Hi, I’m Dr. Eric Cobb of Z Health Performance. We are going to begin a series of short but hopefully very useful videos on low back pain today. If you are new to Z-Health, we are a professional education company.
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Let’s get into discussing low back pain.
If you are not familiar with modern pain neuroscience, please go watch the long video I posted a few weeks ago because it’s important that you understand how the brain and body work together when someone is experiencing the pain of any kind but for now we’re we’re focusing on low back pain. So with low back pain, we have acute and we have chronic.
The great news for most of us is that acute pain, I woke up, I did something weird, my back kind of froze up, is considered self-limiting.
For many people, that means two or three days, it’s gonna be a little bit sore, and then you’ll be back to normal. However, there is a subset of the population that can experience chronic pain, which can go on for six, eight, twelve weeks and much longer.
So whenever we start dealing with pain issues of any kind, it is important for us to remember kind of two key principles. One, the brain creates pain based off the level of safety and danger it feels in the body. Alright?
We’ve been talking about this for a very long time. like I said, go watch the video presentation so that you really understand that a brain that is fearful of movement or tension will often use pain as a way to prevent that from happening. It’s a survival tool.
The second thing that I also need you to understand about pain from this brain-based perspective is that whenever we start the rehabilitative process, our primary job is achieving what I call the one pain free rep. So whatever it is is bothering you, we need you to get to the point that you can do something pain free at least one time because that now starts to convince the brain that, hey, this is safer than I thought. So as we get started, the most important thing that you can do is if you have low back pain is to do some some type of self-assessment. So when we talk about the low back, we obviously have flexion, we have extension, we have lateral bending, we have rotation, and then we have gliding motions.
We then can combine all those. Maybe we have flexions with rotations with some glides. I don’t know you. I don’t know what you’re currently experiencing, but you do. So what I need you to start off with is stand in a neutral stance, just feet straight ahead, heels directly underneath your hips just nice and tall, and go through a variety of movements. Your first job is to assess how far you can move in any given direction before the pain begins. Most people when we look at the literature that are experiencing low back pain will complain of either lateral bending or extension with another subset that have more pain with flexion. So again, you need to test for yourself how far you can go, but also how comfortably you can get there.
A lot of people who have pain, if they move very slowly, will be able to achieve a larger range of motion than if they try to move quickly. So you’re looking at the speed of the movement and the depth of the movement. Alright? So just assess that for yourself beginning in this nice neutral stance. Now what we’re gonna move to is something that may be a little bit foreign to you, but I want to explain. Whenever I work with someone with low back pain, I tell them I want to focus on postural and positional safety. That typically means that in a perfect kind of ideal postural stance, although that doesn’t really exist, a lot of people feel like they have to do all of their mobility work or movement work in this type of posture.
And because we’re trying to achieve one pain-free rep, this often backfires. So what I want you to do now is I want you to either take note of or remember when you had pain, and we’re now gonna start playing around with some alterations. So the next thing that I want you to do is bend your knees And I want you to repeat those same movements that were painful for you. I want you to notice, does the knee bend increase or decrease what you’re experiencing in the low back? You’re then gonna repeat that with your feet turned out, and you will then also repeat it with your feet turned in. What we are looking for is the lower body position that is most comfortable for you. We want the one pain free rep position because if we have to start in some kind of strange position to do good mobility work that is pain free, we will begin there to convince the brain that it is safe to move, and then we can gradually work back toward a more normal position. Alright.
So we’re gonna start off neutral and then we’ll try feet out and feet in both knees straight and knees bent. Again, you’re looking for postural and positional safety. Now, once you have done that, I want you to use the foot position that’s worked well for you, and then we’re gonna go to the pelvis. In the pelvis, you’re going to try three different things.
You’re gonna just use your normal pelvic position, which you’ve already been testing, then I want you to do what’s called a posterior tilt. In other words, I want you to tuck your tailbone. Alright. So you’re gonna tuck the tailbone and you’re gonna repeat those same test while also utilizing the lower body position that worked well for you. Finally, you’ll repeat that same test by tilting the pelvis forward. This is called an anterior tilt. And see again how far you can comfortably move into the painful position.
Ideally, when you get done with all this testing, you will have a foot position, a knee position and a pelvis position that is comfortable. And if it’s a little bit weird, that’s okay. We actually have had people where their right foot is out. their left foot is in. One knee is straight. The other knee is bent. The pelvis is tucked and a little bit rotated. And they’re like, right there, I feel comfortable.
Now, if you look at any textbook, this is gonna be a very strange position to begin exercising from, but this is safe right now. We’re helping people achieve one pain-free rep. So guys, this is this starting point for what I want you to do. Now from here, we’re gonna add in two more elements to again achieve this postural and positional safety. Because the low back is very reactive to the eyes and the inner ear, we now want to add something to the mix here.
We’ve achieved hopefully a comfortable lower body, knee position, and pelvis position. What we’re gonna do now is we’re going to add in the inner ear or the balance system or the vestibular system. For that, I’m going to need to use some kind of brace because I’m standing on the floor and I’m not by a wall. I’m gonna use some sticks from stick mobility because what we wanna make sure of is we want to see how much balance challenges are impacting your ability to move comfortably and without pain. So what we’re gonna do now is we’re going to get into that safe position for you, whatever that is. Let’s imagine for me, it’s my toes in, knees bent, pelvis tucked. and let’s say I have pain right here when I go into extension. I’m gonna take these poles or a wall and I’m gonna make sure that I feel more support So I can be pressing down into the floor, which is decompressing my spine a little bit.
But more importantly, it’s helping me feel stable. If I can now feel very stable like I’m not gonna fall, bend my knees, tuck the pelvis, whatever my position is. And all of a sudden, I can double or triple the range of motion that is comfortable for me, it may be indicating that part of my low back challenge is coming because my inner ear is not functioning well. If that’s the case, then we need to check out some of our other videos on the vestibular system.
There are a lot of other things that play come into play with that particular system, but this is just kind of an easy way to know, hey, if I support myself, with a chair, with a wall, with some sticks, and I feel more stable, am I able to move more freely? If that’s case, it may be pointing to the vestibular system.
Finally, we’re going to now add the eyes to the mix. Normally, whenever we have people add the eyes, we’re gonna ask them to test four different positions to begin with eyes up, eyes down, eyes right, and eyes left. Each of these eye positions and movements influences muscles within the neck and also down into the spine.
So what I would have you do is once again get into your comfortable position Whatever that is, check your painful movement. And now go eyes up and retest. Eyes down and retest. Eyes right. and retest. And eyes left and retest.
What you may find is that by holding your eyes in one of those four kind of cardinal gaze positions, you may find that you’re able to achieve the same range of motion more easily, or you may find that it decreases the pain and you can go even further. The reason that I’m talking about the eyes and the inner ear is that it is impossible to truly separate the body into little components and say, hey, you only have a back problem. because our eyes and our inner ear help us move through the environment, utilizing the rest of our body. So problems in the eyes, problems in the inner ear will often be reflected in the musculoskeletal system, and the low back is a very, very common area in which we will see issues. So I know this is a lot to take in but the end goal here is for you to find a position that is safe for you and comfortable.
So you’re going to look at your feet. You’re gonna check your knees. You’re gonna check your pelvis, you’re gonna think about your inner ear and your eyes.
All of that we will use as we go into the next video where we start talking about restoring kind of normal ranges of motion and different strategies around that.
So I hope you enjoyed this. Let us know what you think in the comments.