It has been estimated that approximately 80% of people in Western countries have experienced low back pain (LBP) at some point in their lives. Most cases resolve within 2-4 weeks without any medical intervention. However, within 1 year following the first episode of LBP, 60-80% of patients will have recurring pain. Current research has reported that in most cases of LBP, certain muscles of the back that stabilize the spine are reflexively inhibited (shutdown) after injury. These muscles do not spontaneously recover even if patients are pain free with a return to normal activity levels. These specific muscles work together to support and stablize the spine to help prevent LBP. These muscles include the

lumbar multifidi and the transversus abdominus:

What Are the Lumbar Multifidi and Transversus Abdominus?

The lumbar multifidi are the deepest layer of muscles of the the back. They attach from the vertebral arches to the spinous processes. Each multifidi connects 1-3 vertebrae, (the vertebrae are the bones of the spine) controlling movement between the vertebrae. The transversus abdominus is the deepest of the abdominal muscles and is also a stabilizer of the spine. Support by this muscle is considered to be the most important of the abdominal muscle and has also been found tobe in a weakened state in those who have chronic back pain or problems. Its normal action along with the action of the the lumbar multifidus muscles function together to form a deep internal corset that acts to stabilize the spine during movement. This pattern of protection is disrupted in patients with low back pain.It is uncertain why these muscles become dysfunctional after a low back injury, but specific exercises focusing on the contraction of these two muscles together will improve the protective stabilizing ability of the spinal muscles, reduce pain intensity, and improve activities of daily living as well as improve body awareness and posture

How Is Low Back Pain Treated?

Physical therapy treatment for LBP often involves a wide range of techniques including heat therapy, ultrasound, massage, mobilization, exercise, and education about posture and body mechanics. Stabilizing and strengthening the lumbar spine (specifically lumbar multifidi and transverse abdominus) through a lumbar stabilization program is also an important part of a rehabilitation program for the patient with low back pain.

What Does a Lumbar Stabilization Program Involve?

The lumbar stabilization program is a program of back exercises designed to teach patients strengthening and flexibility in a pain-free range. It not only improves the patient's physical condition and symptoms but also helps the patient with efficient movement. It provides the patient with movement awareness, knowledge of safe postures, and functional strenghth and coordination that promotes management of LBP.

Prior to starting a lumbar stabilization program, the patient should first be evaluated by his/her primary care physician and physical therapist. Together the MD and PT will design a comprehensive rehabilitation program with the above mentioned techniques along with a lumbar stabilization program specified to the patient. Since every patient is an individual and presents with different conditions, a physical therapist is needed to design and monitor the rehabilitation program.