News

Jan 4, 2013

The biomechanical approach to back pain.

One of the most disabling and common ailments in our society today is back pain. In fact according to Messers Twomey and Taylor, researchers from Curtin University in Australia, lower back pain is as common as headaches in modern society. A study by Nachenson in 1995, showed that if you see your GP with your back pain, if he then refers you to a specialist, who then sends you for X-rays and MRI scans, the accuracy of diagnosis is 15-20%.  A frightening yet little known fact.  Unfortunately the principles of modern medicine mean that the medical profession cannot treat an injury without an accurate diagnosis; is there any wonder why the incidence of back pain has doubled every 10 years for the last 30 years? As you can imagine, the problem is made even worse when you have had back pain for some time. The problem is that when you have had an injury for more than 6 weeks, another part of your body will start to compensate so you can have new pains as your condition deteriorates. So you can actually end up with more than one injury due to the mechanical compensations, which makes diagnosis even more difficult. We need to shift the paradigm and look at back pain differently. 

Scientists, called Biomechanists, have been looking at back pain quite differently for some time.  They look at the mechanical causes of back pain rather than focusing on the pain itself. They have found that they get better results by managing the biomechanical causes. In fact independent research published in the New England Journal of Medicine 1998 has shown that if you see a therapist over a 6 week period for your low grade back pain, your average improvement will be around 39% in functional capacity (the capacity of your back to perform work). Work by Barrow and Haines then found that if you were to perform an exercise programme to manage the mechanical causes of your back pain, your average improvement would be around 141%. A profound difference and one that cannot be ignored.

This biomechanical approach is rapidly taking over from the medical approach in popularity as a much more effective method of managing back pain.

The most interesting thing about this method though, is that patients can be shown how to use it to look after themselves.  This reduces the risk of them becoming reliant upon an individual therapist or doctor, and interestingly their compliance with their exercises programme is higher too.

Of course no single method can be the panacea of all ills, but what we are finding is that if the mechanical causes are addressed, the pain can subside without treatment on the 'injury', whatever it might be.  Sometimes treatment is also required, however, but often people find that once they've committed to an exercise programme addressing the causes of their pain, they are then more able to manage the problem themselves. Then if local treatment is necessary, it is more likely to be successful, as the mechanical causes are no longer present.

Here is one test that can highlight one of the causes of your back pain, its called the 4-sign. 

The test

Start
Sit on a chair or stool and cross one leg over the other as shown in the diagram here:

Test
Relax your knee down to a comfortable position. Look at the height of your knee from the imaginary line running through your other knee, running parallel to the floor. Your knee should be only 2 – 3” higher than this line. Now try the the other leg and see if there is a difference in knee height from the imaginary line and compare each side.
 
Results
There should be symmetry, with the right side range of movement the same as the left.  As a guide, the distance from the knee to the imaginary line should be no greater than 2 – 3”.  Try using a mirror to gauge the difference if you are unsure.  If you have asymmetry where one knee is higher than the other there are exercises that will help. 

Meaning
If one knee is higher it means that there is a muscle in your hip that is tight or in spasm.  This can limit the movement in your pelvis and in turn can put more pressure on your back, causing pain.  A simple exercise to reduce the spasm in your pelvis can help it move again and take the pressure off your spine.

4-sign exercise technique

• Sit on a chair and cross one leg over the other as with the test
• Relax your knee down to a comfortable position
• Place both hands on the inside of your knee
• Press your ankle down into the knee it is resting upon, which should want to lift the knee you are holding still. Do not let your knee raise
• Pull up at 20% of maximum effort, just enough to engage the muscles in your hip
• This is a static contraction, so make sure the leg does not move

Instruction

• Hold the contraction for 20 seconds.
• Do 4 sets on each leg
• Do this exercise regularly throughout the day, maybe 4 – 6 times. Certainly you should try and do this exercise before and after any exercise or activity (like going for a walk or shopping) and before and after any period of inactivity (like watching TV or sitting at a computer)

Notes
If you have identified a problem with your pelvis by it being asymmetrical when doing this test, try the 4-sign exercise.  Make sure you are gentle and do not work at it too hard, otherwise it can be counter-productive.  As with any new exercise you may experience some discomfort afterwards.  If its low-grade muscle ache or stiffness, that is not usually something to worry about.  Keep going.  If its far less commonly sharper or more severe you may have over done the exercise so when its settled down, please ease off the exercise and be more gentle with your contraction the next time.  If it continues to be painful afterwards, please stop the exercise and see a Biomechanics Coach or therapist.

If you have pain when you adopt the cross-legged position then simply lift your knee a couple of inches higher than the relaxed position and that should be more comfortable.  Try the exercise in that position.  There is no advantage in being in pain during the exercise as it would be counter-productive and may aggravate matters.

You should find that as you perform the exercise more frequently over the coming weeks that your knee falls lower as you cross your leg and that should coincide with a reduction in pain or stiffness in your back or pelvis.

If you would like more assessments and exercises peronalised to you, go to www.imovefreely.com.