Monday 7 September 2015

Dysfunctional Patterns - Understanding Your Back Pain...

It has now been 4 months since I started on this very specific and intentional journey of addressing my postural imbalances and bio mechanical dysfunctions, with the main goal of relieving my bodily aches and pains as I approach my 40's.



As per my last status update post, focussing on postural improvement has simply been an amazing discovery and I have never felt better, literally in every aspect of my life. See previous post for further details.

http://smfr-tpop.blogspot.co.uk/2015/07/an-update-on-my-progress-so-far.html

So, aside from the on-going corrective KMI bodywork (Structural Integration), what have I really been doing to identify and correct my postural and movement dysfunctions.....?

Well, step 1 has actually been to educate myself on some basic anatomy and physiology. This is of course incredibly important. You need to understand how we are designed to stand and move as humans, before you can start making improvements. This really helps to start understanding the basic dysfunctional patterns in your own body as well, because if you don't know why your lower back hurts (or your shoulders, or knees or hips), then how are you ever going to fix it, but crucially, also prevent it from reoccurring......?

From what I have learnt so far, lower back pain for example is incredibly easy to explain and also fix in the majority of people who suffer from it. It is really a mechanical issue, an issue of poor bio mechanics and ultimately, a lack of strength, even in seemingly 'strong' people. By 'strong', I mean muscly. Big muscles do not equate to strength, at least not in the context of being a functional and efficient human being, they are actually quite detrimental to it, but that's a topic for a future blog post.

The cause of mechanical lower back pain really stems from reciprocal inhibition and muscular compensation.....sound a bit like 'wank words' don't they? But what do they actually mean? Well, it basically means we are out of balance in our bodies...... in our muscles and in our structures. Our generally sedentary lifestyles lend themselves to creating these unintentional imbalances, which then lead to fairly predictable chronic pain and injury. We are simply not designed to sit! We are designed to move!!!

The typical dysfunctional patterns that are caused from a sedentary lifestyle in today's technology driven society are actually quite predictable. Starting from the hips, because as I have learnt over the last few months, this is where the majority of dysfunction and chronic pain will actually stem from. After some basic anatomy education, mobilising the hips and correcting hip dysfunction is step 2 to correcting your posture and relieving chronic pain. Acute pain as well actually, but additional consideration and expertise is required for more acute cases. Maybe a course of osteopathic or chiropractic treatment would be required first, but the cause (and cure) of the acute pain is really just the same as the chronic pain....the signs have just been ignored for too long, so additional intervention is now required. Ignore them for too long though, and that might be a hip replacement, or some other surgical intervention later on down the road.

The typical dysfunctional pattern from the hips will manifest itself in the following way. Firstly, with over active and tight hip flexors, predominantly caused from sitting too much. These hip flexors, the primary ones being illiacus/psoas, rectus femoris, satorius and TFL, become short and tight and given that they all attach to the front of the pelvis, this tightness in the muscle, will pull the pelvis down out of it's natural position and into a forward tilt.......

Mobilising the hips, basically means loosening up those tight hip flexors. But that on it's own is not quite enough.....although it will bring very quick relief to lower back pain, I have witnessed this in others, it will only be temporary relief unless additional corrective steps are taken.

So the hip flexors are over active, very tight and short from sitting down too much. But muscles, groups and chains of muscles even, operate in what is called 'antagonist pairs'. That is, when one group of muscles are contracted and short, the opposing muscle group/chain is relaxed and long. The bicep/tricep relationship is probably the easiest analogy to use here, even though I hate it because it is such an isolated and overused view of human bio mecahnics, but it does make it easy to understand the principle.

When you bend/flex your arm at the elbow, your bicep is the agonist muscles (the mover), which contracts and shortens. While the tricep is the antagonist (or reciprocal) muscle opposing that movement while relaxing and lengthening. Extend your arm again and that is reversed, the tricep contracts and the biceps relaxes. Simple?! This doesn't apply to all muscles in the body, but it certainly applies to the muscles groups which are causing your lower back pain......so anyway......back to the hips.......

The hip flexors are over active and tight from sitting down too much.....so what are the reciprocal (opposing or antagonist) muscles of the hip flexors?  Well, it is obviously the hip extensors, which are primarily gluteus maximus, the big muscle of our butt, and the hamstrings which work with the glutes to extend the hips, when standing, walking and running for example. They are the primary hip extensors! Other muscles facilitate them in that function (or over compensate for lack of function), but these are the big guns which should be doing the bulk of the work when extending our hips. However....we make a very bad habbit of switching these muscles off, both physically and neurologically. That is when other muscles have to step in and compensate and over time, that musclar compensation becomes a hard-wired, or a programmed dysfunctional pattern which will eventually results in pain and injury.

The other key factor in hip dysfunction is the relationship between the abs and the supportive/stabilising back muscles, like quadratus lumborum, multifidi and erector spinae muscles. The abs, transverse abdominus in particular, is another muscle that becomes very weak from spending too much time sitting down. As we slump over our desk with rounded shoulder and a forward tilting head, we are basically switching off our abdominal muscles, which play a major role in supporting the spine. Again, we adapt over time to this dysfunctional pattern causing compensations with other muscles. In this case, the deep and supportive muscles of the back (as mentioned above) are the ones which are forced to compensate for the weak abdominals....and guess what....that is going to start causing some pain and discomfort in your back, especially the lower back.




This same pattern of dysfunction and reciprocal inhibition expands and in very simple terms can be applied all over the body in the common areas of chronic pain.......the relationship between the abs and the lower back,  the chest/pecs and the mid back, and the neck and upper back.



Dysfunction and pain in all these areas, between all these muscles groups, is very common place and it is ultimately down to sitting too much in combination with a lack of movement and true functional strength. I say it a lot, but a huge part of the problem really is with sitting!!

The final piece to relieving your back pain for good, step 3, is building a good and solid foundation for your body with functional strength. Having mobilised the hips, which in turn will facilitate better gluteal activation, now you need to activate those glutes, remind them how to work properly and get them really firing up, but in the relevant context of human movement, i.e. Applied to how we stand and walk. This is actually quite challenging to do properly in the context of efficient human movement, but it is very, very important for the prevention of future chronic pain and injury, otherwise you will just be chasing the pain! To use a cliché........, 'prevention is better than cure'.

Strengthening the supportive abdominal and back muscles is the next step along with the glute activation. All these muscles and groups of muscles need to learn to operate in complete integration, not in isolation - so stop doing crunches to strengthen your abs please, they cause excessive hip and spinal flexion and if you spend a lot of time sitting, are pretty much the worst thing you can do as it just compounds the problems that sitting causes!

Anyway, this is how the body will be re-programmed and re-learn the functional patterns that we all develop as babies, but then are unintentionally forgotten about as we evolve to our sedentary and high tech life styles. Kids slumped over iPads is going to cause big problems for the next generation if ignored!!



Along with yoga, pilates and a specific stretching routine, which are amazing systems for general core strength and flexibility that have obviously been around for years, I have also discovered some new and amazing methods/training modalities for specifically addressing and specifically targeting these areas of dysfunction which I will be sharing in future blog posts.

Hopefully, if you are still reading this, you can start to understand these dysfunctional patterns a little bit and once you start to break down these patterns for yourself and consider your lifestyle and exercise choices (if any), you can start addressing the problems and fix the dysfunctions and imbalances in your own body, with the ultimate goal of improving posture, movement and just generally feeling great!

#ThePowerOfPosture




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