Latest / The Driven Athlete / Unlocking Your Lumbar Spine | Ep 88

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Unlocking Your Lumbar Spine | Ep 88 · The Driven Athlete

• 0:00
  Speaker 1: If you're a driven, active person who wants to reach and pursue a higher quality life with some ambition, then guess what this podcast is for you.
• 0:07
  Speaker 1: This is the Driven Athlete Podcast.
• 0:10
  Speaker 1: What's up y'all?
• 0:13
  Speaker 1: It's your man, dr Kyle.
• 0:14
  Speaker 1: Driven Athlete Podcast.
• 0:16
  Speaker 1: Back at you.
• 0:17
  Speaker 1: Today we're talking about lumbar spine and joint mobility and pain referral patterns from the lumbar spine.
• 0:26
  Speaker 1: So this is a super common thing we see patients with.
• 0:30
  Speaker 1: So I'm like man.
• 0:30
  Speaker 1: I want to educate people and at least bring some insights from the lens in which we would perceive this and how we would treat it and the approach we would have, and some explanations on where does it come from in the first place, like where does pain come from with this?
• 0:41
  Speaker 1: So to begin with, a little bit of an anatomy breakdown and I'm not trying to insult anyone's intelligence, just make sure we're on the same page.
• 0:48
  Speaker 1: The lumbar spine is the lower part of the back of the spine.
• 0:52
  Speaker 1: That's the last five vertebrae that connects to your tailbone.
• 0:56
  Speaker 1: All right, so, and they're numbered One, two, three, four, five.
• 1:11
  Speaker 1: So L for lumbar one, l2, l3, l4, l5.
• 1:12
  Speaker 1: Some cases it's more rare than not is an L6.
• 1:13
  Speaker 1: It could be like a sixth lumbar vertebrae and it could be a lumbarized sacral vertebrae or a sacralized lumbar vertebrae if they're more articulated or fused with either side, but anyway.
• 1:20
  Speaker 1: But the lower five vertebrae is the lumbar spine.
• 1:23
  Speaker 1: They're bigger, they're stout, they're built for more stability and the orientation of their joints that work together are built more for bending down forward and bending up backwards, so flexion would be bending down, extension would be bending up backwards.
• 1:39
  Speaker 1: So lumbar flexion and lumbar extension, that's how the joint orientations of the lumbar vertebrae facet joints are positioned.
• 1:48
  Speaker 1: That's kind of the architecture.
• 1:50
  Speaker 1: So, with that being said, they're really not made for rotation.
• 1:55
  Speaker 1: Not much rotation mobility comes from the lower lumbar vertebrae.
• 1:59
  Speaker 1: But we see people and athletes and active individuals.
• 2:04
  Speaker 1: They compensate by rotating through the lumbar spine because other joints above the lumbar spine or below the lumbar spine aren't rotating like they should and that would be like your hip joint below.
• 2:16
  Speaker 1: So imagine like rotating through your hips with a tennis swing or a baseball swing or a really commonly down here in Florida is a golf swing.
• 2:24
  Speaker 1: Or above the lumbar spine, in your thoracic spine, the thoracic region of your vertebrae, of your spine.
• 2:30
  Speaker 1: If somebody is lacking rotation range of motion in their thoracic spine, what right below it is going to overcompensate to make up for that the lumbar spine.
• 2:40
  Speaker 1: So with biomechanical compensation patterns, the lumbar spine will take the brunt of some of those movements, all right, and that can lead to disparities in mobility, all right.
• 2:54
  Speaker 1: So every vertebrae, from L1 to 2 to 3 to 4 to 5, to S1, s1 would be sacral vertebrae number one, all the way up to T12, which would be thoracic vertebrae number 12.
• 3:05
  Speaker 1: That's the lowest thoracic vertebrae.
• 3:07
  Speaker 1: There's 12 of them, all right.
• 3:09
  Speaker 1: So T12 is the lowest one, and that articulates with L1, which articulates with L2, which articulates to L3, to L4, to L5, down the chain to S1.
• 3:18
  Speaker 1: So that kinematic chain of those lower lumbar vertebrae, those lumbar vertebrae, those lumbar vertebrae, they all work together right, and they move.
• 3:26
  Speaker 1: At every segment.
• 3:27
  Speaker 1: Every segment has its own segmental mobility.
• 3:30
  Speaker 1: But if some segments move more extraneously than the neighbors above or below, those mobility disparities can cause problems.
• 3:41
  Speaker 1: And those segments that maybe move extra compared to their neighbors above or below, we would call those segments that move extra, those would be hypermobile segments, hypermobilities.
