Introduction
About 80% of the world population suffers or has suffered, at least once in their lifetime, from back pain. This term identifies a complex of symptoms affecting the back-lumbar spine, characterized by pain and functional limitation.
For us "fitness" operators, it is therefore essential to have a correct approach towards people affected by this problem.
Until a few years ago, it was customary to think that a person suffering from back pain had very weak abdominals, or even erector muscles of the spine ... and then down to do hundreds of crunches and / or hyperextensions, in the "intent on giving some relief and improving the health of the person."
In reality, the question is a bit more complex.
Muscular component
The erector muscles of the rachis are hardly weak, since, during the day, they are constantly in contraction; you can verify this by trying to walk and to put a finger on the sides of the spinous processes at the lumbar level, you will notice that with each step these muscles contract.
What does it mean? That these muscles need to be "stretched" and not "strengthened".
For the abdominals, the situation changes. Often, doing the toning exercises for the abdominals, you realize that in reality you are also working and straining the lumbar area; this is absolutely physiological, since abdominal and lumbar muscles develop from the same embryonic sheet. For this reason, when training the abdomen there is, inevitably, also the activation of the lumbar part, which is not really desirable for a lumbago, since, as we said, his spinal muscles are too "short" (retracted) .
So the approach to a client suffering from back pain must be very precise; the "initial anamnesis becomes fundamental to understand if the pain is" point "(trigger point?), if it radiates towards the" radicular "leg (nerve root?), if it is spread over a wider area (visceral?), if the pain is on the spinous (rotation?), or on the transverse (many muscles are inserted in this vertebral area).
At the end of the anamnesis, a series of tests are carried out on the spine, both in flexion and in extension, to verify the degree of elasticity and any joint blocks, both in rotation and in lateral flexion. The latter are particularly useful for verifying, in first case if there is an "evident discrepancy of mobility on one side with respect to the other", and in the second case the harmony of the curve at the lumbar, dorsal and cervical level.
Obviously, in these cases, making use of medical and paramedical figures becomes very important, since the tests are used by us as "Personal Trainers", to understand if the problem is within our competence or not.
Let's take an example: if the muscle tests do not show any problems and we see that, despite this, our client complains of back pain, we can assume a visceral problem; in this case, using a gastroenterologist can be of help.
If, on the other hand, the tests reveal evident joint blocks, a physiotherapist can be an excellent adjuvant solution.
If, on the other hand, we experience evident muscle retractions, etc. that "our" task will be to re-lengthen the muscles subject to shortening.
When back pain is related to a lumbar problem, we often find the following muscles retracted: ileus psoas, quadrate of the loins, paravertebral, and diaphragm.
When the pain involves the lumbar sacral area, therefore a little lower, the following muscles are often retracted: piriformis, internal and external obturator.
However, often the main cause is, in both cases, the poor mobility of the pelvis, the cornerstone of the ascending (from the bottom to the top) and descending forces (from the top to the bottom).
But many other important muscles are inserted in the pelvis which can indirectly be the cause or contributing cause of back pain (tensor fascia lata, sartorius, rectus abdominis, traverses, etc.).
So we find ourselves again having to think, as it should be, of the body as a whole.
Pain is an important alarm bell that signals that something is wrong, but focusing attention only and exclusively on the point where there is pain is limiting; it is necessary to check all the muscles that are inserted in that point, the muscle chains that pass through it, then also use the global stretching methods to find the cause of the problem.
