84% of the population develops lower back pain at some point in their lives. 11-12% of people who experience this pain are disabled by it. Don't be one of them.
“If I just stretch, I don’t have any low back pain until the next morning.” “Of course my low back hurts, I’m getting older.” “I have low back pain because I played football in high school.” “3 years ago I hear a ‘pop’ while walking, and that is why I have low back pain.”
I have heard all of these statements. Lower back pain is the most common ailment that I treat. Everyone over the age of 23 seems to have it. Some teenagers I work with have it. It’s annoying. Nobody wants low back pain. Yet, it is unbelievably prevalent. Why is it prevalent? Here is a list of some of my ideas why:
The list goes on. I’m going to stop there before someone confiscates my degree.
If you believe you have been burdened with any one of these complications, you are not alone. 84% of the population develops lower back pain at some point in their lives. 11-12% of people who experience this pain are distabled by it.
I want to shed some light on some more of the pieces of the back pain puzzle. Last week I discussed the anterior oblique sling and posterior oblique sling. These two body slings promote efficient force transfer. They allow rotation. If you’re not training rotation, this could lead to back pain.
Rotation isn’t the only solution. Having a complete approach to spinal stability is the key to eliminating lower back pain for good. Today, we will also discuss two more body slings: the Deep Longitudinal Sling (DLS) and the Lateral Sling (LS).
Your spine is important. The muscles that attach to it are important. The neurons that sense things and cause motion are important. That is why spinal stability has three components: structural anatomy, neural mediation, and muscular force transfer. Each of these components has a specific job. They also are interconnected.
The spine is composed of discs. It is attached to the pelvis at the sacrum. This joint is called the sacroiliac, or SI, joint. If you have gone to a physical therapist for lower back pain, they may have mentioned this joint.
The pelvis anatomy is designed to improve spinal stability. This is called ‘sacroiliac joint form closure.’ Quite literally, the sacroiliac joint aids as a closing form between the pelvis and the sacrum. What results is passive stabilization of our spine. The whole region is called our ‘lumbo-pelvic hip complex,’ or LPHC.
The LPHC gives us our first 90N of stabilization capability. However, our spine is able to withstand 1500N of force. So, there must be other components that further lead to spinal stability.
Our neurological system plays a role in spinal stability. I’m sure that wasn’t hard to foretell. Imagine the brain and the spinal cord (the central nervous system) as the body’s version of air traffic control. Air traffic control anticipates the path of flights. It controls where they take off. It controls where they land. If air traffic control cannot properly respond to the path of a flight or the timing of a takeoff/landing, you can imagine the hysteria.
Your body works in the same way. The central nervous system (air traffic control) anticipates movements. It responds to movements that occur. It prepares for movements that are about to occur. The central nervous system adapts to changing conditions. These actions allow for the proper contraction and relaxation of the muscles within the interconnected systems. This leads to further improving spinal stability. Imagine the central nervous system mismanaging the preparation of movement. Just like when air traffic control is asleep at the wheel, hysteria ensues. (hysteria = pain and dysfunction)
The central nervous system has strategies for improving stability. It uses different strategies based on the predictability of movement and risk to bodily structures. In static positions, it uses deep muscles to stabilize the SI joint and surrounding structures. It changes it’s strategy during dynamic movements. Here, the central nervous system will take a global approach. It recruits the interconnected body slings. These slings respond efficiently and effectively to changes in movement and body positions.
Remember, all of the body slings cross the LPHC.
Our muscles are the final piece of the stability puzzle. It is our spines active stability mechanism. The deep muscles help with static positions. Then, they are paired with the surface-level musculature to generate dynamic movement. These interconnected systems are what the central nervous system uses to act upon the movement and possible movement it detects.
All of these interconnected systems lead to further stability of that SI joint. ‘Form closure’ is the stability from the passive, bony structures. ‘Force closure’ of the SI joint is the stability provided by the ligaments, muscles, and fascia that cross it.
