BACK PROBLEMS: REFERRED PAIN

Many people come to class complaining of discomfort or pain in their legs, thinking that they have pulled or strained a muscle and are surprised to learn that it may well be a back problem which is causing referred pain.  Most of us have either had sciatica or understand the idea that it is something to do with the back, not a pulled muscle in the buttock.  With a herniated disc, for example, this pain can travel right the way down the back of the leg and originates from the bulging disc irritating the sciatic nerve.  The same is true of other nerves: there are nerves all over the body and depending on which one is being irritated will depend on the area you will feel this referred pain. 

Spinal Cord and Nerves 

The spinal cord comes from the brain and is housed by the spinal canal which helps protect this delicate organ, together with the cerebral spinal fluid.  The nerves branch off the cord and exit through the foramen, gaps at the side of each vertebra, making their way to parts of the body and organs, transmitting information to and from the brain.  The cord and brain make up the central nervous system, whilst the nerves connecting the cord to the body make up the peripheral nervous system.  The nervous system is responsible for all movement, function and sensation of the body.  The spinal cord ends roughly around the first couple of lumbar vertebrae and the rest of the nerves hang down in a bundle, like a horse’s tail (cauda equina).  Each  nerve has a protective sheath around it, extending just beyond the spine, but any changes in the facet joint or the disc can cause contact, causing the nerve to become inflamed.  This causes pain, for example, sciatica. 

The Torso Muscles 

In Pilates, these muscles are sometimes referred to as the corset muscles because this is exactly the way in which they act, running vertically, laterally and diagonally.  Without these muscles, the spine would collapse in a heap.  Research is ongoing as to how best to exercise these muscles, but one thing everyone agrees on is the importance of strengthening them and keeping them strong.  The major muscles involved make up what is known as the core:-

Avoid back problems: Pilates will create a girdle of strength by toning the core & torso muscles

• Rectus Abdominus:  These are the “six pack” muscles, clearly visible in mostly male athletes, running down the centre of the body from breast bone to pubic bone.  They can separate during pregnancy.  A good example of a Pilates exercise to strengthen them would be the roll up.  Their role is to support the spine when flexing (bending)
• Obliques:  These muscles wrap themselves diagonally around the body – external around the ribs, internal roughly from hip to pubic bone.  The side planks work these muscles very effectively in Pilates.  They offer support when rotating (twisting).
• Transversus Abdominus (TA):  The deepest layer of muscle, offering stability to the spine, a bit like a weight belt and running laterally.  In Pilates, these are referred to as the core muscles and great emphasis is placed on strengthening these muscles – 100, single leg stretch, front plank – and using them in our daily lives.
• Pelvic Floor:  Running like a hammock from the pubic bone to the tail bone, strong pelvic floor muscles keep the uterus, intestines and bladder in place.  They work with the TA and MS in a co-contraction to support the pelvis and spine.  Pelvic floor and exercises
• Multifidus Spinae (MS):  The most important of the spinal muscles, a deep layer running either side of the spine and very much in control during bending, almost pulling each vertebra back up and restacking.  Works very closely with transversus. 

Strong abdominal muscles, together with a co-contraction with the back muscles work to keep the spine upright.  A strong contraction during bending offers the lumbar area good support (a bit like filling up a space as you suck back the abdomen) and allows the ligaments to do their job in stabilising the spine.   During bending, it is essential that the muscles of the torso, including the back muscles, are contracted first to stabilise the spine and control the movement.    

So you see, it is essential to strengthen the torso muscles and use them during movement to avoid back problems.  Poor posture and a sedentary lifestyle have contributed to a breakdown in the corset muscles and this is often the first stage of a back problem.  The featured video (also here http://www.youtube.com/watch?v=eZOOHQzos8s) this week shows the Twister which targets all the core muscles, but if you haven’t done Pilates before, please do not attempt it.  Download the Beginners Pilates course and learn safely from the very beginning.