Low back pain is certainly rampant these days. I myself have had my fair share of low back pain over the years stemming from an injury in my teens. Certainly, my education in massage therapy has helped me become aware of causes of low back pain and in doing so helped me develop my own personal self-care routine. This being said, my experience from both viewpoints, that of a practitioner as well as a patient, gives me a well-rounded view on the subject. Although I would love to have never had low back pain, it certainly has given me empathy for clients who come see me who have acute or chronic low back conditions. I really do feel for them as I know exactly how they are feeling as they lie on my table in discomfort.
While there are numerous causes of back pain and treatment does need to be catered to individual cases, there is one technique which I feel is applicable to many forms of back pain. The technique is spinal decompression. Now I’m sure you have heard of spinal decompression in its traditional sense. It gets a lot of popularity, especially in late-night infomercials selling devices which flip your body upside down and suspend you like you are on a playground…..for only 5 payments of 19.99 plus shipping and handling….never mind. I have nothing against these devices but in my opinion, exercises which are meant to help with spinal decompression should be done functionally. While hanging upside down to decompress the spine does work, a better option would be to learn how to do this in a more natural and active way which also allows for conditioning of supportive muscles at the same time. Also not having to buy a large piece of equipment is not practical for your patients. They will appreciate this exercise as it is quite simple and free.
Before I demonstrate the exercise, I would like to quickly talk about the spine to make sure we know what we are dealing with.
Looking at the side profile of the spine, we see that the vertebral discs are on the anterior portion and the facet joints are on the posterior of the spine. These two structures are where the vertebra of the spine come together and weight is distributed. The intervertebral disc takes the majority of the weight where the facet joints are mainly for stability.
Many instances of low back pain occur because either one of these two structures are involved. Whether it be a disc pathology, such as a bulge or herniation, or degenerative changes due to facet dysfunction or other underlying conditions, these anatomical structures are routinely involved. The main reason for this is compression of the spine due to postural issues ( like our classy lady in Figure 1), weakness of supportive muscles, and the habitually poor mechanics due to these issues. These factors create a spine which is unsupported and prone to injury. When we have a spine which is chronically unsupported and moving improperly, compression of the intervertebral discs and degeneration in the facet joints occurs causing issues.
Let me demonstrate a specific example. If a client has a functional hyperlordosis in the lumbar spine, this consists of a couple characteristics. First, the paraspinal muscles will be hypertonic while the abdominal musculature will be over lengthened and weak. The result causes the facet joints in the posterior portion of the spine to be continually compressed, potentially leading to degeneration and facet joint pain. Pain associated with this is increased with extension of the lumbar spine and relieved by flexion. Inversely, if we have a hypolordosis we will have more pressure put on the intervertebral discs due to a loss of lumbar curve. Along with this, we will have weakness in the paraspinal muscles causing instability of the spine and hypertonicity in abdominal muscles. Altogether, this creates an environment where disc degeneration and potential injury can occur. Pain associated with disc involvement is increased with flexion of the lumbar spine and relieved with extension.
A third scenario is one where we have both facet degeneration and disc degeneration. This is not all that uncommon when chronic dysfunction has been present for a long time. Both of the previous scenarios, although quite opposite, involve compression and can lead to one another. Pain in this scenario can be present with both flexion and extension, making it very limiting.
This information in hand, we can understand why compression in the spine can be an issue, and why decompression of the spine can help with a lot of clients’ pain. If we can enable the spine to have more room in between vertebra, thus creating more disc and facet joint space, we can bring better function and pain relief to a client’s spine. Now, I want to clarify that decompression alone will not create lasting results. Yes, it can feel good, but some sort of reconditioning of the supportive musculature needs to occur as well. This, in my opinion, should happen side by side and not independently. Paired together with massage therapy treatments, it is a great combination.
I would like to share with you that I consider to be one of the best exercises/ stretches to help back pain. This exercise is meant to be ancillary to actual massage treatment and is something that can be given to your clients for home care. I would strongly recommend this being done as part of a spine wellness regimen for ongoing care and done even when not in pain.
As mentioned before, flexion and extension of the lumbar spine can be relieving depending on the condition involved. Usually, extension feels very good for a client with a disc injury but bad for someone who has facet syndrome or degeneration. This is true because extension of the spine decompresses, or draws apart the spine and creates more room for the intervertebral disc (this is your common cobra pose in yoga). However, at the same time, this position creates compression in the facet joint by closing down the joint space which can be painful. So how can we gain the benefits of decompression from extension exercises while not irritating facet joints? We can do this by adding a traction aspect to our extension exercise. By doing this, it allows the spine to extend while pulling apart. This is important because it does not allow for the facet joints to jam together as extension occurs, allowing for the decompression we need to create pain relief.
- We will begin laying prone on the floor.
- Raise up onto your elbows to create a moderate extension in the lumbar spine. Focus on keeping your hips and low back relaxed. This should be fairly comfortable.
- To create our needed traction element in the lumbar spine, use the elbows to pull your upper body forward by driving them into the ground and back. Your lower body will create resistance on the ground enabling the spine to decompress. No movement should actually occur, only the traction effect.
- Hold this position as long as you are comfortable and wait for the lumbar spine to relax.
- Relax back down the floor.
- We will do this exercise again, however, this time we add an anchoring technique which creates added traction by pulling the pelvis inferiorly.
- Squeeze your knees together strongly, activating your adductor muscles. This anchor and pulls the pelvis inferiorly creating more traction.
- Raise up on to your elbows while keeping the knees firmly together (This can be tricky).
- Drive your elbows into the ground to, once again, create traction. keep squeezing your knees together.
- Take a deep breath in, while focusing on elevating your chest.
- Exhale but do not the height of your chest to move back down
- Inhale again and try to raise your chest higher than before.
- Exhale and once again actively maintain the new height of your chest.
- Inhale once more and raise your chest even higher. Hold for 5 seconds.
- Exhale and relax back down to the floor.
- Repeat 2-3 times.
By adding the traction element to our extension exercise, we should be able to avoid any irritation to the facet joints. Also, once this exercise is done consistently for a few days, pain should be diminished, making this routine easier. Decompression of the spines joints will begin to occur and function will begin to return.
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