Low back pain is a very common condition and when we talk about its causes, one area which is often under looked or neglected is weak abdominals. Our Trunk muscles consist of back extensors, that bend the trunk backward, lateral flexors that bend it sideways, and anterior abdominals that bend it forward.
Low back pain is often a resultant of weak core muscles or a faulty posture resulting from weak muscles. Now fortunately, marked weakness of these muscles is very seldom. In persons who have faulty back posture with roundness of upper back, weakness may exist in the extensors of upper back, but low back muscles are seldom weak. they are often tight, and it is the abdominals which are on the weaker side.
To check the strength of abdominals usually trunk raising test is done, although it is a valuable test for checking the strength of upper abdominals, however it doesn’t predict lower abdominal strength accurately for which a different test is used. From the standpoint of good posture, the lower abdominals are more important than the upper, as it helps in holding the pelvis in posterior tilt with low back flat.
Double leg raising test is done from supine position to test lower abdominals strength. No abdominal muscles cross the hip joint, so these muscles cannot assist directly in the leg raising movement. Although in order to perform double leg raising from supine position, the pelvis must be stabilized in some manner. Although the abdominal muscle cannot enter directly into the double leg raising movement which is done by hip flexors, the strength or weakness of these muscles directly affects the trunk position and the way in which the pelvis is stabilized. Leg raising through hip flexors tilts the pelvis anteriorly . The abdominals muscle pull upward on the pelvis in the direction of tilting it posteriorly. So if the abdominals are weak, the pelvis tilts anteriorly as legs are lifted. As this tilt occurs, back hyperextends, often causing pain, and the weak abdominals are put on a stretch and vulnerable to strain.
Strength is graded based on the ability to keep low back flat on the bed or plinth while slowly lowering both legs from vertical 90 degrees. The angle between the extended legs and table is noted at the moment the pelvis starts to tilt anteriorly and the low back archs from the table. It is interesting to know that men have advantage in the leg lowering test and women have advantage in the trunk raising test.
Back pain relief exercises must include abdominal strengthening exercise too, focusing on getting posterior pelvic tilt. To do the posterior pelvic tilt correctly, lie in supine position, tilt the pelvis to flatten the low back on the table by pulling up and in with the muscles in the lower abdomen, avoid contracting gluteal. Hold the low back flat and breathe in and out easily, relaxing the upper abdominals. Make it appear like chest expansion, hold it for few seconds and then relax. Repeat 10-15 times. Another exercise is with knees in flexion, Tilt the pelvis by pulling up and in the muscles of lower abdomen. Try to breathe in and out 3-4 times while feet slide down and return to bent position, sliding one at a time.
Some common causes for weak abdominals are prolonged hours of sitting, pregnancy related stretch on lower abdominals, poor posture. Now we understand that to get pain relief from low back pain condition, along with strengthening of back extensors, lower abdominal strengthening exercises are also crucial in ensuring proper pelvic stability and hence pain relief. Book your physiotherapy consultation visit with us today and learn about our customized back strengthening program. We offer physiotherapy near you in Chandigarh and Mohali.
