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021 Low Back Pain Part 1

021 Low Back Pain Part 1

By Jurmaine Health

Do you understand your system? Just because you have tight lats, it does not necessarily mean you should ‘tenderise’ your lats with a foam roller (with teeth). Are you rolling yourself into back pain? Are you a piece of meat? Sometimes we prefer a bread pin roll! If you do high volume activity – you will lose body awareness more easily. After 9 shopping mall massages sessions, why do you expect your clinician to fix you in 1 session?

SHERMAIN [3:47]

That’s right. So that’s quite common. So what low back pain usually means it’s usually it’s from the underneath the ribcage, where you can feel it and feel a few underneath your ribcage around to the back of the spine.

SHERMAIN [14:30]

Well, wasn’t thinking that But okay, that’s, that’s, that’s a good start because we are to keep yourself out of trouble. You need to prep your body in a couple of ways. One is that you need to know your own strengths and weaknesses, threats and opportunities.

SHERMAIN [16:07]

But if you are doing cricket, you really don’t really need bench press. If you’re doing cricket you really don’t need to do deadlifts.

Dr Shermain Wong is a seasoned chiropractor with particular expertise in Sports Medicine and a passion for the benefits of in ‘Active Release Technique™ (an advanced Soft Tissue Technique developed by Chiropractors). She is professionally trained in ART and has a Masters in Clinical Chiropractic from RMIT University. Dr Wong has provided chiropractic and movement rehabilitation services at international sporting competitions, and provided rehabilitation and training for professional dancers, professional football players and professional athletes.

She can be found at https://www.jurmainehealth.com.au/dr-shermain-wong/

Episode 021 : Low Back Pain Part 1

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We will bring you topics on neuropsychology, neurobehavior, neuromusculoskeletal and neurogastro. Movement is well being, metabolism and microbiome, which are also some of the services that we provide. Today's podcast is our second in our low back pain series. And today we'll be talking about the muscular tenderness causes of low back pain. So I have Dr. Shermain Wong with me today. So say hello, Shermain.

SHERMAIN [00:38]

Hello.

JACKIE [00:39]

So guys, when I'm talking about or referring to muscular tenderness, I'm referring to either the muscles contributing or the tendons or both being the causes of back pain, of the low back pain and today will give you a brief summary of some of the muscles that can be causing or pretty much will try to give you a rundown of all the muscles that can be contributing to low back pain or can be mimicking, or referring to the area or even for a better word as well. And pretty much give you an idea of the mechanism as to how that it's causing it, as well as a brief idea of where it might be attaching to, which is the other contributor as to how it's causing the presenting as a low back pain issue. So before I continue as well, I'm just going to give you a brief intro into the trigger points, or how they sort of work with when we're referring to the trigger points. So guys, trigger points when we talk about the referral patterns. So pretty much every single muscle in the body has what we call trigger points, they are little bands in the muscle that if they're aggravated or if they're under a lot of tension. So let's just say that you've been using the muscle a lot, or you've been holding that particular muscle in a sustained position, so tributing to the muscle being under tension. Sometimes a trigger point becomes what we call active or can also be latent. When we call latent, it means that there's an actual trigger point there. But it only hurts when somebody pushes down, whether it's Shermain, myself, Sarah or anyone else. So even you, if you're really truly poking yourself somewhere, you'll feel the pain. If we're talking about an active trigger point, it means that it's sending the referral patterns by itself, so it's sending the pain by itself. So these trigger points can actually be a big cause of back pain issues as well other areas of pain of course, in other muscles that are around in and around the body, but they're often the ones that are involved in chronic types of pain. There are also ones that can be extremely scary just because of the not maybe not so much the sharpness but the intensity of the pain, but they're also usually the most common, and also the least probably the ones that you have to worry about least because probably the best word to say, to describe them, but it's just a brief intro into the trigger points for you and just so that you get an understanding so yeah, usually they're being contributed to it to muscular issues, especially in and around the lower back, but they're also the least sinister, or the least ominous of anything.

SHERMAIN [3:21]

Of the low back issues that would be quite accurate.

JACKIE [3:27]

Especially the ones that we're discussing.

