November 20, 2017
Erick Mojica – B.S Kinesiology
One of the most common injuries to both athletes and non is the lower back simply because of our anatomy and how we use it (often misused). The lumbar spine is connected to the sacrum and pelvis, a network of muscles, bones, and connective tissue that is responsible for almost every movement that involves the legs and spine. From walking, exercising, and even sitting all of those parts have something to do with what we are currently doing- carrying a majority of our bodyweight.
The network of the Lumbo-pelvic Hip Complex that I am talking about begins with its bone structure. From the top you have your Lumbar Spine which consists of 5 vertebrae cushioned with intervertebral disks labeled L1-L5. This structure connects with the sacral curve and other forms of connective tissue. To finish this network you also have the pelvis connected in which it sits on the femur in a ball-and-socket joint allowing a wide range of motion at the hip.
Now when referencing the all the muscles of this Lumbo-pelvic Hip Complex, I like to use the analogy of sticks and rubber bands connected all together. In order to have motion at any joint, the muscles have to either contract, elongate, or relax. In order to move a limb in a particular direction, the muscles receive a message from the nervous system to do either of the three in an efficient manner to provide “optimal movement.” I say “optimal” in the sense of having a full range of motion with minimal-to-none discomfort or pain. The reason we feel tightness/pain in our back, hips, and legs is because we have overactive and underactive muscles (rubber bands) that are not pulling the bones (sticks) efficiently. Depending on your activity level or lack thereof, the connective tissues and joints can get worn out because there are imbalanced forces acting upon them. Still with me?
When we have tightness, discomfort, pain in our lower back, there is an extremely high likelihood that we have a muscle imbalance within this body region. How do these imbalances happen? Well mostly because of inefficient joint movement and improper contraction of the muscles that are used. While what we feel is in the lower back, the root of the problem can often be found in the region below.
In a previous article “The Injury Bug,” I talked about my experiences with a herniated disk. After the MRI results the two doctors I saw confirmed the diagnosis of the disk herniation of the L4-L5. After a progressively worsening back pain that lasted for about a year, I finally had an answer for structural damage.
The original approach was to deal with the inflammation and nerve irritation through medication and physical therapy to strengthen the muscles in my lower back. After the 6 week period the pain worsened and it had expanded to my right hip, eventually a numbing pain down my leg. After further evaluation, the MRI also showed Femoral Acetabular Impingement (FAI), a dysfunction at the hip joint likely from a tearing of the labrum in the right hip. Remember the anatomy of the ball-and-socket joint? Well with any basic movement at the hip joint there was a constant pressure and grinding of the labrum. The reason that this information was so important was because it helped explain a number of questions that weren’t asked from the very beginning.Now that we knew that there was a structural issue at the hip joint, we were able to explore what movements were limited and what muscles were overactive and underactive. When it came to basic pelvic movement, we discovered that I had an anterior pelvic tilt, making it extremely painful to shift my hips into a neutral position. This helped explain a probable cause for lumbar disk herniation because the pelvic tilt was putting pressure onto the vertebral disks. When we tested hip flexion with the Dead bug exercise, we discovered that my right hip was externally rotated while my left was internally rotated. Not only did this tell us that both hips had a very improper alignment, but that there was an extreme muscle imbalance to the hip abductors and adductors.
In terms of a rehabilitation program, we knew that surgery was the only way possible to “fix” the damaged connective tissues, and even with it there was no guarantee that it would fix the entire problem (that of muscle imbalances and movement patterns). Once the structure of our anatomy is damaged we can improve its function but can rarely ever restore it to its original “100%” structure. Because of inflammation and possible nerve damage from the spinal cord down to the right hip, pain management and corrective exercise was the best option. So what did we decide to do? We started by getting the hips realigned through chiropractic adjustments. This helped fix the positioning of the sticks but we had to consider how we changed the tension of the rubber bands. Corrective exercise involved a lot of glute activation and more so of the weaker muscle groups (abdominals, hip flexors/extensors and abductors/adductors). Over the span of 3 months of daily corrective exercise the muscle imbalances tested at a much lower rate than it did in the beginning. Throughout my senior season I still experienced pain and discomfort but it was enough to get me back on the field for a daily frequency.
So does my case study make a general point for lower back pain? I think that it does. The structural damage and muscle imbalances vary from person to person so no rehab program should be alike. Several studies have shown fairly similar traits in terms of improving these inefficient movement patterns to alleviate lower back pain and discomfort. People respond differently to different treatments such as chiropractic adjustments, acupuncture, physical therapy, and rest. But at the end of the day muscle imbalances attribute to a majority of structural issues to the body. I think that is why there are skeptics towards chiropractors (I was one!) because of the notion that you have to continually get treatments. If a good chiropractor can realign your body, those adjustments can only last as long as the body allows it to maintain those proper positions and posture. This is why I am so adamant in finding the root of the problem rather than fixing the symptoms. So if you are experiencing lower back problems ask yourself this question, “Is my injury only where I feel the pain?” If so we have to be willing to explore the biomechanics of basic movements to find all the pieces to the puzzle. There is a lot that does into it and is why it is important to explore the entire body. In terms of having a hip issue, there is always a possibility that the root of the problem is in our knees, ankles, and feet. For example, a sprained ankle can lead to compensation when walking or running, which can ultimately impact how we apply forces to the hip joint. A simple change in movement patterns can affect the entire chain of movement!
So if you are experiencing any issues I highly recommend that you get yourself a solid team of health professionals that can help you understand what your body is doing. Such a team should consist of doctors, physical therapists, chiropractors, corrective exercise specialists, and even certified personal trainers. Research your symptoms through credible sources and find the greatest amount of information possible to take initiative of your injuries. Once you do all of that, you are halfway there towards moving and feeling better!
The term “We” in this article references my doctors and physical therapists, professors and classmates in my Clinical Kinesiology class at Avila University as well as the athletic training staff and strength and conditioning coach. From evaluations, discussions, and answering all of my questions, this team helped make it all happen. Thanks!!!