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Posted by CH on 4/29/05 at 17:43 (173939)

I have had flat feet all my life. I suffered a fall down a flight of stairs in 1967, (age 19). My back has bothered me since then. Now that I am older (57),and weigh much more, it gives me a fit. My MRI indicated that I have a problem disc (L-5). My doctor states it is really not necessary to operate which I don't want anyway. Everyone just throws pill at me, and I don't get continued relief. I tried a Chiopractor, that was just more pain. Now I want to try accupucture.

What are your suggestions for this worn out lady with continued low back pain?


Dr. Z on 4/29/05 at 19:01 (173945)

We have a Dr. Rob who may be able to give you some ideas that could help you. In addition it is possible that biomechanical orthosis could help you . You need a complete evaluation of your back and lower extremity. Lets see if Dr. Rob can point you in the less invasive direction possible

Re: There is hope

Robert J. Sanfilippo, DC, CCSP, ART on 4/29/05 at 21:31 (173954)

Hi CH,

I'm sorry to hear about your low back pain. Unfortunately there are many sufferers with the same condition as you. You noted in your history that you had a bad fall back in 1967. Did you injure your back at all? Did you receive any care after the fall? With many low back issues there is usually a mitigating factor that will begin the process. Definitely a fall like you had would create the cascade of problems in your back. When you suffer such a significant trauma it will definitely affect the biomechanics of your spine. If this is left unchecked the spine and its structure will degenerate over time. So the MRI that you had revealed what with your L5 disc? Is this disc protruded? Has the disc 'shrunk?' Is there visibibe arthritis in your spine? All of these findings will indicate altered mechanics which in turn causes alot of arthritic changes. Are you having any tingling or pain travelling down your legs and into your feet?? Hopefully your doctor did a complete neurological and orthopedic assessment of the low back and lower extremities.

So you went to a chiropractor and he/she didn't help? Well being a chiropractor I do know that many of my colleagues utilize different techniques. May I ask what this chiropractor did for you? If any doctor causes more pain than good it usually is an indication that that doctor's treatment won't help. You are supposed to feel some discomfort during a treatment but shortly thereafter you should feel improved. Personally I utilize many different techniques for herniated discs. I first would check the biomechanics of your spine then evaluate the core muscles that could easily create alot of your back pain. Those muscles include the hip flexor (iliopsoas), deep lumbar muscles (rotatores, multifidii), gluts, etc.. If there are muscular imbalances or just a lack of tone they will play big time into your back pain. I utilize spinal manipulation when and where it is needed. I also use flexion-distraction technique to decompress discs that are actively pinching nerve roots. If your back pain is mechanical in nature I would try a chiropractor that has training in sports medicine and soft tissue techniques. I would also focus on losing weight because a pendulous abdomen will create a hyperlordosis thus creating more back pain. I would also have your feet evaluted and maybe get some orthotics.

Dr. Rob


Julie on 4/30/05 at 02:03 (173960)

Dr Rob has given you good advice for approaching your problem. I'd like to add a chorus of agreement to one aspect of it: the evaluation he suggests of the core muscles that are involved in the movement and stabilisation of the lower back. Tight hamstrings, gluteal muscles, and above all tight iliopsoas muscles are all implicated in low back pain, and a good chiropractor, osteopath, or physiotherapist should be able to prescribe exercises to help. The muscles I'd like to say something about are the deep, intrinsic, core muscles whose job it is to support and stabilise the spine.

Research in the past ten years or so has indicated the importance of engaging and using these muscles: the transversus abdominis (the deepest of the three layers of the abdominals) and the multifidii (the deepest layer of the spinal muscles). The horizontal fibres of the transverse muscles wrap around the torso from front to back and from pubic bone to sternum, like a corset. The multifidii are short, small pairs of muscles that attach to each vertebra and ensure that it doesn't shear too far off its neighbours. In a healthy individual with no history of back pain, these muscles work together, co-contracting to maintain the spine's stability when it is asked to move or to bear load, and preventing injury by limiting movement between the vertebral segments.

What research has shown, though, is that in a person with low back problems, i.e. one who has experienced episodes of back pain or injury, the transversus abdominis muscles weaken and the multifidii atrophy. They stop doing their job of stabilising - and - most interestingly - do not recover automatically when the episode is over. Cutting edge physiotherapy for rehabilitation following injury or surgery now focuses on helping the individual to rediscover, isolate, and re-educate these muscles so as to restore their ability to function.

