A patient came in this past week with low back pain and was told by another physiotherapist that she had a weak core, tight hamstrings and weak glutes and that was why her back hurts.
Now, I do not agree with that. Actually studies show that back extensor strength is more important than flexor (abdominal) strength when it comes to low back pain (Lee et al, 1999).
Like I wrote previously, the idea for the need of a strong core was first introduced by Paul Hodges (Hodges and Richardson, 1998) when he published his article on the Transverse Abdominis (TA) muscle. His research compared the timing of TA and Multifidus in people with low back pain (LBP) for 18 months or more against healthy subjects with no LBP.
Hodges suggested that the TA was likely to be the main cause of LBP as it is the most important and deepest muscle in the abdomen. It looks and works like a corset to stabilise the back.
This article made the allied healthcare/ fitness industry conclude that the TA was a trunk stabilising muscle that was very important to strengthen for those with LBP. Patients who had LBP had weaknesses in their TA which led to instability in the spine.
Similarly with 'tight' hamstrings (Halbertsma et al 2001) and weak glutes. This female patient of mine can deadlift 90 kg. Her glutes are not weak nor are her hamstrings tight.
You can put all those myths to rest. Your low back pain is not caused by a weak core, tight hamstrings nor weak glutes. Stengthening your back extensors will be a much better option than the previously mentioned.
References
Halbertsma JP, Goeken LN, Hof AL et al (2001). Extensibility And Stiffness Of The Hamstrings in Patients With Nonspecific Low Back Pain. Arch Phys Med Reh. 82(2): 232-238. DOI: 10.1053/apmr.2001.19876
Hodges PA and Richardson CA (1998). Delayed Postural Contraction Of Transversus Abdominis In Low Back Pain Associated With Movement Of The Lower Limb. J Sp Disorders. 11(1): 46-56.
Lee JH, Hoshino Y, Nakamura K et al (1999). Trunk Muscle Weakness As A Risk Factor For Low Back Pain. A 5-year Prospective Study. Spine (Phila Pa 1976). 24(1): 54-57. DOI 10.1097/00007632-199901010-00013
No comments:
Post a Comment