A Brief word on Chronic Lower Back Injuries

There are a number of different factors which can contribute towards a lower back dysfunction. Here are some of the most common;

- The position of the pelvis in relation to the femur. i.e. anterior / posterior pelvic tilt. The negative consequences of these will most often be experienced during prolonged periods of sitting or standing, during flexion (bending forwards) for posterior tilts and extension (straightening up) for anterior tilts. These can often lead to disc compressions and hernations and facet joint impingements respectively. Once you recognise the tilt of your pelvis, you can make some adjustments to the common daily demands on your body.

- The ability of the pelvis and the lumber spine to flex synergistically. Bending forwards should hopefully involve bending of the lower spine and the pelvis 'rolling over the top' of the femur in fairly equal measure. Most often you see tight hips and hamstrings 'gluing' the pelvis and the lower back becoming hypermobile and consequently aggravated. The reverse can happen too although less common in my experience. SI joint issues may happen mainly when the former happens on one side. You will likely need a keen professional eye to assess this one.

- Healthy sequencing between the deep glutes (top of your bum) and your lumbar errector muscles. Glute medius and minor can try and take over lumbar extension (sitting up straight) and continually switch off the back muscles in the process which will lead to weakness. This will often overload and aggravate QL's too. Take the lumbar into extension whie 'distracting' your glutes with some abduction.

- Chronic tension in the quadratus lumborum from stress (physical or emotional). Theses QL's take some serious punishment as they are often the 'last man standing' in terms of the muscles actually giving support to the lumbar spine. They are also closely linked to the psoas and adrenal glands and get easily impacted by stress. Breathe deeplyreduce stimulants and take naps in 'Static Back' position.There is a useful and detailed article here; https://www.healthline.com/health/quadratus-lumborum-pain…

- The ability of the inner unit (diaphragm, TVA & pevic diaphragm) to activate and stabilise the trunk under load. Think of these muscles as an inverted airbag which should contract and 'corset' inwards before loaded movements of the lower limbs or trunk. Failure to do so may result in impacts being absorbed by ligaments, the spine and less able muscles. Classical mat Pilates is particularly good at addressing this issue.

- The ability of the posterior sling (lats & contralateral glutes/hip rotators) and obliques to stabilise rotational movements. It's easy to underestimate the need for this type of stabilisation, but trunk rotations should be happening during normal healthy gait and especially during running. Get. On. The Cable. Machine. Wood Chops all the way.

- The healthy functioning of the illiopsoas muscle for hip flexion and dynamic stabilisation. There have been entire books written on this one, so I can't do any type of justice in a paragraph. Poor digestion, emotional uncertainty and over-training will likely have the most negative impact on this function though.

In my experience, Acupuncture, Soft-Tissue work, corrective exercise and a patient attitude where you manage your expectations and see recovery as a process rather than a quick fix, will resolve even the most chronic of lower back problems. Don't hesitate to get in touch if there's anything I can help you with. Warmest regards,

Alexander Boylan BSc(Hons) MBAcC


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