SHERMAIN [3:29]

And also those are the most common things for trigger points. Everyone has it.

JACKIE [3:36]

At the very least everyone on which has the latent ones they may not have active, but latent will be extreme. Yeah, like you said, almost everyone has them

SHERMAIN [3:47]

That's right. So that's quite common. So what low back pain usually means it's usually it's from the underneath the ribcage, where you can feel it underneath your ribcage around to the back of the spine. From there you feel the bones to the top. I mean, I think to the level or a level of where your pelvis is, and that would be your low back pain region. And that's a very common region because sometimes before for many reasons, if you're talking about musculoskeletal, just muscular pain, one of them is, if your person is too flexible, it's one if a person is too stiff is another so both ways you can get back pain out of that.

JACKIE [4:36]

SHERMAIN [4:38]

Really Yeah. The only way to is either number one, you have a strong glute, very strong glutes. Very

JACKIE [4:48]

strong but not tight.

SHERMAIN [4:49]

You're strong but not tight glutes and hamstrings. A mobile hip joint. I'm not talking about you know

JACKIE [4:59]

We are not talking about dislocating your hip on command. It's not the one that we're talking about

SHERMAIN [5:04]

Well, some people, some people from like Cirque de Soleil will be able to do that. But most people time, so try not to get that happen.

JACKIE [5:16]

We do not advocate trying to dislocate your hip on command.

SHERMAIN [5:20]

That's right. And a strong, a strong but not overworked or overpowered abdominal. We're talking about your obliques, your internal external obliques, you're talking about the rectus abdominus as well. You're talking about the Transverse abdominus as well

JACKIE [5:40]

The beloved TA

SHERMAIN [5:41]

Where there have been lower TA all the structures cannot and should not overpower the glutes really, and that sometimes can happen quite easily.

JACKIE [5:53]

Quite often

SHERMAIN [5:54]

Quite easily quite often, and not forgetting the internal structures that are sitting underneath those muscles like the ... Don't smoke the email cuz and inner soleus you know, so as we show the hip flexors, those structures, you can google all these. So I'm speaking as low as I can. So you're able to Google

JACKIE [6:11]

Write down at Google the words.

SHERMAIN [6:14]

So for example, I had a guy that came in the other day. He has like, yeah, sure, I don't know my muscles, but whatever you say, Boss kind of thing. And I was saying, explain, try to explain to him that your body is a system. And so one thing will affect the next thing. There's no, you can't say, Oh, my shoulders are in pain, and it's almost its own pain. But if your pelvis is so tight, because the abs are overworked, or the inner soleus are overworked, then what is going to happen or most likely to happen or your lats? It's going to lock down and all most people do is to foam roll the lats and that's quite common. And then they keep foam rolling it for like a good 45 minutes on one side.

I don't know what they're doing

Marinating, they are sort of marinating. They are not marinating, they are tenderizing.

your poor little lats I like roasted especially when those rollers with teeth is like why do you do that to yourself?

JACKIE [7:24]

I met someone recent dumbbell on him to the point. Yeah, somebody bruising me on what did you do all? I was I had a dumbbell.

Tenderizing yourself come on you are a piece of meat. I'm probably the least kind when somebody says.

They didn't have a foam roller or it wasn't doing the job.

It's quite funny. Funny, not funny. No something somebody will do you use, you know the pin role for the Bread.

I recommend that though. I do recommend that one but

I usually say that for the shins.

SHERMAIN [8:02]

If you are over overperform rolling your lats, what is going to happen is that you feel like your shoulders are not going to cope you feel like your back is going to go out because you've just tenderized it, right. And it attaches all the way to the hip. So and then attaches all the way through your shoulder. So what are you going to do then with that, that kind of mechanics, it's going to be very hard for you to not have back pain because you literally have rolled yourself into back pain. So this one case is

JACKIE [8:32]

Big one.

