Back pain continues to be a major failure for our medical system–costing over $100 Billion dollars per year on health care. I would highlight two reasons: 1) we have focused on structure as a sole cause; 2) we have sought expertise of the few, instead of common sense of the many. We continue our series on back pain with this second post: encouragement to properly order your recovery plan.
After a back injury, you might have been told to “strengthen your back”. What does that mean? Was your back strong enough the day before the injury? How strong do you need to be? We need to discuss the order of flexibility, stability, and power. Most in our culture argue injury can be met with improved strength & power. Additionally, yoga and pilates have led a wave of flexibility as a primary goal. I would strongly argue we must start with stability.
Prior to stability, flexibility and power aren’t just mistimed, they are dangerous. Flexibility is precarious if range of motion moves beyond what is stable. Power is reckless without control of motion. Strength which moves into a range uncontrolled could lead to tissue damage and injury. We must develop stability first, followed with appropriate range of motion (flexibility), and finally strength (power). You may have experienced a therapist or physician who recommended stretching or strengthening first. I hope we can agree it is unwise to perform activity of lengthening or power before it can be controlled well by the brain.
How do we gain stability in the low back?
In brief: create a cylinder of support. This cylinder involves both deep back muscles and core muscles. We need to form a “brace” around the spine, not pulling harshly, but lifting, firming, guiding the spine in all directions.
Stay tuned to our series of posts as we to discuss suffering with back pain and what you can do to help. Our next post will offer pragmatic examples of how to create a “cylinder of support” and what care should look like when you’re in pain. I hope you’re ready to seek strength with the ability to control all your motion.