There are a lot of ideas about what causes lower back pain.
A joint of out place, muscles that are too tight or too loose, weakness of your or butt muscles, hips too tight, herniated disc, arthritic joints, weak, stretched or sprained ligaments, “poor” posture, overweight, out of shape, to name a few.
Because there are so many possible causes of lower back pain, there are almost as many treatments or things to do for it.
But, in almost every case, a fundamental principle that ties all of these things together is that the soft tissues of the spine lack sufficient strength to stand up against the force of gravity.
A popular treatment for lower back pain, from the 1940’s through the 70’s, was an exercise regimen called “Williams Flexion Exercises” (WFE). An orthopedic surgeon developed the concept because he believed lower back pain was caused by the curve in the lower back.
Flatten out the curve and you would feel better. And it worked for a lot of people.
Then in the 1980’s, Robin McKenzie promoted the idea that lower back pain was from bulging and herniated discs. McKenzie believed you could push the discs back into place (this theory was later disproven even though the technique works for some people) and thereby fix lower back pain. So, his initial program was the opposite of WFE. Instead of flexing the spine, he put the spine into extension or backward bending.
And his program also worked for a lot of people.
How is this possible? How can both programs work?
One approach moves you one way, the other moves you the opposite way yet both can be effective at relieving lower back pain.
To follow the WFE and the McKenzie program (MP), you have to get out of a sitting position, which is what most people do all day, lie on the floor and do the exercises (a few of the MP exercises can also be done in standing).
And at least with the MP you’re supposed to do the exercises every hour. The WFE were also performed frequently over each day.
Both programs take a person who normally sits most of the day, with gravity pressing down on weak or injured tissue, and then neutralizes the effect of gravity by having them lie down.
And…you feel better because you have matched the physical capacity of the spine with the physical loading of the spine.
If you’re trained in one of these methods you might argue that there’s more to it than that and I wouldn’t disagree with you. But, the reduction in physical loads is a significant factor.
When you move from a sitting position to lying down, the reduction in load on the spine is close to 300%.1)https://clinicalgate.com/applied-anatomy-of-the-lumbar-spine/
One of my mentors once told me that sitting for the spine is like placing a plastic bag over a friend’s head and then asking him to breathe.
Kind of dramatic but it gets the point across.
Getting up out of sitting and lying down to do the exercises lets your spine, in a sense, breathe.
And here’s another way to look at it.
Ever sprained an ankle and then tried to walk on it? Hurts. Usually a lot.
So, what do you do?
You use crutches to reduce the load on the ankle. By pressing down on the crutches, you can counter the weight on the injured foot and find the amount of force that doesn’t hurt. And this isn’t just to reduce pain but to encourage the injured tissue to heal properly.
But, pain isn’t that simple. After all, if all you had to do to get rid of lower back pain was to lie down, then, well, wouldn’t that be it?
Reducing load reduces symptoms for one thing. It doesn’t, in and of itself, make you any stronger or more physically (or emotionally) resilient. You still need to rebuild your capacity.
And, to complicate matters, pain is in the brain and there’s a lot going on in there.
WUF for one thing. Worry, Uncertainty, and Fear. When those emotions get involved, pain lasts longer, feels worse.
But at least on the physical side, reducing load seems to help just about everyone with lower back pain feel better.
That’s all I have for now.
Thanks for reading.
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