If the deep stabilising muscles aren't working properly, the more superficial abdominal (e.g. rectus abdominis) and spinal muscles try to come to the rescue. But these muscles are 'movers': they are made for that purpose, not for stabilising. The conventional exercises for 'strengthening the abdominals' ('crunches', etc) will shorten rectus (but not necessarily increase its efficiency) but won't have the slightest effect on transversus. There are specific exercises for working on transversus, and on multifidus.

I'm speaking from experience, having recently experienced a badly ruptured disc, for which I had surgery in January. Since then I've been working one-to-one with an experienced Pilates teacher, with good results: on a recent hiking holiday in Crete I had no problems, and my lower back felt stronger and more trustworthy than it has for a long time. My problem was gradually building up, but it was only when a serious problem arose that I realised it was vital to tackle it.

I am not a doctor, but a yoga teacher with 35 years of experience of safe practice and teaching and training teachers, so it wasn't easy for me to acknowledge that yoga was not the whole answer for me. Although I've always emphasised stability and strength, not just flexibility, in my practice and teaching, there was much that I was not aware of. I've made this long post, which I hope is clear, to share with you what I've learned in the hope that it will help you, too.

Two more quick points: your worn disc may or may not be the cause of your problem. Muscle imbalance, from shortening and tightening of the iliopsoas, hamstrings, etc, possibly as a result of your fall, is a more likely possibility. There are other possibilities, and a complete evaluation of your lower back and lower extremities should certainly be carried out.

Finally, I'll add for the record that I am a lot older than you (yesterday was my 70th birthday) - so it IS possible for 'worn-out old ladies' to learn new tricks to deal with old problems.

Best of luck to you.


Dr. Z on 4/30/05 at 10:19 (173968)

Happy Birthday Julie !!!!


Julie on 4/30/05 at 10:44 (173971)

Thank you Dr Z!

Re: To Julie LOW BACK PAIN Will it really help???

Ralph on 4/30/05 at 17:44 (174001)

I just invested in a Pilates machine. It came with an instructional video. I plan to begin slowly and build up of course and have my doctors blessing to do anything slowly without going all out.

Will it really help a low back problem? You may remember I posted a while back about a huge pain I had and wasn't certain what it was. After getting an MRI and a few other tests my pain stems from my back not my heart.

He recommended stablizing my large and smaller muscles via physical therapy and of course they set up a program for me but also talked about

I looked at the machine and read about the exercises so decided to invest in one and begin a program very slowly working with my PT and using their advice on the machine exercises.

Will it really help. Like everything else I want it done yesterday, but I realize that isn't going to happen slow and steady is the course that is planned. My question is how do you stay motivated?????

Re: Pilates for low back problems

Julie on 5/01/05 at 02:53 (174007)

Hi Ralph

I do remember your post about your pain, and I'm happy to hear that it comes from your back and not your heart.

Will Pilates help you? I hope so. Stick to the advice your PT is giving you, and follow instructions precisely, especially when using the machine. I hope the programme that has been set up for you targets the deep stabilising muscles, transversus abdominis and multifidus. The first step is to find them (if you have a significant low back problem they haven't been working properly and need retraining - did your PT talk about this?) and then learn to engage them. Then you learn to use them in simple movements. It's a long process of re-educating the muscles - don't be in a hurry, and be satisfied with slow, steady progress.

I did a lot of research and reading while I was waiting for surgery and immediately afterwards, so by the time I started Pilates lessons I knew what I was looking for in a teacher. If you're interested I'll see if I can find a few links for you: the research, most of it by Australian physiotherapists, has been fascinating. I can also recommend a few books for background reading.

Later on, if you want to pursue Pilates specifically, you should find yourself a fully qualified teacher with experience of rehabilitation work, and take private instruction that will target your specific problems and requirements. Pilates, like yoga, has become popular over the past decade, and short, intensive, inadequate training courses have sprung up to satisfy the demand for teachers. A full Pilates training takes a couple of years, and involves thousands of hours of lectures, study of anatomy, written work, and assessed teaching practice. The best teachers are usually those who are attached to dance studios.

Staying motivated shouldn't be an issue as long as your programme is right for you, and as long as you do the exercises regularly and can notice improvements. If you aren't aware of improvements after a few months, talk to your PT.

All the best,