Health Resources

Introduction

About 80% of us will experience back pain in our lives. Most people have the misunderstanding that only athletes or manual workers will suffer from back injuries. However, there is an increasing incidence of sedentary or desk bound office workers suffering from low back pain. 

Most people recover from acute back pain within weeks. However, approximately 50% of these people who have had acute back pain develop chronic back pain i.e. pain lasting for more than 3 months. Many back pain sufferers shop around for doctors or alternative medicines to cure their back symptoms. But there is no magic cure. Up to today, chronic back pain management remains a challenge to healthcare professionals.

Faulty body movement has also been identified as a cause of long-term back problem. Muscle imbalance can develop after an injury or due to poor postures. Over time, the muscles in the back will become stiff and weak, forming thick bands. Most of us have it and we can feel it when we massage our back muscles. The circulation at these bands is poorer and this can give rise to muscle aches and pain. The weak and tight muscles also increase the stress at the spinal joints and discs, causing degeneration. 

Various researchers say it is inappropriate to look at the spine in isolation. In the situation of chronic back pain, the musculature around the hips needs to be examined. Restrictions to the hip musculature are believed to induce excessive strain to the joints at our lower back. Therefore, in addition to the normal stretches to the back, stretches to the hip are as important. 

For successful management of chronic back pain, patients need to understand their conditions and take self-responsibility in the pain management. Panjabi (1992) proposed that spinal stability should be defined as the equilibrium of three subsystems: a) control subsystem - the ability of the brain to control the muscles and making it fire at the correct time; b) active subsystem - our muscles function; and c) passive subsystem - the bones, ligaments and discs. However, after an injury, there is usually a disturbance in these three systems.

Physiotherapy Management for Chronic Back Pain

Traditional physiotherapy management for chronic back pain involves analysis of body movement, prescribing stretches to the hips and back as well as prescribing core stabilizing exercises for the deep trunk stabilising muscles. Passive treatment like joint mobilisation (joint gliding motion), manipulation and massage may be prescribed based on assessment findings but this will be of a lesser focus because, as supported by current research, passive treatment is good only for short term relief but regular stretches and strength training are more crucial in preventing recurrence. 

However, through experience, we realise there is more to traditional physiotherapy. We note that different body types respond differently to the same form of training. Managing chronic pain has to be more specific and may be different between individuals. There is always hope that the pain might disappear one day with proper training. This would require experienced personnel in identifying the cause of the physical problem and apply various training approaches in building the body system. Often, worksite evaluation and on field sports observation helps evaluate the effectiveness of treatment approaches prescribed and therefore, enhances the outcome of rehabilitation. 

For successful management, the whole body system, including the mind and muscles, must integrate and work together to perform smooth and flowing motion. The patients need to learn movement awareness, be patient in changing faulty movement pattern and give time to build up their physique to cope with the daily activities in their lives. 

Training mind-body connection and movement awareness, for example, using fundamental principles of Pilates; re-educating efficient movement pattern in daily activities and sports; incorporating strength training and postural correction are essential rehabilitation components that would create a longer lasting effect and improve the outcome of success. 

Prevention is still the key to back pain management. Our body is made to move. Inactivity or lack of mobility to the joints can lead to early degeneration due to a lack of nutrition to maintain the healthy joints. Losing muscle mass is a process of ageing and this makes our body more prone to strains and sprains while we perform simple daily tasks. Therefore, participate in various form of exercise to let your body experience movement, to maintain muscle tone and stretch regularly. The importance of good posture cannot be emphasized enough. Above all, patients’ understanding of their conditions and self-motivation are the major determining factor to success.

Recall your last overseas experience - how were the pillows in your room? Frequently, you find that the pillows provided at the accommodation are usually very soft. While it is fine for some people to sleep on softer pillow, others may experience morning neck pain and stiffness. If you are used to sleeping on a firmer pillow, here is a suggestion to overcome the problem:

In some ways, our joints work similarly to a machine. In order to maintain healthy function, regular movement is important. Regular movement assists in the distribution of fluids within the joints and improve the nutritional supply to the cartilage. 

