Most of you, with whom I’ve had the pleasure to work, know that I have been on a kick about getting your deep core muscles to TURN ON. I use many different phrases and examples but ultimately getting those pesky little muscles to actually do something is quite different. I am always trying to get you to reboot your system. When this does start to happen spinal stabilization occurs.
Spinal stabilization training consists of education, flexibility, strengthening, coordination, and endurance training. It teaches you to use your muscles in new ways, to act as a sort of corset, or nature’s back belt, to support your spine. Spinal stabilization allows your muscles, instead of your spine, to absorb the force of your daily activities, allowing your spine to heal and providing the foundation to minimize the risk of future injury.
The idea of spinal stabilization is relatively simple. It is for you to find the position of the spine where you have the least amount of discomfort and/or where you feel your spine is most stable. This is called the NEUTRAL POSITION . We then help you learn to maintain this position through a detailed exercise program that addresses strength, flexibility, coordination, and endurance without increasing your pain . Learning to maintain the NEUTRAL position during your activities of daily living is the key to increasing your function, returning to work and activity, and preventing another injury. We like to think of it as “transition” rather than rehabilitation.
Initially, such programs were used predominantly with athletes. Because of the excellent results in athletes, many physicians and therapists are prescribing it for many of their other back pain patients. Recent studies have shown the success rate to be above 90% as measured by the patients’ ability to return to work and activity.
What are the Keys to Success?
There are several keys to success. The first is a motivated patient who is willing to devote the time necessary for training. It is not “practice makes perfect”, but “perfect practice makes perfect.” I know that many of you have heard me preach this. The more dedicated you are to the program, the better the results. The best indicator of success is not how often you come to the clinic, but how often and how hard you practice at home. BAM!!!
The second key to success is education . A basic knowledge of body mechanics and general fitness is key to your lifetime success in managing or preventing back pain or any other condition you might be getting treated.
The final key to success is to have realistic goals. If you have had back pain for several years, it is not realistic to think you will eliminate the pain in six weeks or maybe even in six months. If you were never a runner, wanting to run marathons may not be realistic. Running obstacle courses, playing full court basketball, or going on 20 mile road marches might not be either. Establishing realistic goals with your therapist will help prevent frustration, disappointment, and failure. Likewise, on-going communication between you and your therapist is vital to successfully meeting your goals.
Some Common Questions & Answers
Q. What is the starting position for all of these exercises?
A. You will start each of these exercises in the NEUTRAL position.
Q. Why is the NEUTRAL position so important?
A. The NEUTRAL position prevents putting stress on spinal structures, minimizes repetition of injury, and allows healing. The strength of the muscles in your trunk and extremities helps to stabilize your low back and maintain the NEUTRAL position.
Q. How often do I need to do these exercises?
A. DAILY! ALL DAY!! Ok, maybe not ALL DAY, but multiple times throughout the day is highly encouraged!
Q. How long should I do each exercise?
A. You should strive to do each exercise continuously for 2-3 minutes. Most of the muscles of your back are made up of “endurance” type muscles. Therefore, you must train these muscles by doing the exercises for a prolonged period of time.
Q. How long should I exercise each day?
A. You should first start out doing lumbar stabilization exercises for about 15 minutes per day. Work up to 60 minutes (+ changes to your daily activities)!!
Q. How should I breathe with these exercises?
Breathe out on effort. Do not hold your breath. Holding your breath can increase your blood pressure and the pressure in your spine. Always breathe out on effort. Remember that an important goal of the program is learning to breathe while you keep your spine stabilized.
Q. What is the proper way to activate my stabilizing muscles?
A. There are two ways for you to activate your abdominal muscles. We will talk about both of them and explain why you need to do this a certain way. Most of your first work in lumbar stabilization will be on attaining the proper kind of contraction.
Normally, when we contract our abdominals, we feel the muscles bulging out. To try this, place your hand on your stomach and blow out as if blowing out candles on a cake, or as if doing a sit-up. You should feel the stomach muscles pushing outward. This action activates the EXTERNAL, or most superficial muscles. This is not the kind of muscle activation we need.
The second way the contract the muscles is what we call the “drawing-in” maneuver. Imagine you are sucking your stomach backward. Notice that instead of your muscles bulging out toward your hand, they instead pull away from your hand. Think of trying to pull your stomach in as if you were on the beach in a swimsuit. It is very important not to hold your breath as you do this. This action activates the INTERNAL, or most deep, abdominal muscle, and causes an automatic reflex contraction of the lower back muscles. This combined contraction creates support all around the spine, just like one of those back belts you may have seen. However, instead of relying on an external belt, you are using “nature’s back belt” to support your spine. This all around support of the spine is the reason we need to be so specific about how you contract your muscles.
Using the first method, only the outer abdominals are activated, so you do not have support all around your spine as you do when you use the drawing-in technique. Clearly, half a belt will not help you hold up your pants!
Learning to activate your abdominals this way can be very difficult. Not everyone will pick up this skill right away, and some people take several weeks to really be able to do it well. Be patient. You will find that you may have problems doing this in one position, but in others it will be easier.
Good Luck on your program!!