SHERMAIN [8:33]

Is a big one. The other one there is a big case. I think you are aware of it because we both were in Coburg VFL. Before and I was hammering into you guys because you guys were on the team. And at a time of really good strength and conditioning team as well. They were right on the ball with it to make sure that they have good pliability in the hamstrings because I've been drilling into you guys work hamstrings, it's not so much to massage them, or to treat the tissues is to make sure that they know how to use the hamstring properly, and a lot of them didn't because of the sheer volume of running. So anyone who's training in the sheer volume of whatever they are doing, or choosing to do in their sport, they will lose proprioception, it's as simple as that. So they will lose proprioception, they will lose form, they will lose activation quite quickly and easily so that it's not some skill knowledge. Maybe it could be of skill, knowledge to some people but most of the time in small ones is quite prominent for us to see that. And because of that, that structure definitely alters the way you are going to carry your posture. And when that happens, it shortens the little tiny muscles between the individual spinal process facts, pointers, processes. So they are called interspinal muscles in despite this and then it will shorten your QLs, your quadratus lumborum is a very big piece of muscle and it holds on to the transverse processes of your spine. And when that happens, so everything is shortened to try to hold you up properly. And also the hamstrings are shorted. Guess what happens you have got hamstring tears. You've got hamstring strains, you've got back pain. You've got you know, a very tight pelvis. You can't sit on the toilet.

It's common.

JACKIE [10:37]

And believe it or not, people still ignore the hamstring as a source of back pain. Absolutely. They still ignore Yeah, even here when we sometimes How long can you say the hamstrings like you sure I feel a little in my back. Takes them a few sessions. What post treatment all the hamstring to go. Okay, fair enough. Maybe you had a point versus I'm gonna trust you because you're telling me these, despite the fact that I'm feeling and you're telling me these, I'm gonna trust you for because people just go ok hamstrings or leg. Yeah, they automatically nah. This has no association whatsoever. Yes. So we go

SHERMAIN [11:17]

Well, the one of the best and best ways to know stress test. That hypothesis, if you want to think about it that way is to have them go to shopping center, massage and work the back all the time. And then see what happens. True. Most likely, they will work with a bet for the next four or nine sessions as shopping center massage, and you're not going to get a result. That's what it's going to be. And that's why they end up here and then we go, can you fix me in one session? Yes, we know you guys well, and how you think all of you think that way.

Speaker 3 [11:54]

I'm going to give you one shot or one shot only.

SHERMAIN [11:57]

Yes, after like nine shopping center massages. I don't understand this. Why does this happen?

JACKIE [12:05]

Well we can fix everything in one hit

SHERMAIN [12:08]

Yeah sure that's like injection know there's an anesthetic

SHERMAIN [12:15]

Just not block it and you'll be fine. Right? So there you go, low back pain. What else is there? Your adductors to your rectus femoris which is the muscle that attaches from your hip to your knee. Those muscles can cause back pain to or can be a contributing factor to back pain, oppositional sports, so oppositional sports what is it. You do VFL at a local local club. And then after that season is over, you go to cricket,

JACKIE [12:53]

upper and lower body more or less swap,

SHERMAIN [12:55]

yes. So in a very unstable manner. Yeah. So in a very unstable and then after that, and there's a lot of people who are doing that and then you go do lifestyle lifting. I like to call it lifestyle lifting, I call it half of your lifestyle fitness people, right?

So lifestyle lifting, well, what is it? It's pretty much when you go to a gym who with a PT trainer who doesn't know your body well enough, and then No, that's one. And secondly, then after that, what they do is that all that they have a certificate from cereal box out of a cereal box, and then you are doing lifting with them not lifting properly, and you're lifting with your back and not your legs and there you go back pain.

JACKIE [13:44]

I had 1

SHERMAIN [13:45]

You had one of those recently really. You see we are discussing cases like that over the recording, which means that sometimes we don't get to see each other because we are working

JACKIE [13:58]

that exact one

SHERMAIN [14:01]

Oh really. That's funny. See, we know you, we know your behavior. So what you can get we know that PTs that you're seeing. That's right. So what can be done in a better manner for those of you who love your VFL and then cricket and then going to do lifestyle lifting? Is this one

JACKIE [14:26]

Come to JURMAINE HEALTH

SHERMAIN [14:30]

Well, wasn't thinking that But okay, that's a good start because we are to keep yourself out of trouble. You need to prep your body in a couple of ways. One is that you need to know your own strengths and weaknesses, threats and opportunities. This is as simple SWOT thing that you can do for the business schools always SWOT things right. Second, you need to understand how you play both games. How you are utilizing your body in both games. Do you overstride, do you? Are you weak in your abs? Are you overpowered in your hands? Are you a what's that word called?

