More Common Low Back Pain with Wil Seto

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. We're going to talk about more common the most, maybe most, at least a common type of low back pain. How are you doing Wil? 

Wil: I'm doing really well. Thanks Mark. Yeah. 

Mark: Stumbling all over myself here. 

Wil: Yeah, and people stumble quite often over, you know what is the cause of the back pain. And what I want to talk about today is just a type of back pain that is actually very common, very common in athletes, and just like an everyday type of pain that comes up from lifting, twisting or even just sitting wrong. I mean, wrong in terms of posture, that's not really ideal or optimal. So type of back pain is basically caused by a strain in your iliolumbar ligaments, which is basically a connective tissue and ligaments that stabilize and connect the last two segments of your lower back vertebrae, which is your L4 and your L5.

And so basically you have five vertebrae that make up your lower back. And your L4 and your L5 is your last two vertebrae. And these ligaments, there's a couple of different bands and they connect under your pelvic bone. And that's called your iliolumbar ligament, or iliolumbar ligaments.

Mark: So when you actually like feel along the iliac crest or your pelvis in your back, is that where these are attaching, basically? 

Wil: Yeah, it's hard to feel because it's all so deeper. You have to like palpate basically through your muscle and you also have another layer of connective tissue. And so it is really tough. So when we're testing for, you know, we're obviously doing a couple of different tests to see if it is stressing that ligament. But then we're also ruling out on different things because, you know, with the presentation of this type of injury, it can also present itself as possibly other things too. And so we've got to make sure that it's not that as well. 

So there's always a barrage of different tests to really go through. And this type of back pain is also something that can, like when you have it for the first time, it may not be like, oh, it takes a day or two to heal. It may take a little longer because of the nature of how it stabilizes that lower back and that lumbar spine in the pelvic area. And especially if you've had it like as a chronic condition. So what I mean by that is, if it's been recurring, like, you know, you get over it, and then it happens again.

And so when it's a chronic condition, it doesn't necessarily have to be like a specific, like lifting or bending or twisting or athletic type of movement. So like I've seen it in rock climbers and soccer players and volleyball players, and you know, it's common in athletes. Very, very common. And I've seen it a lot. 

And then with non-athletes, pretty common too. So you can be really out of balance in that area, and then you do something like you're sitting kind of with non-optimal posture for awhile, or if you've been sick in bed for, you know, like week with the flu or, you know, in this case a few specific clients that have had COVID in they're in bed for a little longer and then pretty inactive. And then it ends up straining.  So those are the kinds of the ways that you know, it can be injured and it's a lot more common.

Mark:  Would possible ways of dealing with it be that you make core strength training, has to be part of your regular training regimen. Is that going to help? 

Wil: Absolutely longterm. Yeah, for sure. And we also want to do too, when you have this kind of injury, like, especially if it's not going away, like general rule of thumb, is that if you hurt your back, you're not really sure what it is. You know, iliolumbar ligament strains will usually, you know, it's more than just a 24 hour thing. You'll feel it for a couple of days, for sure. You want to get it assessed and see what's going on because you want to also address the specific deficits that's causing it. So it's not just the core strength issue. There's imbalances going on there that you need to address.

And then now that you have this strain, there's in essence, a type of hyper-mobility, or it's like, there's a little bit more play in there now. So it's less stable is what I'm saying. And so, because you have less stability in there. That core strength is very key and it's specific core strength too, to making sure that that actually becomes more stabilized in there. And especially if you're going back and doing anything physical, like if you have a physical job or sports for sure. And the reason why is because would that instability, it can lead to then like more serious injuries if you're not actually rehabbing it, like a disc injury. 

And studies have actually shown that when you actually have a lower back injury and you don't rehab it properly, you don't get the core strength and you don't get the muscle imbalances corrected, then there is actually a high recurrence of back injury and something more serious. And this is a good example of it. 

Mark: So what's a typical course of treatment? 

Wil: Yeah, so I'm thinking about a couple of people that came in with this type of injury recently. And the first thing I do is I address their mobility issues and figure out what's going on. So there's usually a lot of spasming and these people came in, I'm thinking about two specific patients that came in. One who is actually a little more athletic, recreationally. And then another client who's not athletic, but just sits a lot for her job. And they both present with the same type of things in terms of muscle spasms, a loss of mobility, and also a lot of imbalance happening.

And usually that's also really key too, because you want to look at what kind of areas are like really shortened in terms of muscles. And also you want to look at the movement patterns. So we're addressing the bigger picture of what's going on in their movement patterns and why that's caused it to strain. 

So for example, the person that sits a lot for her job, you know she does a sit and stand. So we corrected that. But also just looking at how she walks even something as simple as that and we need to really correct the alignment of that area and part of that is okay, you know what? Her hip flexors are super tight, pulling all that, compressing things. And then her other bigger back muscles are also super tight. In addition to the spasming, that's protecting the injured area. And then she's got weaknesses in certain areas that are not just from this injury.

And they're like chronic weaknesses that she's had which are very apparent because there's some atrophy going on. That's more than just like a week's worth of injury.  So those are important to address. She had a lot of tightness up in her upper back,  which meant that she wasn't moving through her upper spine and she's not getting this rotation movement. She is pretty active, but not athletic. You know, that she's going to move a lot through her lower back when she does things like gardening and everyday stuff. And so that puts more stress in that area. And then those muscles tend to get tighter and get used more like in the lower back area, causes it to be a precursor to something happening and she wasn't a big fan of stretching and mobility work and core work to begin with. And then we would address the muscle spasms and do things with manual therapy in that specific area, and also IMS, dry needling and stuff like that.

Mark: And what's the typical. Kind of treatment timeframes for this to get better. And of course it always depends on how bad it is, but, or how chronic it is, but what's a more typical recovery time. 

Wil: Yeah. So for someone who's experiencing that pain, especially like I'm talking about like these two individuals, you've had pain for a week and finally, like, I need to come and see someone about it because I don't know what's going on. And they're a little more concerned. You know, the ilia lumber ligament was specifically diagnosed then, you know, four to six weeks is a typical timeframe for it to heal. And it doesn't mean that you're not going to get any better. Like with both of these people within one session, they felt like night and day. So they went from like, basically a six to seven out of pain. Pain scale on a visual analog scale in terms of subjective rating, to like a three out of 10 within like 24 hours. Which is significant. 

And then when you look at that timeframe, like it's that healing process is important, because the soft tissue injury needs to heal where you strained it. And then once that sort of, you know, heals up. And then when we talk about the person who's more athletic, we get him doing more higher level core stuff, but, you know, he even came in to see me like six weeks later. And he was no longer having problems with that ilia lumbar area, but he was still having, yeah, it's like a one out of 10 pain Wil, and like, I can do stuff now. Six weeks later. But now he's like, I want to like start lifting more and, you know, it's sort of that process of like getting him ready physically to do that. And wanted to go in the gym and started lifting weights. And he liked to, you know, typical sort of gym routines that involve a lot of your traditional, like squats and deadlifts and bench press even too. So you gotta be careful with bench press even at this stage. 

Mark: So the basic message here is that the most common low back pain is not from discs. It's from this ligament you're talking about. 

Wil: Yeah. It's very common, which then can lead to possible disc injury, if you don't rehab it correctly and then make it a part of your daily routine. 

Mark: So if you're in Vancouver and you have lower back pain, you can call Insync Physio to book your appointment in Vancouver at 604-566-9716. In North Burnaby, they have a North Burnaby location as well, 604-298-4878. Or you can book online insyncphysio.com. Thanks Wil. 

Thanks Mark.