Back Exercises and The Back Training Program
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Back Pain, Nasla Breathing and Exercises This section explores the positive impact that breathing combined with back exercises has on low back pain. At the end of the article are a links to videos that will give you a tool to measure your baseline breathing quality, and provide techniques you can use to start treating your back today.
Low back pain is the most common complaint I hear from patients. The pain can range from severe, "I couldn't get out of bed if the house was on fire," to annoying, "The pain is just always there." Regardless of the severity of the pain, I begin all of my back pain evaluations and treatments with a look at the patient's breathing patterns. Changing those breathing patterns not only helps in eliminating my patient's back pain, the change also provides a back pain prevention framework the patient can use on their own. To be clear, back pain has a multi-factorial etiology, but breath-work and the diaphragm are absolutely the place to begin your journey to ending back pain. If you suffer from the following, these exercises can help:
Breathing and Back Pain The primary muscle we use to breathe is our diaphragm. Without a functioning diaphragm we will quickly suffocate. Without a functional diaphragm we develop low back pain. Why? Our diaphragm's secondary role is to provide stability to your spine. It provides this stability through direct attachments to the lumbar spine and with the creation of intra-abdominal pressure. However, many of us can and do persist with a dysfunctional diaphragm. What makes a diaphragm dysfunctional? Our breathing style, our posture and a history of low back pain conspire to degrade our core strength, ultimately leading to back pain.
Get rid of back pain with slow, deep, nasal breathing. Do you breath primarily through your nose or your mouth? How many breaths do you take in a minute? These are the two factors I take note of immediately when observing new patients. If you breath primarily through your mouth I know that your breathing is too shallow and too rapid. This relates directly to your back pain. If you are not taking slow deep nasal breaths, you will not develop the necessary intra-abdominal pressure required to stabilize your spine and stimulate the musculature that supports the low back. This is well supported in the scientific literature.
Get rid of back pain, fix your posture. Do you slump or round your shoulders? Do you excessively arch or round your low back? After noting a patient's breathing style, I assess my patients posture and how it may be hindering their breathing.
Get rid of back pain, fix your history? The single biggest predictor of low back pain is a history of low back pain. If you have had a case of significant low back pain, severity and/or duration, there is a high likelihood that your body has stopped using your diaphragm to effectively stabilize your low back. This is a common pattern with musculoskeletal injuries. Our body "turns off" muscles that could increase our pain/injury while we are in the acute phase of the injury. When we have low back pain, our body will limit the diaphragm's role in spinal stabilization. If you don't "reactivate" the diaphragm during the recovery phase of the injury, you many not recover the full stabilizing role of the muscle and set yourself up for future back pain.
--Back Training Program--
Picture this. You have to stop your 3-4 day a week trail running routine because after 2 miles your low back hurts and you have pain shooting down into your right buttocks. 2 weeks later the pain has started to subside, so you decide to "test the waters" and go for a short jog. You can guess the outcome; the pain comes back. You invested 2 weeks in trying to get pain free, and you got the appropriate physiologic return on that investment.
If you focus on solving the underlying problem, a movement dysfunction, and decide to extend that rehab plan out to 10+ weeks you will have a much better chance of returning to your sport, family time, fitness class with a functional and strong back. Why does this 10+-week timeframe work? It’s hardwired to our physiology. Think about your approach to running a half marathon, or a century ride, etc. To train for these physical endeavors takes time and your body needs that time to adapt to the physical stress of training to get stronger and have more endurance. When injured, your body needs the same amount time to accrue the same physiologic adaptations that occur when training for a race.
When working with patients with back pain I break up the process into stages that roughly correspond to and enhance our body's healing process.
Stabilization Through Down-Regulation, takes place during weeks 1-2. Your immune system is inflaming the injury site and you core stabilizing musculature is offline. Towards end of this phase your inflammation is starting to subside, and impaired muscles are just beginning to come back online, although not to full strength. The focus in this stage is the down-regulation of your pain response. At the end of this stage, patients feel less pain and often assume that they are better and can start their physical activities in earnest. The main problem at this point is that your core muscles can remain impaired indefinitely until you reeducate them.
Core Re-Education, takes place during weeks 3-5. There is a dramatic decrease in pain, but your core stabilizing muscles are not fully functional. We know that even after your back pain has subsided, your core musculature's ability to stabilize your spine remains diminished. This phase involves muscular reeducation and entails isolating and releasing core invested muscles that are short and overactive, and activating core invested muscles that are elongated and underactive. Again, the timeframe for this phase is tied to our physiology as your neuromuscular system needs this time to become more efficient at performing progressive exercises designed to stabilize your spine.
Core Integration, takes place in weeks 6-8. At this point, pain is a distant memory, and the patient has become efficient at voluntarily and involuntarily engaging their core musculature to stabilize the spine during dynamic movements. During this phase, the patient must learn how to integrate their core with the rest of their body. I utilize the patient's upper and lower extremity to introduce progressive loads and force, compelling core stabilization. With this approach I are not only increasing arm and leg strength, but teaching the body how to efficiently transfer force from the legs through the core and into the arms, and vice versa, without hurting your back.
Return to Sport, takes place during weeks 9-10. At this point the patient has laid the foundation for a functional and healthy back. The therapeutic exercises are starting to resemble more fitness-based exercises. For this two-week phase the patient begins to increase the intensity and frequency of their exercises inducing further strength and endurance gains for their core stabilizing musculature. This is the appropriate time to start "testing the waters," to see if you can accommodate your sport or fitness routine. At the end of this stage I discharge my patients to their own self-guided training program or I put them in contact with one of the many competent fitness experts I work with in the Front Range.
If it is not apparent, this plan and timeframe is generalized. Some patients do require a long longer recovery, and that recovery timeframe is dependent on many variables. The takeaway from this article is that to truly rehabilitate a dysfunctional back, the timeframe is rarely less than 10 weeks and this is tied to our body's healing process.
Breathing/Back Pain Exersise Progression
CO2 Tolerance Test
#1 Nasal Breathing and Severe Back Pain
#2 Nasal Breathing and Cat/Camel
#3 Child's Pose
#5 Bridge Stretch
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