Low back pain is unfortunately a very common complaint that I see as a physiotherapist. It can affect up to 84% of people throughout their lifetime and is the fifth most common reason for seeing a family doctor. I always thought we could blame it entirely on desk jobs, as sitting is “the new smoking”, but in reality they are equally as prevalent in manual labourers. This achy dull persistent pain is often the bane of our existence but I have some information that will help you.
Have you heard about relieving back pain through strengthening your spine, core and pelvic floor? There are three main muscles that stabilize your spine. One of them runs along either side of your spine, the multifidus. The second is the deepest layer of muscle in your abdomen called the transverse abdominis. And the third is your pelvic floor, which as the name suggests, supports the bottom of your pelvis. These three muscles, when working properly, hug and support your spine. More often than not these muscles get deconditioned and fall into the shadows of the bigger and stronger “moving” muscles. The first step to retraining these stabilizing muscles are to find and contract them individually.
The multifidus is one of the paraspinal muscles that are found deep in the spine. It occupies the groove between the vertebrae and under normal function, engages prior to spinal movement. It’s often a tricky muscle to try and feel, or palpate, without guidance from your physiotherapist but if you’re up for trying it this is how I suggest you try to find it. Lay on your side with your knees bent. Keep your spine in neutral, reach behind and find a spot of your back that feels bony. This is the spinous process of one of your vertebra. Let your finger gently slide off that bony marker (left or right) until you feel a little groove. This is where the multifidus is located. In order to contract the muscle, you will do the slightest movement of your pelvis as if you’re trying to push your buttocks behind you. If you do this correctly, you will feel the muscle fill the groove that your finger is touching.
The next spinal stability muscle is the transverse abdominis. It hides beneath three other abdominal muscles: rectus abdominis, internal oblique, and external oblique. It spans horizontally from the midline of your abdomen around to the thoracolumbar fascia (connective tissue in your lower back). This muscle helps to support the abdominal contents, control the pressure of your abdomen, and stabilize your spine. To palpate this muscle, lay on your back with your knees bent. Put both of your hands on your hips and feel the front of your pelvis. You will feel two bony prominences. These are called your anterior superior iliac crests. Once you have found them, slide your finger one inch IN, and one inch DOWN. This is the only place you will be able to find the transverse abdominis. Now, to contract. The easiest thing I tell my clients is to slightly draw in your belly button. This will be the ever so slightest movement, and is easier to contract if you coincide with an exhale.
And finally, the most interesting of them all, the pelvic floor muscle. This muscle lines the bottom of your pelvis from front to back. It acts as a bottom to the cylinder of spinal stability muscles. This muscle contraction is done without palpating but rather talking through how it should feel. For ladies, it will be through a kegel exercise. It feels as if you were to sit on a marble and you were trying to lift it up. For men, this contraction would feel it would if you were to jump into the freezing cold ocean. This will also be a sensation of drawing upwards. The most important part that I always focus on is the relaxation of this muscle. Yes, the contraction is important, but you should be able to fully relax too. Often incorporating relaxing with an inhalation, and contraction with exhalation.
Like I mentioned earlier, the first step to getting these muscles working properly is being able to contract them. Then we will start to contract them together, often adding two together before all three. Once you have mastered that, we begin to add movement to the body, for example sliding a leg straight out in front of you.
I hope you enjoyed reading a bit about these muscles and how they work together to support your back. Please do not be discouraged if you were unable to palpate or contract either one! It takes time and focus, and often one on one training with a physiotherapist. If you are someone who is suffering from back pain and you are interested in seeing a physiotherapist to improve the strength of your spine, I provide assessments and therapy for patients throughout the week. We have a great team of health care professionals with a variety of skill sets and are passionate about decreasing your pain and improving your quality of life!