You may say, “I move the whole day”. In actual fact, we seldom stretch our joints to its full range. Think about it: how often do you turn around fully to look behind your desk in the office? How often do you look up to the ceiling? Or stretch your arms back? 

Here are some tips to stretch out your lower back while at work. It needs to be done 5 times every hour.

A normal spine comprises of 26 bones block and they stack up one on top of the other. These bones are held together by ligaments and muscles. As the shapes of the bones are not uniform, therefore, it gives rise to the 3 curves in our body. 

Apart from looking good and giving padding to our bones while seated, buttock muscles also contribute to the stabilisation of our back, knees and foot arches in upright motion. The three major muscles located at our buttocks are:

• Gluteus maximus

Assist one to get up from a seated position, to climb up stairs and slope.

• Gluteus medius

Essential in maintaining pelvic stability.

• Piriformis

Hip rotators and are usually found tight in people with back and hip pain. Tightness of this muscles lead to joint and nerve compression.

In clinical studies, it has been observed that people with a relatively flat lower back or those suffered from low back pain have poor activation of their buttock muscles. Those with knee pain usually fail to fire their gluteus medius sufficiently to stabilise their pelvis and knees, thus exaggerate dropped foot arches. 

On the other hand, those who tend to stick out their buttocks excessively while walking or running have very tight buttock muscles. The tightness causes increase tension to the surrounding soft tissues (fascia) which could give rise to mid and lower back and knee pain. 

Thus, “butt” work is one of the major focuses in minimising injuries. If your buttock muscles are tight, it is appropriate to stretch it out but if it is weak, then strengthening is the way to go. Here are some suggested strengthening exercises and stretches for buttock muscles. All exercises should be pain free. If you are not sure, please check with your doctors, physiotherapists, sports trainers or fitness instructors.

Pregnancy is one of the most meaningful and remarkable experience in a woman’s life. Physical radiance, the surge of endorphins, and excitement about becoming a mother for the first time or again are among the most enjoyable benefits. However, pregnancy is also a physically and emotionally taxing experience because of the pain and discomfort arising from the anatomical changes. In fact, pregnant women typically develop lumbar lordosis (increased back arching), which contributes to a very high prevalence of lower-back pain, and it is pregnancy rather than childbirth itself that has the greatest effect on the pelvic-floor muscles, developing incontinence symptoms during this time.

Women with uncomplicated pregnancies should continue exercising at mild to moderate intensity levels to help offset some of these discomforts and to prepare for the birth ahead. Provided they receive clearance and special instructions from a physician, expectant mothers will benefit immensely from staying active throughout their pregnancy.

In clinical studies, it has been observed that people with a relatively flat lower back or those suffered from low back pain have poor activation of their buttock muscles. Those with knee pain usually fail to fire their gluteus medius sufficiently to stabilise their pelvis and knees, thus exaggerate dropped foot arches. 

On the other hand, those who tend to stick out their buttocks excessively while walking or running have very tight buttock muscles. The tightness causes increase tension to the surrounding soft tissues (fascia) which could give rise to mid and lower back and knee pain. 

Thus, “butt” work is one of the major focuses in minimising injuries. If your buttock muscles are tight, it is appropriate to stretch it out but if it is weak, then strengthening is the way to go. Here are some suggested strengthening exercises and stretches for buttock muscles. All exercises should be pain free. If you are not sure, please check with your doctors, physiotherapists, sports trainers or fitness instructors.

How Can Pilates Exercise Programs Help?

