By Dr. Simone Losi
About 80% of the world population suffers or has suffered, at least once in their life, from back pain. This term identifies a complex of symptoms affecting the dorso-lumbar spine, characterized by pain and functional limitation.
For us "fitness" operators, it is therefore essential to have a correct approach towards people suffering from this problem.
Until a few years ago, it was customary to think that a person suffering from back pain had abdominals, or even erector muscles of the spine, very weak .... and then down to do hundreds of crunches and / or hyper extensions, in the intent to give some relief and improve the health of the person.
In reality the question is a bit more complex, because:
the erector muscles of the rachis are hardly weak, since, during the day, they are constantly in contraction; you can verify it by trying to walk and to put a finger on the sides of the spinous processes at the lumbar level, you will notice that at each step these muscles contract.
What does this mean?
That these muscles need to be "stretched" and not "strengthened".
For abdominals the speech changes ....
Often, by doing the toning exercises for the abdominals, you realize that you are actually working and also fatiguing the lumbar area; this is absolutely physiological, as abdominals and lumbar muscles develop from the same embryonic leaflet. For this reason, when training the abdomen there is, inevitably, also the activation of the lumbar part, which is not really desirable for a lumbago, since, as we have said, its spinal muscles are too "short" (retracted) .
Once the anamnesis is over, a series of tests is carried out on the column, both in flexion and in extension, to check the degree of elasticity and any articular blocks, both in rotation and in lateral flexion. The latter are particularly useful for verifying, in the first case if there is an evident discrepancy of mobility on one side with respect to the other, and in the second case the harmony of the curve at the lumbar, dorsal and cervical level.
Obviously in these cases it is very important to use medical and paramedical figures, as the tests are used by us as "Personal Trainer", to understand whether the problem is our responsibility or not.
Let's take an example: if the muscle tests show no problem and we see that, despite this, our client complains of back pain, we can assume a visceral problem; in this case, using a gastroenterologist can help.
If, on the other hand, obvious joint blocks emerge from the tests, an Osteopath or Chiropractor can be an excellent aid to our work.
If, on the other hand, we experience obvious muscle retractions, etc. that the "our" task will be to lengthen the muscles subject to shortening.
When back pain is linked to a lumbar problem, we often find the following muscles retracted: psoas ileum, square of the loins, paravertebral, and diaphragm.
When the pain involves the loin sacral area, therefore a little lower, the following muscles are often retracted: piriformis, internal and external obturator.
However, in both cases the poor mobility of the pelvis is often the main cause, a cornerstone of the ascending (from the bottom up) and descending (from top to bottom) forces.
But many other important muscles are inserted into the pelvis which can indirectly be the cause or cause of back pain (tensor fascia lata, sartorium, rectus abdominis, transverse etc ..).
So we find ourselves again having to think, as it should be, of the body as a whole.
Pain is an important alarm bell that signals us that something is wrong, but focusing attention only and exclusively on the point where there is pain is limiting; it is necessary to control all the muscles that are inserted at that point, the muscle chains that pass through it, then also use the global lengthening methods to find the cause of the problem.
