Lumbar Instability: Why It Matters & How It Affects Pain and Performance
Picture this: you’re outside shoveling your driveway (your favorite winter activity), when you feel something slip and catch in your back. In your mind, you groan, because you’re sure you just threw your back out and will be laid up for the rest of the day, if not longer.
This often occurs due to lumbar instability. Your spine and the surrounding muscles were unable to handle the forces you were putting it through, so it buckled, throwing out your back and creating pain.
Some studies have suggested that around 85% of chronic low back pain has no known cause, but more recent research has suggested that anywhere from 50-90% of patients with chronic low back pain suffer from lumbar instability.
What Is Instability?
Instability is the lack of stability…. duh. The easier question to answer here is what is stability, since instability is just whatever happens when the spine isn’t stable.
Stability is essentially how your body controls and resists movement, both intentional (you moving your body) and unintentional (forces acing on your body, like a weight, another sports player, or a shovel full of snow). Instability occurs when your body is unable to control and resist these movements, creating injuries, pain, or dysfunction.
There are three aspects of stability to discuss: active stability, passive stability, and neural stability.
First: Active Stability. Active stability involves the use of your muscles to create stiffness and stability in the spine. This is the most changeable of the three aspects and is what we attempt to train with core and stability exercises. Active stability uses primarily your “core” muscles (your abs, paraspinal muscles, and quadratus lumborum), as well as other muscles like your psoas, latissimus dorsi (lats), and gluteal muscles. When they contract, these muscles can create movement, like when you bend forward or backward. But if you don’t move, these muscles create stiffness, basically working to hold your spine and body in place. A combination of movement contractions and stiffness contractions is how we perform most of our daily activities. When you walk, one leg is moving forward, while the other is stabilizing you so you don’t fall over. When you bend forward, some muscles are pulling you forward while others are holding you back so you don’t flop over too quickly. Having enough strength and endurance in these active stabilizing muscles is essential for spinal health and injury prevention/treatment.
Second: Passive Stability. Passive stability involves structures you don’t actively control, including ligaments and discs. Ligaments are sheets or bands of tissue that connect bones together, which act like a rubber band, allowing some movement but resisting that movement as you move further from neutral. The discs exist between all your vertebrae, and they serve to absorb force as we move and do our daily activities. These discs are highly innervated and are sensitive to damage. Normally, these discs are fairly resilient, but when we don’t have active stability, these discs take on more load. As the discs take on more load and particularly when they experience repetitive movements like bending over, they start to wear out and provide less stability.
Third: Neural Stability. Your brain controls your entire body, sending its message along your spinal cord and your nerves. Every movement you make is stored in your brain, and your brain sends messages to multiple muscles for any movement you make - some messages create the movement, while others create stability and work to control the movement so you don’t injure yourself. This is involved in the above examples of walking and bending forwards. These signals need to be properly coordinated, so that your muscles contract in the right order to create movement and stability. When these signals get off their pattern, problems like pain and injuries can arise. Things like sitting too much and lifting with poor technique can contribute to an uncoordinated firing pattern and subsequent pain and injury.
All three of these aspects are necessary to create spinal stability, but sometimes one fails, and the others need to pick up the slack. It’s when these failures happen that we experience problems.
Why Do I Care About Spinal Stability?
There are three big reasons you should care about your spinal stability:
Stability is necessary for your spine to successfully manage load and movement
Building stability can eliminate micromovements creating pain and dysfunction
Having the ability to stabilize your spine and core improves your athleticism and performance
First, stability is necessary to manage load and movement of your spine. We use our spines all the time, for a variety of movements, from lifting, to sitting, to walking, to playing sports. Nearly anything we do involves the use of the spine, either directly through spinal movement or indirectly through muscular attachments. To manage these movements and forces, the muscles of your spine and core create a system of guy wires (like the ones that hold up telephone poles) to keep your spine stable and able to move.
Second, training stability helps to prevent small micromovements in the spine that create injury and can degenerate your spine. These micromovements occur when your vertebrae shift out of line with the rest; imagine bending over to pick something up off the ground, and you probably imagine a smooth curve when your spine bends. A micromovement breaks this smooth curve, indicating that the muscles and ligaments stabilizing your spine failed, allowing extra movement to occur and creating pain. Most notably, these micromovements and instability, in general, are the primary reasons that your body develops bone spurs and osteoarthritis, as these bone spurs (also called osteophytes) increase the surface area of your joints, decreasing their ability to move around; basically, the bone spurs work to lock your joint in one position, without relying on your muscles and ligaments to keep it there. By training your body to create stability using your muscles, the need for these bone spurs will decrease.
