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Lower back issues

Susan2012-05-22 19:25:59 +0000 #1
I have been having issues with my lower back for years. First, it was only noticable when I had "overdone" it - heavy garden work, extra long hikes or something like that. Over time it became a chronic issue. My back bothers me, no matter if I am standing, sitting or even lying in bed. It's in the lumbar region and doesn't go down into my legs. I have a very stiff back (the lower part won't bend at all) and very tight hamstrings (can't reach my toes bending down).

Knowing that back pain is mostly cured by training the muscles around the problem area, I tried to work on it by myself, but mostly because I didn't know what exacly I should do without making it worse, I asked my doctor about it and she prescribed 14 PT sessions and massage.

I really hoped that this would at least result in some pain management, but 2 month after starting the PT sessions I have to say, I don't notice any change to the better. If anything it got a little worse. Because it was so bad for some days in the beginning (which was, according to the PT, normal) that I could hardly move, I tried some exercies from a book called "Foundation training", that DH brought home. It has some routines for strengthening the back muscles. If I do the routines, I really notice some pain relief.

Here is what bothers me: the exercises in the Foundation book seem to contradict the exercises I got from the PT.

My PT told me to "tuck my tail" (sorry but I just can't figure out what tilting the pelvis "backwards" or "forwards" means - I always confuse them) for most exercises - there where some for the lower abs, some lying on my stomach, some sitting on a Pezzi ball and stretching exercises while standing. To come back from a bend down position for example, she told me to bend my knees, tuck my tail, and come up in a "rolling" movement.

This movement with tilted pelvis hurts my back, but I though maybe this was necessary to get improvements.

The Foundation book basically tells me to do the opposite - extending my back and bending my knees when I bend down. Very similar to what you do when you do squats in weight lifting (if you don't know what I mean, there are some videos on their website: foundationtraining.c...e_learn_how_to_move/ ). Coming back up from a bend over position you try to keep your back extended.

Since the Foundation exercises feel good and seem to help, I went on doing them, but still, I'm confused about the two different approches. From my understanding, I must do something wrong in my everyday movement patterns, else my back wouldn't hurt so much (so I'm not convinced that I know what is best for me, I can't go just by feel). But am I supposed to "tuck my tail" to protect my back, or do the opposite? The natural curve of the spine goes inward in the lumbar region, doesn't tucking your tail bend this part in the wrong direction (or is this wrong direction on purpose, some kind of stretching move?).

If I have to lift heavy things (like garden soil or kids )- what is the right movement pattern? Can I safely assume that I do it the same way as squatting, with extended back?

I'm only 33 (and on some days my back makes me feel a hundred years old), and really fear to not be able to move at all some day, if I don't get this sorted out.


OakLeaf2012-05-22 19:34:07 +0000 #2
There are McKenzie therapists in Austria: www.mckenzie.at/ . Don't know if any of them are near you. I would definitely see if you can connect with one of them.
e3rdpower2012-05-22 20:10:14 +0000 #3
I am a PT, but I do not diagnose via the internet

Having said that, everyone is built and moves a bit differently. "Tucking your tail" may be your PT's way of getting you to engage your transverse abdominus. There are many ways to skin that cat, and the Foundation program is very solid and gets you to engage very well. Essentially Foundation teaches you to stabilize your spine in a neutral (for you, which varies from person to person) position while you complete tasks. Very safe, and an excellent way to move.

Pain is by no means necessary to see improvement. Talk to your PT, let them know your concerns, and tell them about the benefit you feel with Foundation. It's an very well thought out and good program.

Good luck!
Kathi2012-05-22 20:36:49 +0000 #4
I too have had lower back pain coupled with SI joint issues. For various reasons I've seen 4 pt's for this issue. The last PT, a woman, identified my low back as flat, no natural curve, and very stiff. Much like you're describing.

All my therapy involved gaining mobility in my spine. While I still have some pain at times I can definitely see an improvement. Because I had so much pain from the SI joint and also have the stiffness in the morning, I sleep with a small pillow under my knees while on my back or between my knees if I'm on my side. This has really reduced the morning stiffness. I also use a lumbar support pillow when riding in the car. Mine are inflatable and I can adjust them to fit my comfort needs.

Your video seems to follow what my PT told me. I also found this website. hab-it.com/blog/?p=55 There's lots of valuable information here on how to strengthen the important muscles of the low back. Read through the entire blog, including the answers. Sometimes, there are exercises included in the answers that are helpful. I found that keeping the tailbone "up" really has helped my pain and my posture. The other exercise I found is laying on your stomach for a few minutes with your head on a pillow. At first I had to put a pillow under my hips as it hurts my SI joint but it really calmed my muscles.

Hope this helps, I know how frustrating it is to have low back pain.
OakLeaf2012-05-22 20:46:57 +0000 #5
I should add that my McKenzie therapist who treated me for related troubles last year prescribed glute strengthening exercises along with (initially twice, then once) daily press-ups, knee to chest and supine twists to improve my lumbar mobility. I've had bad experiences with PTs too in the past, but my sole experience with a McKenzie therapist plus the excellent advice here on TE has me a believer.
Kathi2012-05-22 20:28:14 +0000 #6
My PT said that changing the position of the low back is difficult, some people never get it and it can take up to a year for things to settle down. I have to constantly think about the position of my tailbone and hips.
Kathi2012-05-22 21:41:06 +0000 #7
One PT had me doing knee to chest stretches too, which didn't make sense because that's the way I could bend. It's the other direction, tailbone up, I couldn't bend. I also read, not sure if it's true but makes sense, that a flat back, or tucked tail, opens the SI joint which can get one in the situation I'm in. I do notice that when I tuck my tail my SI joint starts "talking to me".

My SI gets out of whack about every 6 mos and has to be adjusted so we'll see if this "new" position works.

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