Low back pain is one of the most common musculoskeletal diagnoses in the world. The low back is typically considered the lumbar spine region, but it is also important to remember the pelvis and the hips influence motion at the low back. After an injury or unpleasant experience in this region, the human brain is capable of rewiring it’s movement. Sometimes as a protective mechanism, the body will move in a more rigid pattern, thus less dissociation from joint to joint. In these scenarios, you have to go back to the basics to retrain the foundations for healthy movement. This article describes three exercises to help retrain low back dissociation.
Intro to Dissociation
The lumbar spine articulates with the sacrum and pelvis, which collectively is the lumbopelvic region. Lumbopelvic dissociation is independent motion about the hips or lumbar spine without directly changing the osteokinematics at other joints . We always want to promote motion, but we want to learn to control that movement. Learning to anterior and posterior tilt the pelvis on stable hips when laying supine is always a great place to spot. We trying to teach people a new movement, you want to limit the degrees of freedom. Supine is excellent because the trunk is support on the ground. The next progression is moving to a quadruped position on your hands and knees as this increases the demand on the lumbar spine.
When learning low back dissociation, the first big progression is moving from a static to a dynamic multi-joint motion. This is also a great squat regression that limits the degrees of freedom at the ankle and knee. This will promote motor learning directed at hips prior to standing squats. The focus here is to move through the hip joints without excessive pelvic movement. It is important to know anatomy and lifestyle will affect an individuals lumbopelvic mechanics. This may be influenced by structural anatomy, learned movement strategies, or pathokinesiology & pathoanatomic contributions. In this video we are EMPHASIZING independent hip joint mobility with proximal Lumbopelvic stability. Appreciate the movement in the first two demonstrations, followed by excessive posterior pelvic tilt and excessive lumbar extension.
The next progression in lumbopelvic dissociation is learning to maintain a neutral spine during independent motion at the trunk and limbs. The Bird Dog is a staple exercise in learning how to activate and use the anti-rotational muscles. When you lift a limb you create a rotational moment at the spine and pelvis, one must rely on their rotators such as Multifidus and Obliques to keep the low back aligned. This exercise requires a lot of balance and deep core strength, begin with just an arm raise and progress as you tolerate the exercise with optimal mechanics. Core stabilization exercises such as the bird dog have been shown to improve performance of the trunk and back muscles. Be sure to check out our upcoming bird dog series!
Pirouzi S, Emami F, Taghizadeh S, Ghanabari A. Is Abdominal Muscle Activity Different from Lumbar Muscle Activity during Four-Point Kneeling? Iranian Journal of Medical Sciences. 2013; 38(4): 327-333.