Chronic Back Pain

Why do some people experience repeated bouts of back pain?  This is a very large question with many variables to consider.  An interesting paper published in the journal Pain shed some light on this topic, investigating the role of the lumbar multifidus muscle and the effect back pain has on it.

Without question the muscles of the lumbar spine play a huge role in stabilization of the spine.  The coordination and activity of these muscles is very important in the maintenance of normal spinal biomechanics and therefore the prevention of pain and injury.  There is plenty of research to substantiate the idea that the lumbar stabilizing muscles are dysfunctional in patients with low back pain.  This finding was perhaps the basis for a general emphasis on lumbar strengthening and core training in both rehabilitation and the strength and conditioning world.

According to prior research on muscular activity in the lumbar spine, there should be a feed-forward response in how certain muscles work.  That is, in healthy subjects, certain muscles of the lumbar spine have been shown to activate slightly before rapid upper limb movement.  The multifidus is one of these muscles.  Yet in those with lower back pain, this feed-forward mechanism of the multifidus is dysfunctional.  The multifidus does not activate prior to upper limb movement, but rather after it!

The interesting finding of the aforementioned research published in Pain was that this impaired function of the lumbar multifidus muscle does not recover after the resolution of back pain.  Therefore, if you’ve had a significant bout of back pain in the past, there’s the likelihood that you may be at an increased risk for the development of future episodes as this muscle is likely still dysfunctional.

Many people come to our clinic with lower back pain and are very happy with the results of treatment.  Unfortunately for some people, they don’t continue with home strengthening exercises after their pain resolves.  Given the aforementioned research, this likely allows the multifidus muscle to stay dysfunctional and puts these patients at risk for future episodes.

Does this sound like you?  Have you experienced repeated bouts of lower back pain?  Give us a call.  We can assist you in resolving your pain and teaching you how to properly strengthen the muscles of your lumbar spine and core area so that the possibility of future episodes is minimized.

References:

MacDonald D, Moseley GL, Hodges PW.  Why do some patients keep hurting their back?  Evidence of ongoing back musle dysfiunction during remission from recurrent back pain.  Pain 2009; 142(3): 183-188.