The basic message I want to get across to patients with low back pain is about your personal responsibility to support the muscle system of the spine. Have you heard of Core Stability? If you are into Pilates, yoga or strength training you have experienced core strength training and stability training.
If you are my patient you have heard me talk about the fascia and the joints. In particular for the low back, I talk about the fascia, muscles, and joints around the lumbar spine and sacro-iliac joints. These are part of your low back stability system. Contrary to what old rheumatologists will tell you, the sacro-iliac joints – which connect the fused section of the lower spine (the sacrum) to the pelvic/hip bones on either side – do need to move during normal daily activities such as walking and running. These bones were meant to move. On the other hand the lower lumbar vertebra were not meant to move very much. These lower lumbars usually need stability training to get them to “hold” in place better.
The motion of these joints and the surrounding fascia needs to be critcally evaluated by feel, not just by an MRI evaluation. It is both necessary and desirable that the sacro-iliac joints move, because they need to act as shock absorbers between the lower limbs and spine, and also as a way of providing proprioceptive (body positioning awareness) feedback for co-ordinated movement and control between the trunk and lower limbs.
As the sacro-iliac joint is capable of movement, that movement needs to be properly controlled, as with any of the body’s joints. Some control comes through the natural architecture of the low back and pelvis, but more is possible by using the surrounding muscle, ligament and connective tissue system (fascia) to provide compression on the joints. This is important because we can influence the effectiveness of the compression through exercise and re-training after injury.
The most effective and safest exercises to support the muscles and fascia that help to stabilise the pelvic girdle are these:
- Gluteal Activation: Bridge