Pilates offer a mind-body approach that balances strength and flexibility training. It combines flexibility and strength training with body awareness, breathing and relaxation. Pilates exercise is perfectly suitable to preparing women for labour and a speedy recovery postpartum. A no-impact regime, it places special emphasis on restoring the spine’s natural curves (postural alignment) and on improving stability and mobility in the lumbar pelvic and shoulder girdles — all important factors during pregnancy and beyond. 

1) Postural Alignment

Throughout the gestation period, postural alignment alters, and many muscles become imbalanced, which can put mechanical stress on the lower back, pelvis, hips and feet. The shoulders and upper back begin to round forward due to the increased weight in the chest, causing the chin and neck to poke forward, creating what is called a “forward head posture”. As a result, the mid and upper back muscles at the shoulder girdle become stretched and this can lead to neck and middle back ache.
  
The lower back develops a deeper arch due to increased weight at the womb, causing tightness and contributing to lower-back pain. Improving postural alignment is therefore a key benefit of Pilates training during pregnancy.

2) Lumbopelvic Region

As the baby grows, the woman’s center of gravity shifts, affecting coordination and balance. Pilates exercises can enhance these skills without compromising safety. In addition, the hormone relaxin affects the joints and connective-tissue collagen fibers in the pelvis, particularly the joints around the pelvis, namely the sacroiliac and symphysis pubis. Relaxin, while essential for the expulsion of the infant during birth, can produce the negative side effect of increasing instability in the pelvis. Strengthening the abdominals in a controlled and safe manner helps stabilize the lumbopelvic girdle.

3) Pelvic Floor and Incontinence

During pregnancy, your tummy muscles are stretched over your growing baby and may weaken as a result. Your pelvic floor muscles are also placed under great stress and tend to stretch and move lower down into the pelvis under the weight of the baby. As a result, you may find it harder to contract these muscles and to hold them for very long. If your pelvic floor muscles are very weak, you may find that you are leaking urine when you cough or sneeze. Pilates targets the tummy and pelvic floor muscles which is important for normal function and in sustaining quality lifestyle. Furthermore, many Pilates exercises are performed on a "hands and knees" position, and this is an ideal position for pregnancy. It helps to take a lot of stress off your back and pelvis.

4) Shoulder Girdle

The physical demands of lifting and carrying a newborn require upper-body strength and stability. A Pilates exercise program will strengthen the necessary muscles at the neck, shoulders and back.

Pilates Programs and Exercise Recommendations

Clients should be encouraged to take private Pilates lessons to ensure exercises are properly modified and adapted as the pregnancy progresses. At each trimester, there are different aims and objectives for the exercises program.  For example,  

1st Trimester – focus on general well being, stretching and general body toning. Exercising in lying down on the reformer and mat work are encouraged for relaxation and body stability.  

2nd Trimester – focus on toning as the pregnancy has become more stable and fitness is important to sustain the pregnancy. Greater body changes are noticed as the body gain weight, with more fat deposits around the body. 

3rd Trimester – focus on relaxation and more stretching. Exercises would need to be modified to a more upright position.

Questions and Answers

• How can Pilates help a mom-to-be prepare for labor?We educate the mother as to which muscles are required to work during labor and how to assess them. Then we strengthen those muscles and increase the muscle stamina so she can pace herself during labor.


• Will Pilates help avoid a postpartum flabby belly?Not always, but by getting the abdominal wall back in shape, it will help to reduce it.


• How often should a mom-to-be have a Pilates workout?It is best to start off two to three times a week. As the mom-to-be progresses through the pregnancy, the individual will determine how often they want to work out. Some lay off from Pilates 1 month before labour while others do Pilates till the day they deliver. It varies between individual as long as one is comfortable with their bodies.


• Can a mom new to working out start Pilates?Yes, of course, but they should find a teacher who has had a lot of experience with pregnancy and new moms. An established Pilates studio is strongly recommended rather than joining group classes which there is limited attention and supervision given. The teacher should be teaching for more than five years in a studio environment, because in a studio environment, there are more exposures and dealings with a variety of different bodies and other physical issues.