

To have a fit back we need to take account of several aspects of what fitness means, including lack of pain, good range of movement, strength, endurance, stability and functional skill. Pain can be addressed by treatment from a physiotherapist or other therapy professional, stability can be learned from the same practitioners or a Pilates instructor and strength and endurance developed by a gym programme. Once instructed, range of movement exercises can be regularly performed by us at home to maintain joint movement and counter any restrictions. - 16004

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