SHERMAIN [15:13]

pitcher

SHERMAIN [15:15]

a bowler or a batter

SHERMAIN [15:18]

not batter, a better or a fieldsman yeah a fieldsman. What are your strengths? What do you do with how you're moving? And then you train

JACKIE [15:29]

SHERMAIN [15:34]

Yeah, that's right.

SHERMAIN [15:36]

And, and then once you know what your roles are in those different sports and your strengths and weaknesses. Then you start training for it in the gym. It may not require you to do deadlifts. Thank you very much. If you don't know

JACKIE [15:57]

Deadlifts are the be all end all exercise. Along with bench press

JACKIE [16:03]

Sure they are compound exercises.

SHERMAIN [16:07]

But if you are doing cricket, you really don't really need bench press. If you're doing cricket you really don't need to do deadlifts. If you are doing VFL back squats will be much better way to go than deadlifts. Even not so much of back squats, front squats will be do an even better job than your deadlifts. So if you get confused and you are not sure, what you need to do, give us a call

JACKIE [16:36]

tel: 03 9478 1810

SHERMAIN [16:40]

Otherwise, break down those things into little bite sizes, right and organize your body in that manner. Otherwise, you're going to get yourself into a lot of trouble. And then you need to come to us for nine times as compared to like shopping

SHERMAIN [16:57]

at the massage for nine times.

So there you go

JACKIE [17:02]

on the episode we'll be on the right track.

SHERMAIN [17:03]

That's right.

JACKIE [17:05]

So this is probably the other one. I know you mentioned that already here before. So this is the hip flexor. I did have a case once as well. She was a cleaner presented with back pain couldn't straighten up or had the most pronounced back pain was on again in any few weeks or if she would have gone to a shopping center like we were just discussing yet it would have been the back that they would have addressed no problem. You would have looked at just automatically he would have suspected Yeah, cool. Let's just poke the back No problem. As I said, cleaner because I delved further going all right. Talk to me how what how work, what positions are you in cleaning, etc. Also found that she does have the vacuum cleaner on the back and stuff like that tends to be often so her position her pretty much daily position for a good six to eight hours, sometimes 10 hours was in that hunched over position, hip flexors short. And that's it with a pack on the back on top if. That's all it was. hip flexors were shortened. We had to just release the hip flexors, release the soleus, try and get that one given exercises to work on lengthening them. No problem hasn't had any issues with the back since. I think I've seen a couple of times since then, not the low back or back has been fine since simple thing. But again, easy one to miss if you're not following the chain, or if you're not following what somebody is telling you. The other the other information the person's give you

SHERMAIN [18:48]

Annoying bits about low back pain. And that kind of happens.

It seems to have this muscle trend that I don't know. You know, people just follow latch on and then and then a bit of news. Have this bait and switch effects. First system first deal. They're all going for like, you know, the transverse abdominus. Like, how are you saying in the first session? Then after that? It's deep. Some guru was saying, Oh, it's the multifidus. Then I say, oh, is there a erectus spinal? Guys? It's all one system. All right. They all have fascia attached to each other.

So stop thinking in pieces. Your lower back is not made out of little pieces of your well it is but

they're all joined together. Yeah. Okay. And not my

JACKIE [19:38]

Your back's not just your lumbar spine. It's everything that's attached to it above below, around.

backside side, inside, outside, through that little canal that runs in between within the

vertebrae. So it's all there.

SHERMAIN [20:00]

So sorry, we get a little bit exasperated they go, Oh, it's this piece of muscle here that's giving me that insight No, don't do it.

JACKIE [20:09]

That's one piece of the puzzle.

SHERMAIN [20:10]

Yeah, so one piece or many parts is okay,

JACKIE [20:13]

one piece of a 1000-piece puzzle. Yes. All right.

