For many years, therapists, trainers and other fitness experts expounded the benefit of stretching, especially when it came to low back ailments. As a young therapist, 25 years ago, certain routines of stretching were commonly prescribed for low back pain. Whether stretching into extension, which arches the low back, or stretching into flexion, which rounds the low back, dynamic stretching or static stretching were most commonly prescribed. Core strengthening or spinal stabilization exercises were not terms defined at that time.
With the introduction of advanced imaging such as the MRI, more specific diagnoses are made. As therapists we now see clients who have confirmed stenosis, a narrowing of the spinal canal, degenerative disc disease, a narrowing of the disc space and herniated discs or migration of the disc from its central location between the vertebrae. MRI reports may indicate any of these three findings at a specific level or numerous findings at various levels. Most of my clients are retired, 65 or older, and their MRI reports have lots of information at all levels of the lumbar sacral spine. The most prevalent finding is degenerative joint disease.
So, where do I start in prescribing a therapeutic exercise program. Even though pathologies can be the same based on MRI data, a physical exam during a physical therapy evaluation is crucial in defining impairments and functional limitations. Each individual differs in presentation. Even though we all have the same joints, muscles and nerves, we still all have different histories, different postures and different stressors in our daily lives. And we all also have different goals. Out here on the North Fork the two “gs” — golf and gardening — lead the list as far as goals for my patients.
Here is a simple exercise that can give you information about your own flexibility and stability. Reach up to your highest cabinet with your dominant arm, keeping both feet on the floor. Can you use the motion in your shoulders to retrieve an object or do you have to arch your back to gain more height? If you had to arch your back you may have tightness in your shoulders leading to overuse in your neck and low back while performing this activity. In this case stretching the shoulder soft tissue structures may have to be instituted before core stabilization exercises are prescribed.
Spinal stabilization exercise or core strengthening exercise are safe in almost any pathological condition. Strengthening small muscles around the spine enables the body to absorb shock better through activities of daily living such as golf, gardening or even vacuuming. However, stability exercise may be difficult and even painful if there is excessive tightness in the shoulder and hip musculature. Therefore, it’s imperative that a complete fitness evaluation be performed to determine if flexibility exercise should first be instituted into an exercise plan for chronic low back pain.
Denise Plastiras is a physical therapist at Maximum Performance in Greenport.