(Part 3 of a 4 Part Series)
Today’s blog is about Low Back Pain and Exercise. My wife will ask me sometimes to treat her back after I get home from work. Like many of my patients I see during the day, she wants to see quick results. “Doc, can you just fix me, PLEASE!” Short term pain relief is possible. But, long term pain relief requires strong muscles. To get Strong Muscles takes more effort on the part of the patient, and more effort on the part of the therapist in order to ensure the proper exercises are being prescribed.
Chronic Low Back Pain
Chronic low back pain by definition is low back pain that does not resolve easily on its own (chronic = lasts for more than a few weeks). The same websites that give out “Great Home Exercises for Low Back Pain”, might on the same site also state that “Low Back Pain Has High Recurrence.” (http://europepmc.org/abstract/med/6223365) Insurance companies are happy if care is stopped as soon as possible. This helps keep costs down. However, it does not keep the pain from coming back. I have always believed that low back pain is usually under-treated. Otherwise, it would stay fixed.
Three Reasons Low Back Pain Returns After Physical Therapy
Back Muscle Strength Not Measured Fully
Exercises were not specific enough to the problem
Rehab was cut short or stopped before strength returned to normal
Full Muscle Testing for the Low Back - Manual Muscle Testing
At Muscle IQ we test muscles in two different ways; Manually and Mechanically. Every patient with low back pain receives a thorough evaluation of the muscle of the back. Manual muscle testing is a simple and quick way for us to see whether there are muscles that are not responsive and quick to contract. Many times we will identify muscles that are being inhibited, or where the muscle tone is being turned down, possibly as a protective mechanism from the injured area in the low back. When we have identified muscles that are inhibited we can work on treatments that are specifically helpful in turning these muscles back on. Muscles that have been turned off for a while are always deconditioned and weak. This is why we also perform mechanical muscle testing with our computerized David Medical Exercise Machines.
Full Muscle Testing for the Low Back - Computerized David Strength Testing
The second way we test for Low Back Pain muscle weakness is through computerized isometric mechanical muscle testing using the David Medical Exercise Machines. The results show the amount of force generated by your back muscles in six different directions. Because the testing is computerized, we also get to see how your scores compare to the average results of other people of the same age, size and gender. (Click Here for More Info about the David Machine Testing)
The Best Exercises for Low Back Pain! Show Me The Numbers!
How can you tell whether an exercise is good for your low back pain? What is the purpose of exercise? An exercise is good for low back pain if it does not cause more pain and if it leads to increased motion and strength in the areas that were measured to be limited. If you have low back pain, you should be given exercises that are specific to the weakness that were found during examination. The right exercises will not be painful. This is very important. Pain during exercise can trigger muscles to be turned off. The muscle tone can be inhibited by pain. Also, the exercises, when repeated, will lead to increased strength. At Muscle IQ we can show you your progress because we measure your back muscle strength and we can show you the numbers. No other physical therapy clinic in Utah County measures muscles like we do.
Should I Stop Rehab When the Pain Stops?
We discussed in an earlier blog that MRI results are not a good predictor of future episodes of low back pain. We believe a good predictor of future low back pain is Muscle Strength. So, it follows that you should focus your rehab efforts on returning to normal strength. Strong muscles protect against re-injury and re-occurrence of low back pain. Once you reach normal strength you can maintain that level of strength with a Home Exercise Program. You put yourself at a disadvantage if you cut your rehab short, before seeing a return to healthy strength levels for an injured low back.
Low Back Pain - Muscle Strength Summary
A return of low back pain is all too common when someone has been through physical therapy.. Our goal at Muscle IQ is to reverse this trend. When back muscle strength is not measured fully you will not know where your true weakness are that are contributing to your pain and loss of function. Every low back pain Rehab Program should include exercises that are not painful to perform and are specifically prescribed to the weaknesses found in the examination of the low back. A full recovery must include a restoration of normal muscle strength with test results as proof. Rehab programs that are cut short before reaching normal muscle strength increases the likelihood of recurrence of low back pain episodes in the future. Stick to it. Don’t give up. With the right care, and a lot of effort on your part, you can achieve a pain-free low back.