One of the most common complaints that bring people to the physiotherapy clinic is low back pain or pain in the lumbar region. In some people, it may be a sudden onset after lifting or bending, or it may be a chronic condition with frequent flare-ups. Lumbar stabilisation involves strengthening your core stabilising muscles to protect the spine from injury and prevent low back pain.
A physiotherapy assessment will involve evaluating your sitting and standing posture, range of spinal movement, associated muscle lengths, functional capabilities and assessing the strength of the lumbar stabilising (core) muscles which include the abdominals, back muscles and hip muscles. If these muscles are weak, the spine can be prone to injury because the role of these muscles is to provide strong protective armour around the spine and surrounding areas.
Postural re-education is taught first and foremost in a lumbar stabilisation programme. The patient is taught how to adjust their pelvis through active movement so that the spine is in a neutral posture, rather than having excessive lordotic curvature (a big arch in the lower back). Once this posture is established, it is important to practice maintaining the posture through a variety of movements (e.g. sit to stand) and in different positions such as lying down or when walking. Having the spine in a neutral position means there is less stress through the intervertebral joints and from this position, the lumbar stabilising muscles are in a better biomechanical position to contract more effectively.
The deep muscles of the abdomen and back and the large muscles of the hips all act to stabilise the lumbar spine. Exercises are taught for each muscle group to ensure they are working effectively and that the muscle balance between opposing muscles is correct. This may involve muscle stretching exercises as well as strengthening exercises.
These core muscles can be strengthened in several ways including with pulley weight systems and machines, with reformer equipment (as used in Pilates), by performing advanced abdominal and lumbar floor exercises or by doing a Swiss ball exercise programme to name a few. Abdominal crunches alone do not constitute a lumbar stabilisation programme and, if performed incorrectly, these exercises can inhibit the core muscles from working properly!
As you progress with your lumbar stabilisation exercises and become stronger, the exercise programme is modified to suit your higher level of function. The aim is that once you have established sound core muscle strength and endurance, through continuing with your exercises long term, you will prevent recurrence of low back pain and injury and reduce the need for ongoing physiotherapy treatment, medication or surgical intervention.