Many rehabilitation programs address acute stages of the injury, to decrease swelling and pain in the injured area and to restore range of motion but they fail to provide a proper treatment program to prevent further injury and to improve any remaining symptoms like chronic pain, muscle stiffness, weakness in the mid section and the lower extremities, muscle imbalances, bad posture, and weakness and instability experienced when trying to perform certain activities that require core stability like skiing, shoveling snow, lifting, moving and carrying heavier objects etc., other traditional treatments like manual therapy, spinal manipulation and EMS relieve the symptoms but do not treat the cause.
The core or mid section of a person (below the pelvis up to the nipples) is the very foundation for virtually any activity that requires standing upright and performing a movement. The muscles of the core work together to stabilize the spine, protect it from injury and to coordinate and execute movements. The deeper muscles like the multifidus, quadratus lumborum and transverse abdominis primarily function to stabilize the spine and give it structural integrity to prevent injury during movement. The more superficial muscles like the abdominals, spinal erectors, obliques, iliopsoas and gluteals function more to initiate and execute movements of the limbs and trunk (although they can also function as stabilizers when contracting isometrically).
If the deep stabilizer muscles are weak then the spine is unstable and susceptible to injury. Once an injury occurs these muscles become even weaker because they are the closest to the site of injury and this makes the spine even more unstable and more susceptible to injury. The larger more superficial muscles have to work harder to compensate for the lack of stability. This causes a muscle imbalance: some muscles become tight and some muscles become weak.
If there is any structural abnormality such as a deformed spine, scar tissue, muscle imbalance, or compression of the vertebrae then a client’s functional capacity (the ability to perform certain activities) will be significantly affected and there will be residual symptoms such as chronic back pain, stiffness, and weakness. You may not be able to restore the spine to its previous uninjured condition but you can strengthen the stabilizer muscles to give the spine more stability which reduces compression and shear forces, protects against further injury and unburdens the more superficial muscles thus restoring balance to the system. Strengthening these stabilizer muscles should improve the residual symptoms because weak stabilizer muscles are the broken links in the chain and are essential for keeping a healthy back.
To illustrate this with an example, a client of mine herniated a disc 10 years ago shoveling snow. He underwent traditional rehabilitation but continued to suffer from low back pain, weakness in the core and lower extremities, as well as stiff muscles in the lower back. His lower back posture was flat with little lordosis (spinal curvature) and he had a limited ability to hyperextend. He made regular visits to his chiropractor for traditional treatments such as adjustments, interference current and soft tissue work. This offered some relief but the relief was temporary and his symptoms persisted. He also engaged in a rigorous stretching regiment because his lower back was always tight but this also failed to provide proper relief. I tried my best to strengthen his core using various traditional exercises that target the superficial muscle like the abdominals, spinal erectors and the obliques. Although he did make some progress in functional strength (i.e being able to push pull and carry) his symptoms persisted.
Another client of mine also herniated a disc although not as severely (only a slight bulge) and he developed chronic pain on the left side of his hip which spread to his lower back. When I did an assessment on him I discovered that he had lower crossed syndrome (a common muscle imbalance).
Each person’s symptoms, the cause of those symptoms, and any currently present structural abnormalities depend on several factors like site of injury, nature of injury, posture, preexisting muscle imbalance, weight and age. These factors interact in complex ways to produce symptoms and structural abnormalities that are unique to each person. For example a person with a posterior lumbar disc herniation can either have lordosis (a hyper-extended spine) or a flat back with minimal lumbar extension (as in the case of my first example). The etiology of any musculoskeletal disorder is very complex because it is dependent on many factors. However, whatever the cause is, chronic back pain can be significantly reduced and re-injury can be prevented by a properly designed spinal stabilization program because spinal instability is at the root.