I have a back problem… so why are we working on my abs?
Nearly every one of my patients that comes to see me for back pain, regardless of the source of the pain (bulging disc, strained it while lifting, poor posture etc.), will get a pelvic tilt as their first exercise. Why? Because I’m sure you and I, and the rest of the average people out there have weak abdominal muscles. But what does that have to do with my back you ask? Let me explain. Think of your abdominal muscles like a girdle and your back muscles like the laces of that girdle. Ladies know what I’m talking about, guys think of your football pads. If the laces are tied in knots but the pads don’t fit it’s not doing you any good when the lineman hits you, right? It’s the same thing with your back. If your abdominals, or your “core”, isn’t strong, those poor back muscles have to work overtime which leads to all kinds of problems and ultimately, pain. So we give you a pelvic tilt where you are asked to tighten up your stomach muscles. If only life were that simple though. You have to be sure that you are using the muscles appropriately and not including any other muscles, say for example you gluts (your bum) otherwise, you will continue to promote the problem; hence the need for physical therapy. We are trained and educated to tell you if you are using the muscles correctly or incorrectly. I can’t begin to tell you how important it is to have a strong core and strong glut muscles. This is not to say that you need Arnold Schwarzenegger six pack abs. You just need to have a good balance of strength between your back and your stomach muscles. So if you have been compensating with your back, it’s time to give those muscles a rest and let your abdominals take over for a little while.
The next question we get is, “Do I have to do this forever?” Well, honestly, yes. You can’t eat healthy for 4-6 weeks and expect that to last you the rest of your life, so you can’t expect to come to therapy to work on your core muscles and expect your back pain to be gone forever. Ideally we are retraining you and your body to work the way it’s supposed to so that it becomes automatic for you. You should be able to naturally lift a heavy object with your legs and gluts and not your back. You should naturally be able to activate your abdominal muscles when carrying a heavy object or lifting it overhead instead of relying on your back. So I wouldn’t think about it as something you have to do forever, but rather it’s retraining you to work more efficiently and more effectively. Like putting your left shoe on before your right shoe every morning because that doesn’t cause you pain.
My job is educating and retraining your body to work how it’s supposed to in order to avoid pain. It doesn’t matter if your pain is limiting you from getting up out of bed every morning or if it’s limiting you from your recreational activities (golfing, walking, standing, bowling etc.) I may not know the proper way to hold a golf club, but I know the basic motions your back needs to go through and how to avoid that little bit of extension after the swing which shoots that pain up or down your body. We look at the motion that’s causing you pain and modify it in ways you maybe haven’t thought of before. That’s the beauty of understanding how the body works. Unfortunately, we don’t have magic wands to suddenly make everything feel better. If we did I can assure you I would be on a yacht somewhere in the Pacific sipping a cold beverage. It’s going to take some effort and a change in habit, but I can assure you that if you work on those abdominal muscles and those glut muscles, your back will be much happier with you in the long run.
Kacey Kline, PTA