Lower back, knee, and shoulder pain rank among the top contributors to hindrances to functional movement and participating in physical activities we enjoy. Sitting at desks all day or mustering through routines of manual labor can cause us to ignore our body’s pain points. After logging off the work scene, physical pain from previous injuries or current musculoskeletal conditions can become a prominent presence. An after-dinner walk with our spouse, playing a round of tennis in the afternoon ladder league, or throwing a ball with our dogs or playing catch with our children and grandkids are a few examples of recreational physical activity that many people look forward to after checking out from a day of rigorous labor at their jobs. However, when pain presents itself in an area of the body at the end of the day, entering into another physical activity is a crossroad that people afflicted with chronic musculoskeletal maladies commonly turn away from.
Joint, muscle, or nerve pain are a few examples of the issues that affect areas that seem to see more injuries. Along with the knees and shoulders, problems in the spine seem to be a top contender for causing debilitating pain. Back pain can be as severe as a spinal compression fracture or a bulging disc, or as simple as sleeping in an unusual position that causes tightness in a small muscle attaching to the spine. Both can derail a person’s daily quality of life by causing fear and anxiety that a specific movement might trigger constant, sharp, and searing immediate pain. A symptom we see commonly with our personal training clients is sciatica, which is a true “pain in the butt,” both literally and figuratively.
To understand the cause of sciatica, it’s worthwhile to appreciate the anatomy of the area in which the problem arises. Networks of nerves branch off each portion of the spine. A nerve plexus is a network of nerves budding out of the lateral openings of joints in the spinal column. The cervical plexus provides connections to the head, neck, and shoulders. The brachial plexus innervates the chest, shoulders, arms, and hands. The lumbar plexus innervates the back, abdomen, hips, and lower extremities. These networks of nerves send signals to the organs of each area they innervate. A noteworthy portion of nerves includes the group of nerves that supplies a significant amount of neuromuscular signal to the lower extremities at the lumbar plexus, the sciatic nerve.
Originating at the bottom of the lumbar and sacral spine, the sciatic nerve connects at a junction point to create one large nerve that spans down the back of the buttocks, along the hamstring, down the calf, and ends at the bottom of the feet. Suboptimal conditions for the orientation of the vertebrae position over the spinal root nerves, where the base of the nerve buds out of the opening between the joints of the spine, can create an environment around the nerve in which the vertebrae compress the nerve. This scenario can produce sharp, searing, or chronic dull nerve pain. The minor variants of this type of “pinched nerve” can be considered minor and remedied with productive tactics to recover the muscles around the vertebrae so the bones reside in optimal alignment.
If the deep intrinsic core muscles attaching to the spine, such as erector spinae, multifidus, and psoas muscles, are productively strengthened via skill exercise compliance, the likelihood of the spine shifting in a position that causes nerve compression could be reduced. By exercising the deep intrinsic core muscles holding each vertebra together and connecting the spine to the hips, the supporting muscles of the spine have the potential to bracket the spine, acting as a reinforcing feature to avoid shifting of the spine that could lead to nerve impingement.
An exercise commonly seen in physical therapy practices when treating clients reporting low back pain and sciatica includes education on the pelvic tilt exercise. Here are a few cues we offer our personal training clients to develop competency and mastery in performing pelvic tilt exercise against a wall:
Find a stable, flat wall to lean your back against, putting about twenty to thirty percent of your weight pressing against the wall. The knees should be slightly bent, and the shoulder blades and base of the hips should be pressed against the wall. Perform a tilting motion with your hips by pulling the crests of the front of your hips to your ribs, pushing the arch of the lower back into the wall, and pulling the navel toward the spine. You should feel a slight muscular contraction in the abdominal and gluteal muscles. Repeat this movement for five to ten repetitions.
Adhering to general injury prevention exercises, such as pelvic tilts, has the potential to decrease the concentration of pain and dysfunction from current back injuries. Similar to daily routines like taking your vitamins first thing in the morning, performing injury prevention exercises to protect the trouble spots in our bodies is critically important to helping us live happier, healthier, and stronger lives.
Sean McCawley, the founder and owner of Napa Tenacious Fitness in Napa, CA, welcomes questions and comments. Reach him at 707-287-2727, napatenacious@gmail.com, or visit the website napatenaciousfitness.com.