March 12, 2019

Back into Action 2: Building long term stability, chains & slings

Following on from his ‘Back Into Action’ feature looking at the causes, types and treatment of back pain, our physiotherapist Josh Lond is back with more expert knowledge. Today he’s looking at long-term lifestyle changes to protect our backs from pain, and explains body composition in terms of chains and slings. Finally, he’ll focus on the concept of the ‘core’ and core stability, and the key role these concepts play in healthy backs.

If you haven’t already seen Part 1, please click here to read his ‘Back Into Action’ feature on back pain.

Introduction

Treating pathology of the lower back in adults and adolescents is a complex issue, especially when it involves recurring or chronic issues. A holistic approach is centred around preventing pain in the long term whilst building whole-body strength and correct biomechanics. This approach does not try to ‘pinpoint’ the cause of pain but treats the body as a whole. Instead, it focuses on the use of anatomical ‘slings’ and how the body actively moves.

Recap

Before we go any further, it’s important to take note of the symptoms listed below. If you are experiencing any of these we advise that you seek medical attention from your GP. If you have multiple symptoms, call the NHS 111 line or visit A&E if seriously concerned.

• Radicular pain – pain shooting down your legs, one side or both
• Numbness in your leg or a feeling of not knowing they are there
• Numbness within the pubic region, inner thigh or buttock and a lack of sensation when going to the toilet
• Bladder or bowel changes, abnormal retention or unexpected accidents
• Falling or legs giving way – feeling as if your legs lack power and could give way
• Impaired balance – more trouble balancing than normal, a lack of sensation of the floor or an inability to lift your feet when walking

The Body’s Slings

• Anterior oblique sling – Adductor, same side internal oblique, opposite external oblique, abdo fascia
• Posterior oblique sling – glute max, contralateral lats, thoracolumbar fascia
• Deep longitudinal sling – Erector spinae, multifidus, thoracolumbar fascia, biceps femoris
• Lateral sling – Glute med, Glute min, Tensor Fascia Late, Iliotibial band

How do slings work?

Think of the torso as a cylinder, with these slings wrapped around it. When certain slings contract they pull the cylinder around in a smooth movement. If one of the components in the sling doesn’t work efficiently or in time with the others, you could experience poor quality movement and biomechanics. This, theoretically, has the potential to cause pain and instability.

What is my core?

Core stability is a concept – there is no actual physical entity called ‘the core’. The term is a collective concept to explain stability deep within your soft tissues. It is often used in reference to the thoracic and lumbar regions but also applies to the shoulders and hips.

There is a long-standing misbelief that by training your abdominal or ‘six-pack muscles’ you are training your core. In reality, this rarely results in any increase in core stability, although you may notice a cosmetic difference.

Should I train a specific muscle or multiple different muscles at once?

Training muscles in ISOLATION is normally productive. However, when considering slings we look at training MOVEMENT which uses multiple muscles at once.

Planes and axis 

• Frontal plane – side to side movement, bringing the limb out or in by your side
• Sagittal plane – moving forwards or back such as bending and straightening
• Transverse – rotating around a fixed point, such as turning to look behind you
• Tri-planar movement – the motion of moving through all of these planes succinctly for normal movement