Are fitness exercises useful for back and lower back pain?

Unfortunately, pain and discomfort in the lumbar spine are an integral part of our lives. Trying to get rid of the problem, people use different methods of treatment and recovery. One of the main methods of restorative treatment is physical exercises.

As a rule, the main recommendations are to strengthen the muscular corset of the spine, or core muscles. Quite often, patients are told: "You have weak back muscles, they need to be strengthened so that they are strong and fix the spine." However, in practice, patients with chronic back pain and tense muscles often come to doctors. Then the question arises: is it appropriate to use such exercises?

An article from THE AUSTRALIAN magazine will help to understand this issue. The authors of the material are two world-renowned physiotherapists, Professor Peter O'Sullivan from CurtinUniversity and Professor Paul Hodges from The University of Queensland. Based on their observations and research, they concluded that core strength exercises for chronic back pain are harmful. As Professor Peter O'Sullivan says: "The health of the spine depends more on its flexibility and mobility. Obviously, long-term use of core strength exercises for chronic pain only worsens the state of health. Back pain patients already have muscle tension as a protective response to pain. Exercises that strengthen the back muscles only make the situation worse. There is no point in toning already tense muscles. In this case, relaxing the muscles of the trunk will bring more benefit."

"For example, to perform the "plank" exercise (the most popular for the core muscles), it is necessary to take and maintain a horizontal motionless position of the body, which is a simultaneous stand on the elbows and toes. But that's not quite right, because stabilizing the spine requires a balance between flexibility and muscle tone," says Professor Paul Hodges.

For any movements of the human body, only one muscle will never work. A certain muscle group or movement chain (pattern) is always active. The muscles of the motor chain are divided according to their functions: agonists (perform the main movement during contraction), synergists (they can be classified as assistants of agonists), antagonists (opposite to agonists, relax during their contraction), neutralizers (ensure unidirectional movement of the agonist) and m tongues-fixators (fix one of the places of the agonist, ensuring the absence of additional movements in the adjacent parts of the body).

As an example, consider the movement pattern "extension of the torso" (Fig. 1).

• Agonist muscles: back extensors (1,2), quadratus lumborum.
• Synergist muscles (not shown in the picture): semispinous, interspinous, multispinous.
• Neutralizing muscles. Agonists, such as: long muscle of the back, iliac-costal, spinous - are antagonists to each other in relation to lateral bending and rotation of the spine, with simultaneous contraction they neutralize each other.
• Fixing muscles: thigh extensors (gluteus major) (4), semitendinosus, semimembranous and biceps femoris (5), psoas major (8), iliac ( 9) muscles fix the lower place of attachment of the agonist, limiting the involvement of the pelvis in movement.
• Antagonist muscles: rectus abdominis muscle (6), oblique abdominal muscles (3).

Normal movement is performed as a result of complex, consistent, coordinated work of all muscles of the movement pattern. Any change in work can lead to a violation of the pattern, in the movement of which some muscles will be overstressed, while others are relaxed.

A vivid example of such a disorder can be the lower cruciate syndrome (Fig. 2). It occurs when there is an imbalance of muscle tone between the flexors and extensors of the trunk. As you can see in the picture, the abdominal muscles and hip extensors are weakened, and the hip flexors and extensors of the lumbothoracic spine are tense. Visually, such a person has postural disturbances, an increase in the lumbar curve of the spine, and forward protrusion of the abdomen. In this case, performing the "bar" can worsen the condition and provoke new pain. According to medical observations, patients often come for an appointment right after the gym.

Most sets of exercises used in fitness are still suitable for healthy people. People with chronic pain require additional testing and an individual approach to choosing a set of physical exercises. These exercises should be selected taking into account the age of the spine disease, accompanying complications, the strength of pain sensations and the peculiarities of the biomechanics of the skeletal muscles. This approach will help to obtain a long-lasting therapeutic effect.

To make an appointment with a doctor, contact the contact center of the MS "Dobrobut"