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Editors Note: This article was produced in cooperation with the National Athletic Trainers' Association (NATA), the professional membership association for certified athletic trainers and those who support the athletic training profession. For more information on the NATA, visit www.nata.org
Low back pain is one of the most common injuries suffered by athletes from the professional to the recreational level. Not only is low back pain a very common problem among athletes, it's an injury that impacts others and does not seem to subside completely once it strikes.
Once you experience low back pain, it has a tendency to come back and haunt you. Low back pain is like having a small rock in your shoe that you can't get rid of. When you step on the little rock, it hurts. When the little rock moves to the side of your shoe, you have no pain because you don't step on it. In reality, however, you can't get rid of the little rock, and you keep on stepping on it. Low back pain is like this-it causes pain at times and never really goes away.
Throughout my career as an athletic trainer in professional baseball-and currently at Oregon State University-it's always been clear to me that no matter what kind of athlete you work with, they all want to return to their previous activity level immediately. Unfortunately, low back pain often puts a hold on that, and can ruin a season or a weekend of fun with friends.
Treating the Root Cause
Our Western medical model hasn't been very helpful in dealing with low back pain, because this model is based on treating low back pain as a cluster of signs and symptoms or diagnostic criteria. For example, an athlete with the signs and symptoms of low back muscle spasms is diagnosed with low back muscle spasms.
Needless to say, in this model the cause of the low back muscle spasm is totally ignored, as the focus is on the athlete's symptoms. Research, treatment, and training of these individuals often follows the same model, so in our example, low back muscle spasm often gets treated through stretching, and trained through low back strengthening exercises. I remember the days when the athletes I worked with would become as strong as oxen, able to dead-lift hundreds of pounds, but they still had low back pain. Clearly our classic medical model is missing something when dealing with athletes suffering from low back pain.
Luckily, there are newer models emerging that recognize low back pain as part of a movement system or kinetic chain-the head bone is connected to the neck bone, and so on. One of these models is Kinetic Integrations, which advocates that movement is essential to normal life. Movement is best defined as a change in position of the whole body or its parts. If movement is impaired, movement dysfunction will arise. The cumulative effect of dysfunctional movement will inevitably cause injury. Therefore, the goal of this program is to resolve movement dysfunctions to minimize abnormal stress and disability.
Examining the Kinetic Chain
Movement dysfunction refers to specific movement problems caused not only by injury but by repetitive motions or a sedentary lifestyle. Consider low back pain in the athlete: mounting evidence is showing that people with low back pain exhibit movement dysfunctions. They move differently, to the point that it affects their gait pattern. They'll even breathe differently, and change from chest to abdominal breathing.
Have you ever seen an athlete breathe while bulging their stomach out? I can't even think about that being a productive breathing pattern, or that an athlete can exert power from that position. It's important for sports medicine doctors, athletic trainers and rehab providers working with a physically active or athletic population to identify these dysfunctions and develop an appropriate corrective exercise program.
Movement dysfunctions are normal but inappropriate neuromuscular adaptations to preserve function. Sound conflicting? Think about it this way: 10,000 years ago, a man is walking across an African savannah gathering food. Suddenly, a lion starts chasing him, trying to get a cheap lunch. Luckily, there are some trees ahead of him, but while he sprints to them he steps in a hole and twists his back. Agonizing pain runs through his body. His options are either to stop running and become lunchmeat, or keep running to save his life.
Anyone reading this who's suffered from low back pain will remember how they moved around, twisting their body to avoid pain. Remember how you awkwardly moved in and out of your chair? You created a movement dysfunction to accomplish the task of getting in and out of your chair.
Putting these compensatory movements into a modern sports context, a baseball pitcher suddenly has to dive for a ball during a game. When he lands on the ground, he feels a sudden painful twist in his low back. During the subsequent innings his low back stiffens up more and more. Inevitably he changes his pitching mechanics to get the ball over the plate, and unfortunately hurts his throwing shoulder. Low back pain created a movement dysfunction, forced the pitcher to change his mechanics, and put more stress on his shoulder. One injury led to another.
The Big Picture
So what's the big deal about movement dysfunctions? If we move inappropriately, we fire muscles in a different sequence and change the way we use our kinetic chain. This acquired sequence is different from the norm, and eventually becomes destructive to the body.
For example, in 2007, Zazulak showed that recreational athletes with low back pain showed a more forward-leaning posture, altering their knee mechanics and actually relying even more on their already hurt lower back muscles. He also showed that these athletes demonstrated weakness and imbalances in muscles around the hips and pelvis. In sum, his athletes with low back pain placed a higher demand on weaker, fatigable, unbalanced and possibly inhibited muscles, resulting in further movement dysfunctions and overload on lower extremity joints, the pelvis and the low back.
As an example, athletes with low back pain often exhibit poor stability of their femur. If the femur is poorly stabilized by the hip muscles, it will rotate away from its normal alignment and have a destructive effect on the knee and kneecap. To resolve this problem, athletic trainers and rehab therapists will often prescribe specific hip strengthening exercises that restore normal femoral alignment, thereby taking negative stresses off the knee.
Sports medicine professionals should care about restoring movement dysfunctions. We're in the business of injury prevention, returning athletes to function after injury, and increasing performance. The integration exercises suggested here can help athletic trainers and other health care professionals return their athletes to function safely, prevent injury, increase performance, correct faulty posture, restore stability and normal breathing patterns, and ultimately resolve movement dysfunctions.
Low back pain is a common problem in the athletic population. Research has shown that low back pain is associated with movement dysfunctions. Addressing these dysfunctions will facilitate a more efficient return to activity, prevent reinjury, and optimize function.
Resource
Kinetic Integrations. www.kineticintegrations.com
Guido Van Ryssegem, MS, ATC, CSCS, NBFE, RN, is coordinator and clinical athletic trainer at Oregon State University, Corvallis, OR.
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