Third, having the ability to stabilize your spine and core is an essential part of having high-level athleticism and performance in sports, as well as in life and work activities. If you don’t stabilize your spine before moving your arms or legs, you can’t generate any power or speed because your body will just be flopping around; this is similar to jumping on concrete versus jumping on sand. You get great height off a solid, stable surface like concrete, and you get much less height when jumping off an unstable surface like sand. Nearly every professional athlete is as good as they are due to their ability to stabilize their core, at least in part. If you can’t create stability, you simply cannot create power and speed. A lack of stability in athletes (and in the general population) contributes significantly to pain, injury, and poor performance.
The world that we live in today is not well-suited for creating spinal stability. Sitting too much, having poor posture, lifting with poor technique (especially as a job), and generally being in poor physical condition all contribute to lumbar and spinal instability.
A lack of spinal stability creates a poor environment for any physical activity, whether that’s getting out of a chair or playing professional hockey. Since we all move, we all need some sort of stability
How Can I Improve My Spinal Stability?
If you’re struggling with a lack of stability, there are literally hundreds of videos, blogs, and articles out there about how to build it. Unfortunately, not all of them are giving the best advice, particularly for those people who suffer from back pain. Many of these stabilization and core exercises require spinal movement (like sit-ups, as a prime example), which is something to avoid when your spine is somewhat unstable in the first place.
There are some recommendations for where to start creating spinal stability, the “McGill Big 3,” developed by Dr. Stuart McGill, one of the world’s leading experts on low back pain. These Big 3 exercises are the curl-up, the bird-dog, and the side bridge/side plank.
First: The Curl-Up. Lie face up, with your hands under your lower back. Bring one foot up towards your bottom, so it’s resting sole-down on the floor and your knee is at 90 degrees, and leave the other leg lying straight out. Contracting your core, lift your head and shoulders up slightly off the floor - just an inch or two is enough. Hold this position for 5 seconds, then relax, and repeat 5-10 times, 1-3 times per day.
Second: The Bird-Dog. Position yourself on all fours, like you’re going to crawl, with your arms straight. Raise your right hand above your head while lifting the left leg off the ground so it’s pointing straight behind you. Don’t let your spine move while you’re moving your arm and leg. Hold this position for 5 seconds, bring your arm and leg back under you, and repeat 5-10 times. Repeat this movement again with the left arm and the right leg, again holding for 5 seconds and repeating 5-10 times. Do this exercise (both sides) 1-3 times per day.
Third: The Side Bridge/Plank. Lie on your side, propping yourself up on your bottom arm/elbow and resting your top hand on your bottom shoulder. Bend your knees and stack them on top of each other. Brace your core, then lift your body off the ground so you’re just supported by your bottom elbow and knee, with your body keeping a straight line. Hold this position for 5 seconds, then relax down to the ground. Repeat 5-10 times, then repeat the same process on your other side. Do this exercise on both sides 1-3 times per day.
Over time, these exercises will help build the strength and endurance necessary for spinal stability. You may need to advance them (make them harder) or modify them so that they work better with your life and activities.
If these exercises cause pain, stop doing them! They may be too advanced for where you are, or they might not be right for the specific problem you have. If this is you, schedule an appointment with us! There are a variety of reasons that these exercises might cause you pain, and it’s nearly impossible to say why without seeing you.
Parting Thoughts
Spinal stability is an essential part of getting through life without getting injured, assuming that you’re moving somehow throughout your day. Unfortunately, our current society is not good at getting us to train stability, since we’re more physically inactive than humans have ever been. So, we must make a point to train that stability ourselves. We can’t just sit around and expect our health to improve. (I know, life would be so much easier if that’s how it worked, but it’s not.)
If you or a friend or family member is suffering from low back pain, know that you’re not alone, and know that there are answers for you out there. Northbound Chiropractic provides a thorough, personalized examination and a treatment plan individualized for you and your problems. We strive to give you the tools (like the exercises above) to get you and keep you healthy and moving. If you’re struggling with low back pain or another health issue, schedule a visit today to start your journey to getting out of pain and back to your life.
Click the button below to learn more about scheduling your first visit, or contact us by phone or text at 763-373-9710.
Wishing you a happy and healthy holiday season,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties