In Australia, back complaints are the second most common condition presenting to General Practice, following upper respiratory conditions. The annual expenditure is estimated to be $9.17 billion, of which $1.2 billion is on direct health cost and the remaining $8 billion is spent on lost productivity
Research shows that 75-80% of adults have an incidence of low back Pain (LBP) at some time in their lives. 84% of those people will go on to have another episode of LBP within a year and 3% will go on to develop chronic disabling LBP.
With an acute episode of LBP the initial recovery is very favourable with 80-90% showing improvement within 6-8 weeks, whilst those who do not settle within 8-12 weeks are identified as high risk for chronic disabling pain. However, even in those that have recovered well within the 6-8 week period that there is 84% likelihood of recurrence within a year.
When looking at the mechanisms behind recurrent low back pain is essential to look at Poor movement. Studies demonstrate that a single episode of LBP produces dramatic weakness and incorrect firing patterns in the key spinal muscles including multifidus, one of the core muscles.
The switching off of these deep stabilising muscles occurs due to pain and results in a loss of control of the core musculature system (multifidus, transversus abdominus, pelvic floor and diaphragm). This creates a compensatory pattern where the larger superficial muscles, rectus abdominus, obliques and erector spinae take over. As a consequence, there is micro-trauma taking place inter-segmentally due to excessive shearing forces at the level causing degenerative changes. Often these degenerative changes are asymptomatic initially, but by creating compensatory changes in muscle firing and joint mechanic, it will create long-term irreversible degenerative changes with resultant recurrent episodic LBP.
Studies show that spinal stabiliser muscle recovery is more rapid in a patient who undergoes a specific stabilisers retraining program. Importantly training multifidus and core muscles dramatically reduce the incidence of episodes at 1year follow up by 30% compared to 84% in control groups. At 3 years a 35% recurrence rate compared to 75% in the control group.
Pilates is the ultimate in training of the spinal stabilising muscles. Additionally Pilates self-management of low back pain. Studies show that enables those who embraced the self-management model with exercise and increased daily activity into their routine were shown to have more successful outcomes in the longer term.