Sports Injury & Performance Care – Orange County, California

Low Back Pain & ART®

Low Back Pain – Active Release Techniques®

Dr. Sebastian Gonzales D.C., C.S.C.S., ART , Orange, California

Low Back Pain: What can you do about it?

What most people have been told about Low Back Pain
Low Back Pain and the Modern Era
Why prolonged sitting causes Low Back Pain
Why Weak Gluts cause Low Back Pain
Gluteus Maximus Reeducation leads to a decrease in Low Back Pain
How Active Release Techniques can help with resolving my Low Back Pain

It seems like low back pain has plagued every person at one time or another throughout their lives, at least if they are over the age of 30. It seems to just be one of those things that come along with age and it seems to happen to every person more than once. In fact, one of the most common predisposing factors of getting back pain is to have a history of previous back pain. This statement is a no brainer, but if you think about the reasoning behind the reoccurring episodes, you might wonder why this happens over and over again.

What most people have been told about Low Back Pain

In the past, many people have been told their back pain was primarily from a disc herniation or even a short leg. The reasons are all valid reasons and they can all cause back pain, but are they the main cause of your back pain, most likely not. Disc hernations are rather common in the general population and I wouldn’t doubt everyone has some degree of a herniation, but fact is not all of these people experience back pain. Only when pain is experienced will someone look to an MRI of the back and spot the herniation as “the culprit.” Short legs can be identified in patients with low back pain as well, but I would totally expect that when the person walks in crooked. The discrepancies in leg length can truly be structural in some cases, but in most causes it is caused by asymmetrical contraction of muscles of the hip or truck. Go ahead and stand up on both of your feet where you are and visualize this concept for yourself. Lean on your right foot slightly more than the other. Next contract the left side of your abdomen/truck, in an effort to raise your left hip and foot off the ground. If you look down, you now have a left leg which is about 1 inch shorter than the other leg. Based on this alone, I would call the difference in leg length secondary to the pain, but I certainly would not call it the primary cause. So what causes most people’s low back pain? Sitting.

Low Back Pain and the Modern Era

Most jobs today require sitting, not just for a little while, but all day. Same thing with schools, student athletes sit all day and then get out on the field and trying to make big plays. When most people come home from work, what do they do? They most likely sit down, eat dinner, watch the television, or surf the internet, and this is all after they sat in traffic. Again, sitting all day is the primary cause. Now, don’t put the article down just yet, there’s more to it than just that. I will explain all of the reasons why your desk job is evil and how to combat any low back pain you might have currently or is waiting for you just around the corner.

Why prolonged sitting causes Low Back Pain

Anatomical View of the Leg and Hip from the Front of the body. Hip Flexors: Psoas Muscle (at the top of the leg) and the Rectus Femoris (the bright red muscle)

When you are seated for long periods of time, your hip flexors (AKA psoas muscles) are constantly in a shortened, contracted state. This is bad news for two reasons; first off, when you get up from the chair, this is the reason why you have a hard time standing up straight right away. Secondly, when your psoas are being contracted, this makes it impossible for your gluteus maximus to be contracted at the same time. This is known of the Law of Reciprical Inhibition, you can visualize it better with your elbow. Imagine your arm being casted with the elbow bent at a 90 degree angle. After months of being in that same position, the biceps will be constantly contracted and the triceps will be slack and neurologically “turned off” from disuse, after the cast is removed. This is the same thing that happens to the gluts, they are “turned off” from hours of disuse while in a seated position; this is a central nervous system adaptation. The reason this is significant to your low back pain is because the normal muscle firing pattern for hip extension is altered.^2,5 A study in 1998 found significantly greater weakness and fatigue in the gluteus maximus of chronic low back pain patients when compared to healthy patients.¹

Why Weak Gluts cause Low Back Pain

Normally the gluts are the main muscles propelling you forward during walking and running; when it is no longer available to perform its job, other muscles pick up the slack and help out more than normal. This is a problem because the other muscles are not as good at extending the hip as the gluts, due to their muscle orientation. So to get to the point, the other muscles compensating for the gluts become tighter and increase their risk for injury; a few of these muscles are the hamstrings, low back muscles and the external rotators of the hip. This is why tight hamstrings and low back muscles are correlated to low back pain; they are trying to the glut’s job.⁴ A cohort study was conducted in 2001, which could predict the need for treatment of low back pain in female collegiate athletes, based upon a difference in strength between the right and left hip extensors, or gluteus maximus.³

Gluteus Maximus Reeducation leads to a decrease in Low Back Pain

How this dysfunctional firing pattern can be corrected is by the use of glut firing exercises. These exercises are generally lack weight and performed on a daily basis, unlike glut strengthening exercises. Again the first goal in correction of the firing order is to “turn on” the gluts, and then strengthening can occur, by the use of step ups and straight legged dead lifts. A few exercises I recommend are the Cook Hip Lift, Pelvic Bridges and Bird Dogs, however the problem many people come across in trying do these exercises is the that they still have a great amount of back pain, this is because the hyperactive muscles, like the psoas, hamstrings and external rotators, have not been inhibited or relaxed.⁴ The first step before the exercises are initiated should be to relax the tightened muscles; this will yield the greatest benefits from the glut firing exercises. Stretching these muscles throughout the day can definitely help you in the right direction, however if this doesn’t work then Active Release Techniques® is my best recommendation. I know this from personal experience.

How Active Release Techniques can help with resolving my Low Back Pain

Active Release Techniques® (ART®) is a great and relatively new way to quickly decrease back pain and address the issue of muscle tightness, by removing adhesions built up within the muscles. This is the first stepping-stone in getting back a normal hip extension firing pattern, and resolving low back pain forever. Providers of this type of soft tissue treatment are trained to feel abnormal texture and tension within muscles, ligaments, tendons and nerves. ART® is so precise that it specially addresses over 300 soft tissue structures in the body, based upon their biomechanical actions and orientation in the body. Together with the use of Active Release Techniques® and glut firing, I feel most people will radically decrease their low back pain.

For more on Active Release Techniques® or to find a provider in your area: www.activerelease.com

1. Kankaanpaa, M., Taimela, S., Laaksonen, D., Hanninen, O., & Airaksinen, O. (1998). Back and hip extensor fatigability in chronic low back pain patients and controls. Archives of Physical Medicine and Rehabilitation, 79(4), 412-417

2. Leinonen, V., Kankaanpaa, M., Airaksinen, O., & Hanninen, O. (2000). Back and hip extensor activities during trunk flexion/extension: Effects of low back pain and rehabilitation. Archives of Physical Medicine and Rehabilitation, 81(1), 32-37.

3. Nadler, S. F., Malanga, G. A., Feinberg, J. H., Prybicien, M., Stitik, T. P., & DePrince, M. (2001). Relationship between hip muscle imbalance and occurrence of low back pain in collegiate athletes: A prospective study. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists, 80(8), 572-577.

4. Patel , Brijesh. “Hamstring Dominance.” MichaelBoyle.biz. Friday, 22 December 2006. 18 Apr 2008 <http://www.michaelboyle.biz/joomla/content/view/66/34/>.

5. Vogt, Lutz, Klaus Pfeifer, Winfried Banzer. “Neuromuscular control of walking with chronic low-back pain.” Manual Therapy Volume 8, Issue 1(2003): 21-28.

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