SHERMAIN [20:17]

So I'm happy with this with this, you know, ranting at people today talk.

JACKIE [20:23]

Well I thought we'd start on the muscular part because it's as I said, it's the one that's most common. And it's the one that we most commonly see. But it's the one that most people tend to ignore and go for or I'm sure I've got something worse. I'm sure it's a more seamless the case then these are I'm sure I've done a more significant damage but a lot of the time, this is pretty much it. These are the causes, these are the genuine causes. And a lot of the other stuff that sometimes found and Shermain and I were discussing this a couple of days ago as the MRI Despite the fact that MRI imaging any of the sorts, sometimes imaging is not your best source. I was again reading it today before when I was looking at some other stuff. Again, it said the same thing. x rays, MRIs, sometimes they're not the best thing for back pain either. They're great for if you actually see if there is something sinister, then no problem or there's something more serious in their problem. But a lot of the time, if it's something that hasn't been going on for a long time, or it or a complete opposite, if it's on that's been going on for years upon years, unlikely to be the back. So probably like as in an MRI is going to show you the problem if you find a disc injury, which is what usually most people do an MRI for. At that point in time. If you've had the back pain for 30 years. If it shows up as it is. Maybe you've had at least for ages. That's not the culprit anymore. That's an incidental finding. And that's it and that's exactly the same stuff that some of the research been showing, again, a lot of the disc herniation these, disc bulges and everything, the incidental findings, those symptoms don't match up to what you see on MRI, and vice versa. That was the only thing that I watched probably mentioned as well. And that was why we put in that I put in that the muscular part would be I'll bring your stuff for today before

SHERMAIN [22:26]

well isn't easy start to get their head around.

SHERMAIN [22:30]

I didn't think of scaring you guys. Not for the most sinister first.

And then wait, maybe I thought you guys did gently as well.

to finish on the sinister ones. Yes. So a lot of back pains, a lot. Majority of the back pains are about 50% I think

muscular, more muscular and kind of easy to work with. And

JACKIE [22:57]

I mean, easiest as in 50% easy. I agree with the 50%.

SHERMAIN [23:01]

That's right. And then you have the 20%. That is like, this is a pathological case. Where we cannot take this case or we are going to send this case out. And they're like about 30%. I think it's the overtraining, horrible training, which we have, lack of training, poor training programs, mixed training, mixed and confused. Training, mixes, not so much the problems in problem. I think majority have confused training program. Whether you're training yourself or you're training someone else, that's pretty much what it is. Anything else?

JACKIE [23:48]

Nothing.

SHERMAIN [23:50]

Yeah, it's training base. 30% is training base training and

JACKIE [23:53]

a base in some way, shape or form.

SHERMAIN [23:56]

So that makes a majority of 80% of people. So, what are you going to do with that information? Are you going to choose to do something about that? Or are you going to keep on hammering away at how you are creating your own back pain

JACKIE [24:14]

by rolling your lats

SHERMAIN [24:16]]

or rolling a lats? Or your hamstrings or your TFL

JACKIE [24:19]

TFL? Yes.

SHERMAIN [24:22]

So, yeah, so sometimes they just roll the entire piece from the knees to the under the armpit right? They just sit there and roll one hour just side to side the whole time. So stop doing that guys really just stop

JACKIE [24:38]

here to sometimes waiting on their friends.

SHERMAIN [24:41]

They do it then.

JACKIE [24:42]

Then I go like why are you ironing your TFL it literally ironing your TFL

SHERMAIN [24:49]

and your lats and Okay, I should stop now.

JACKIE [24:52]

Guys, if you like what we're presenting, give us a thumbs up a like or share it with one other person whom you think we may be the help and for those of you who are coaches, dancers or athletes and may find difficulty with expressing or executing movement patterns? Please do connect with us on our website www.jurmainehealth.com.au and JURMAINEHEALTH is spelled J U R M A I N E H E A L T H. Or please socialize with us on our Facebook page which is JURMAINEHEALTH and our Instagram which is jurmainehealthbody. And last but not least, since this podcast is made for you, our clients, patients and fans, do let us know what else you might like to hear about. And that's all for today. See you Bye.

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