Which of one these exercises would you say is the best for lower back pain?
1)
2)
3)
4)
The answer: all of them or maybe none of them.
How Can This Be?
Just like any other occupation or task, whether you flip burgers, are a stand-up comedian, or the CEO of a company, everything about your job is not black and white. In all tasks that are performed, there is something called nuance, which are subtleties, and it’s the subtleties that lead to the decision making to provide the right action or answer based on all the information given.
The perfect char on the burger depends on the right temperature, the amount of fat content of the meat, and timing. The stand-up comedian’s joke works because they can read the room and match up the right wording, cadence, and body language to provide a delivery that gets an explosive laugh. The CEO makes a well-timed decision about the company’s future, not based solely on what has worked well in the past, but also considers the industry climate and factors that matter today. Nuance is present in any job you come across in society, so why would the administration of physical therapy treatment modalities be any different?
Encountered on YouTube Or Even Free Helpful Guides
I am always amused by the YouTube Videos or even free information handouts out there that state, “The Top 3 best exercises to Address Low Back Pain” or any pain condition. There is always an expectation that if you do this particular series of exercises, your pain issue will go away, and the comments underneath the content reinforce how correct these exercises are. People who are looking for the answers may get lucky and stumble upon the initial right solution in a video or article by pure chance, without conducting a thorough investigation and spending a significant amount of time educating themselves. That may be fortunate for a few, but for the majority, there will be more questions than answers. Consider the example of the solutions provided above for low back pain.
Option one exercise above, lying on your stomach, may be appropriate for someone whose cause of pain is from central disc herniation that has broken through all the layers, with or without severely degenerated facet joints, or whose spinal ligaments and connective tissue is very stiff, so therefore may not be responsive to repeated movements as seen in exercise two.
Option two exercise above, repeated lumbar extension in lying, may be appropriate for someone whose cause of pain is from a central disc herniation in which the outer layer of the disc is intact, still has more than 70% of their spinal disc height left, whose disc shape is probably more limacon shaped than ovoid, and is under the age of 60 years of age typically.
Option three exercise above, repeated lumbar extension in standing, may be appropriate for someone older than 60 years of age (but not always), whose facet joints and supporting ligaments are not the cause of pain through degeneration and inflammation as seen with autoimmune conditions such as rheumatoid arthritis, whose discs are responsive to repeated motions in loading because the posterior cells of the affected disc needs that extra compressive stimulation to heal that is only achieved in standing and arching back.
Option four exercise above, repeated lumbar flexion in supine, may be appropriate for individuals, who have an anterior disc herniation (yup, that does happen) that presents as low back pain as the same pattern of a posterior disc herniation, or a person who does not have much of a disc left, gets pain with walking that is relieved immediately with sitting, diagnosed correctly with lumbar stenosis.
Main Takeaway
The four exercises above are commonly found to be helpful, and they may be only the starting point for overcoming your lower back pain. If your pain is caused by a disc herniation that is not central and has a lateral component, the exercise(s) to address this are entirely different. If your discs herniate vertically into the body of the above vertebrae, producing a Schmorl’s node, then that treatment will be entirely different. You may have the correct initial exercise for your condition, but how often do you do it? What additional exercises are needed to enhance the effect and accelerate progress? How do you know if you’re fully healed or maybe just a step away from getting reinjured again? I’m not telling you not to look at YouTube videos or not to look at a free guide provided by a group. What I hope you come away with is to take those pieces of information for what they are: snippets of information that may appear as a one-size-fits-all solution, which is entirely not the case. If you are looking to resolve your issue quickly, consider seeking help by taking into account the nuances and measurements to reinforce progress. If you have questions, reach out anytime! Stay well Mobile Spine family!
