The common “lumbar disc is out” diagnosis, we hear it all the time, is it out? most of the time no its not and we can’t really push it back in with manipulation. So what is it? It’s probably most likely to be a facet sprain.
What is a Facet sprain?
Lumbar facet sprains are one of the most common causes of lower back pain and disability in persons under the age of 45. It is the source of pain in about 15-40% of patients with chronic low back pain. Most patients recover in about 6 weeks and it has a prevalence of 23% in the elderly (>60).
How do we get it?
Mostly due to degenerative changes. They typically occur during excessive bending, lifting or twisting movements, where excessive forces are places on the joint. (May involve damage to cartilage or tearing of connective tissue surrounding the joint). Also may occur from a single trauma (e.g. car crash) or due to repetitive/prolonged forces, commonly occurring from a flexed and rotated body position.
Factors contributing to a facet strain include:
- Poor posture
- Lumbar spine stiffness
- Muscle weakness of tightness, inappropriate lifting techniques
- Symptoms worsen by twisting, lifting, arching backwards, bending forwards or sideways or sitting for prolonged periods of time
What do I do when I have it?
You’ve probably heard the terms right or flight and rest and digest before. What these actually refer to are your sympathetic and parasympathetic nervous system. Stress ramps up our sympathetic system and can lead to more muscle tone and feelings of tension. Deep breathing will tone down the sympathetic system and increase the parasympathetic, getting you more into rest and digest mode and helping relax tense muscles.
One of the first things we do with a person who has low back pain is to see how much they can move their spine. With acute back pain, moving much out of neutral can be very painful if you are standing or sitting, and chronic cases will often be sensitive to either flexion or extension.
1. Cat/Cow
If we move to all fours where our spine is no longer weight bearing. This position requires less stability so your body sees it as “safer”, and it will often allow you to move your back here without pain or spasm.
The cat/cow is one of our favourite ways to do this because we move our low back and not just our mid to upper back. Go slow and expand ROM slowly. You may find pain at the end ranges so don’t push too far. Just touch it and reverse. You’ll find that more motion often opens up as you do it. Do 25 with the band and then try to replicate 10 to 15 good reps without it.
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2. Glute bridges
Glute bridges are a great exercise to start building some hip extension strength, serve as a good entry point into the movement pattern before moving into something like a hip thrust, and can be a great exercise to include in low back rehab. But as always, proper form and technique are critical.
The key to it is all in how you start the movement. Rather than laying down and shooting your hips up into the air (and consequently overextending the back), I want you to be a bit more methodical about it, at least at first until you get the sequence down. Here are the steps…
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– Posteriorly tilt your pelvis (roll it back)
– Pre-tense the glute (give em a squeeze)
– Lift with the hip and stop when they stop
– Finish in a straight line from shoulder to knee
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Often times, these chronic low back aches are products of just overstressing the back repetitively through suboptimal technique. And it’s the little fixes that can make all the difference in decreasing that sensitivity. Try it out and fix that bridge.
.Muscles have a length tension relationship. At really short and long lengths, they can’t produce as much force as they can in their midranges. So by bring the heels in to the butt, we create a short position of the hamstrings and allow the glute to do more work.
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Conclusion
If you’ve experienced acute low back pain or any sudden sharp low back pain, it’s not always a disc injury. Keep an open mind and know that its not as bad as it seems, with the right care and management you can be back to your full potential in know time.
Any questions?
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Body & Health Creation Osteopathic Services include these Suburbs:
- North Melbourne
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