When we walk, the AOS and POS have different roles. They are active for certain movements, and prepared for other movements. Going back to our airport example, imagine the planes on the tarmac. Air traffic control is guiding the planes that are actively taking off and landing (the sling that is doing the movement). At the same time, it is informing the planes that are refueling and being taxied out where to go when it is their turn to take flight (the sling that is prepared for movement). When pilots don’t listen to air traffic control, more hysteria ensues. When the muscles of the slings don’t listen to the central nervous system, dysfunction and pain are the result.
Like I said, there are two more slings. The DLS is made up of the erector spinae, multifidus, thoracolumbar fascia, sacrotuberous ligament, and the biceps femoris. The DLS is a key contributor in SI joint stability. When it contracts, it puts the SI joint in an optimal position. It does this by posteriorly tilting the pelvis (rotating the pelvis backward). The sacrum rotates forward as a result. The easiest way to imagine this is a nut and a bolt rotating in opposite directions. As a result, the nut and bolt secure tighter to one another. This action of counter-rotating of the pelvis and sacrum is called nutation.
If the pelvis were to rotate forward (anterior pelvic tilt) and the sacrum were to rotate backwards, bad things happen. Our nut and bolt loosen. Do you want a loose pelvis? (The answer is no). Improper joint mechanics at the SI joint can cause degeneration. This will further deepen the sensation of lower back pain.
The other thing the DLS does is hold us upright. We can all imagine what good posture looks like. That good, upright posture is partly thanks to the deep longitudinal sling. When your upper back (thoracic spine) is upright (thoracic extension), it actually tightens all the structures in your lower back. This increased tension improves lower back stability, especially around that SI joint.
When the DLS is weak, it loses this ability to hold tension. It also loses the ability to cause nutation at that SI joint. To prevent this, we want to strengthen this sling. A great, simple exercise to do this would be a Dumbbell Goblet Reverse Lunge.
The lateral sling goes along the side (lateral aspect) of our body. It is made up of the gluteus medius, gluteus minimus, TFL, and IT band. The deep fascia of the thigh, which includes the IT band, connects this whole system. This connection allows all of these structures to operate together.
If you’re looking at a person head-on, you’re looking at their frontal plane. In this plane, the pelvis can raise and lower on either side. A raise in one side means a drop in the other. The goal of the LS is to keep the pelvis level in this frontal plane.
While walking, the LS keeps the pelvis level. When a runway model walks, pay close attention to their hips. You can see them rise on one side and drop on the other with each step. I’m not sure how this became sexy, because it is actually a sign in the real world of Lateral Sling dysfunction.
When a person walks like this unintentionally, we call it ‘Trendelenburg gait.’ The Lateral Sling in these cases is exhibiting weakness. It cannot hold our hips neutral as we step. So, the hip on the side of the plant leg drops because the lateral muscles and fascia cannot hold it up. This can have severe implications on the alignment of our hips, knees, and ankles. Also, the uneven distribution of forces going up the spine can wreak havoc.
Whenever there are uneven forces upon any structures of the human body, degeneration can occur. Improper loading of the SI joint can lead to degeneration. Even loading of the spinal discs can lead to degeneration, bulging discs, among other issues. That is why strengthening the Lateral Sling can be a step forward in improving your back pain. Try this Side Step with Trunk Anti-Rotation to do so!
The slings of the human body are important. When they are functioning properly, they provide us with stability. When they are not, they cause us pain. Doing bicep curls and leg extensions is fine. However, we must never forget to train our body as a unit. All of these interconnected systems must be trained together if we want to be pain free!
References
Anatomy Slings and Their Relationship to Low Back Pain. (n.d.). Retrieved September 07, 2020, from https://www.physio-pedia.com/Anatomy_Slings_and_Their_Relationship_to_Low_Back_Pain
John is passionate about getting people fit. After work, you can find him reading and watching Formula 1.
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