Low back pain (LBP) will affect more than 80% of all Americans at some point in their lifetimes. This pain can be severe enough to require treatment and time off work, or it may only make life a little difficult for a week or two.
Most acute (short-term) cases actually resolve within two to four weeks, and only 2-3% will go on to become chronic (long-term) back pain, so your chances of avoiding long-term, disabling pain are good. Unfortunately, however, the chances of experiencing a recurrence (another episode of back pain) are pretty high. Research into acute LBP suggests that between 60-86% of people will suffer a recurrence in the first year after resolution of their original pain. Thirty-six percent will have two or more episodes within that year. So although a common-sense approach to your LBP (such as utilizing rest, heat, medication, etc.) may get you through your first episode of pain, it may not help prevent further injury.
The exact mechanism that makes humans vulnerable to re-injury of the lower back is becoming clearer with ongoing research. In a nutshell, the lumbar spine (the lowest 5 vertebrae) requires very specific muscular support for normal activity. This muscular support is commonly referred to as “core stability” and relates to the co-contraction of the lumbar multifidus (LM) and transverse abdominus (TA). The simultaneous firing of these specific back and abdominal muscles (as well as the pelvic floor) controls intra-abdominal pressure. In turn, this controlled increase in pressure helps to stiffen the lumbar spine and allows it to withstand more compression and force. Adverse changes to this core stability system caused by the initial episode of acute LBP are thought to increase the recurrence rate of the injury.
Ultrasound imaging of these lumbar stabilizers (the LM and TA) has consistently shown deterioration in function in people with LBP. This reduced functionality continues after all other symptoms associated with the initial episode of pain have eased. In other words, your back may feel normal, but the muscles that provide its stability are not working at 100%.
Specific exercise that retrains these muscles has been shown to significantly reduce the recurrence rate of LBP. In one study of first-episode LBP patients, re-training of the lumbar stabilizers with real-time ultrasound over a four-week period reduced re-injury rates considerably. Patients who underwent lumbar stabilization re-training had a recurrence rate of only 36%, and these reduced rates of recurrence were still present after three years. Conversely, those LBP patients who were only given advice on activity and medication rather than re-training therapy experienced recurrence rates of 84%.
Understanding what core stability really means and re-training the muscles that produce core stability provide a great chance of remaining pain-free after an initial bout of LBP. Idaho Physical Therapy can provide Rehabilitative Ultrasound Imaging to re-educate the right muscles in the right way and give you the best chance at preventing a recurrence of back pain in the future.
by Glen Bailey, PT