A gradually deteriorating back condition
2008
Tightening the stomach muscles to restore the correct posture could alleviate suffering and improve the quality of life for a number of people
Dear Editor
I have suffered with a gradually deteriorating back condition for some 12 years now. Recently diagnosed as chronic, none of the antiinflammatories, pain killers or physiotherapy I’ve been treated with down the years has brought anything but short term relief. Never clinically diagnosed, the root cause of my problem has never been established.
I have been studying my condition in depth and have devised a simple procedure that has brought my condition under control and very effectively alleviated the pain and discomfort. On reaching middle age, many of the structure and support muscles in the abdomen gradually wither and perish, the net result of which is that the correct posture for the spine is no longer maintained and the resultant stresses and strains cause general back pain and discomfort. This can occur with any activity but is greatly magnified when partaking in rigorous or high impact exercise and sport.
The simple action that I now use has proved so effective in relieving all my back problems that I have felt it necessary to broadcast this to a wider audience. In basic terms, by tightening the stomach muscles and drawing navel to spine, the correct posture of the lower back is restored. I'll emphasise navel to spine by muscular contraction and not inhalation which would not be possible when carrying out rigorous exercise. Higher impact exercises such as running, hill walking and circuit training are what caused me the greatest problems. Rarely during the exercise, but afterwards or even the next day chronic back pain would often result. I now keep my stomach muscles tightened constantly whilst engaged in any rigorous exercise and the results have astonished me, no resultant back pain or discomfort at all.
Other activities could also cause me general backache, such as standing in a certain position at work, doing things at home like washing up or even sitting in certain positions. I now tighten the stomach muscles at the first sign of any discomfort as it is not always possible or convenient to stop doing things, but the results have been as effective as with the high impact activities, the discomfort alleviates as soon as I tighten my stomach muscles. I feel that I must emphasise that none of the many doctors I have seen with my back problem has ever suggested what I am about to say, so if my thoughts are already known then they need to be effectively communicated throughout the medical profession.
In conclusion, I feel I must stress that my tightening of the stomach muscles has not just reduced discomfort; it completely prevents or alleviates it in the two instances described. The majority of middle aged and elderly people suffer backache in some form, much of it not clinically diagnosed; therefore I am writing to you because I honestly believe that the simple act of tightening the stomach muscles to restore the correct posture could alleviate the suffering and improve the quality of life for a great number of people.
Mr R
Response
Thank you for your interesting letter in which you have certainly identified a current hot topic in rehabilitation following back pain.
The importance of the muscular system has long been known about within the back pain world. In the early 1990s, Panjabi described a model for a stable spine, consisting of three subsystems that work together: ‘passive’ (bones, joints and spinal ligaments); ‘active’ (muscles); and ‘neural’ (control centre, including the brain). This concept has been used as a foundation on which to build strong research evidence, underpinning the idea of ‘core stability’. This is influencing current practice and many people have reported similar benefits to those you describe.
Much of the research undertaken in this area is perhaps best summarised in Carolyn Richardson et al’s 2004 (second edition) book ‘Therapeutic exercise for lumbopelvic stabilization’. In this book, Paul Hodges et al report a study involving people with a first episode of unilateral acute back pain. They were randomly allocated to two groups – the treatment group received four weeks of localised core stability exercises whilst the control group had non-active treatment. Whilst the pain resolved in virtually all participants, regardless of the group they were in, the results strongly favoured the outcome in the treatment group: at the long-term follow-up, 30% people from treatment group had recurrences of their back pain, compared with 80% in control group. This book, whilst aimed at health professionals, also includes many other examples of important research in this field. Unfortunately it takes time for such research to reach all avenues of health care and change clinical practice.
In BackCare’s booklet, A people’s guide to active back care (see page 12), core stability exercises based on such research are included. The exercises are also taught to all undergraduate physiotherapists so that future practitioners will be able to play a part in highlighting the importance of these muscles in helping people to get on after back pain. Hopefully, this will minimise similar experiences to the one you describe when people with back pain visit health professionals in future.
You are definitely right about the importance of this issue and thank you for raising it!
Lisa Roberts PhD, MCSP,
Senior Lecturer in Physiotherapy, Southampton University