Education for low back pain
'You have given me a new back for the New Year.' A low back patient said. 'No, no.' I said. 'I have only reminded you not to lose yours. It is up to you yourself to make and keep the best shape of your back!' Patients always look for passive treatments. The best is that we could 'give' them a new back so they do not have to worry about understanding their injuries! Education therefore plays a major role in the treatment of low back injury. A young and fit personal trainer has been suffering from an intermittent nagging low back ache for 2 years despite intensively strengthening her back and core muscles that are supposedly very important to support the low back. Her low back was so painful after running a week ago. She is very worried that she won't be able to run in the Chartered Marathon anymore! This is such a typical case I see everyday. She has the best physique one wishes except very much reduced lower lumbar lordosis (low back S-curve) and restriction of L5/S1 extension (backward bending of the low back) to almost nil. Her very strong back muscles are unable to correct her lower lumbar alignment. Her amazing abdominal muscles may help stabilizing her back but do not help the extension (backward bending) mobility so badly needed for running and even walking and standing. Many patients may even hurt their back swimming as they do not have the lumbar extension (backward bending) mobility required for the sports. Trauma occurs when repetitive extension is forced on the stiff intervertebral segment. This could also explain why back extension is so unpopular. Avoidance however only disables the back further. The simple solution for our fit personal trainer is to perform backward bending to restore her lower lumbar lordosis and extension by simple lumbar hollowing or pelvic tilting as illustrated in the diagrams as much as possible. Strength does not really matters!