• 3:52
  Speaker 1: And another common thing with that too is if the sacroiliac joint, the SI joint, can get dysfunctional too to compensate for lumbar mobility disparities or a lack of hip range of motion, below in the pelvis, or above, with thoracic spine rotation, mobility disparities or a lack thereof.
• 4:13
  Speaker 1: So the compensation patterns can come and go in different ways for different people.
• 4:17
  Speaker 1: That's what we have to investigate.
• 4:19
  Speaker 1: Be like where's the compensation pattern happening?
• 4:21
  Speaker 1: Where's it coming from?
• 4:22
  Speaker 1: What's causing the pain Like?
• 4:24
  Speaker 1: What's the pain generator?
• 4:25
  Speaker 1: Why did it happen in the first place?
• 4:27
  Speaker 1: How do we fix it?
• 4:29
  Speaker 1: And then how do we prevent it from coming back?
• 4:30
  Speaker 1: The how do we fix it part is a recipe of manual therapy, soft tissue work, corrective exercises.
• 4:37
  Speaker 1: But we have to have an underlying diagnosis of what's going on first to actually get a good, clear diagnosis and treatment pattern, because that totally changes the treatment trajectory.
• 4:46
  Speaker 1: So the lens in which we perceive this as movement based professionals and clinicians, we're going to diagnose it off of a movement based problem.
• 4:57
  Speaker 1: Right and biomechanically, compensation patterns can lead to segmental hypermobilities and also segmental hypomobilities, so they're not moving enough right.
• 5:08
  Speaker 1: That makes sense If the disparity in the relationship one's moving too much, the other one's not moving enough.
• 5:12
  Speaker 1: There's a disparity and imbalance in mobility between those two segments or three segments or four segments and very often the painful site actually I'll take that back almost all the time we diagnose off of the painful site being hypermobile.
• 5:29
  Speaker 1: So if we push and palpate on some of the vertebrae in your back and some are really tender and like sensitive and hurt, and other ones really aren't tender and sensitive, don't hurt as much.
• 5:39
  Speaker 1: Very, I mean almost all the time.
• 5:43
  Speaker 1: The hypermobile segments are the tender, more sensitive vertebrae.
• 5:48
  Speaker 1: All right, and that just clues us in to hone in on a diagnosis and figure out what's going on, because then we know what's going on, we can treat it better and we're going to work on treatment stuff and treatment interventions to help fix the problem.
• 6:01
  Speaker 1: But the underlying root cause usually comes from a combination of movement system impairment, compensation patterns, global compensation patterns.
• 6:11
  Speaker 1: It's a recipe of like the hip isn't moving good because the glutes aren't recruited well enough.
• 6:16
  Speaker 1: Maybe they have psoas guarding psoas.
• 6:19
  Speaker 1: Weakness can be a common one a lack of core stability in recruitment and a lack of thoracic spine rotation mobility.
• 6:25
  Speaker 1: That is a really common recipe of body mechanics, mechanical compensation patterns, and that leads to back pain.
• 6:34
  Speaker 1: That we see All right.
• 6:36
  Speaker 1: So, with that being said, those segmental mobility disparities, what do you think is happening at the painful site that there's a hypermobility and it's tender, it hurts to touch in your low back and you have a ton of muscles that connect all over the place, from your pelvis to your tailbone, to your hip joint and your glutes, your hip flexors, your quads, your back muscles, your abdominals.
• 7:00
  Speaker 1: Your diaphragm connects up in there too.
• 7:02
  Speaker 1: What do you think the muscles that connect to those vertebrae that are dysfunctional and hypermobile are going to be?
• 7:07
  Speaker 1: Like?
• 7:08
  Speaker 1: They're really guarded and tense and spasming right, that's usually where muscle spasms come from from underlying joint hypermobility that's been chronic in a long, long time of repetitive microtrauma, from these compensation patterns of the joint that lead to a lot of pain and irritation, local inflammation.
• 7:32
  Speaker 1: And then the muscles that connect to those joints are going to be guarded and on high alert and they're going to be strong and they're going to be spastic, spasm, and they're really sensitive and tender.
• 7:44
  Speaker 1: All right, that's what the muscles look like when they're connected to those, and those muscles are usually in your low back, that they're in protection mode.
• 7:51
  Speaker 1: They're defense mechanism, protection, guarding mechanism and really spastic.
• 7:57
  Speaker 1: And those muscles are your erector groups.
• 7:59
  Speaker 1: All right, it's going to be the longissimus, the iliocostalis, the multifidus, the spinalis are tiny little muscles that connect between every single vertebrae attachment in the lumbar spine.
• 8:12
  Speaker 1: The quadratus lumborum also is a key player with muscle guarding and spasm and tenderness and pain.
• 8:18
  Speaker 1: And then the psoas is also a key player.
• 8:20
  Speaker 1: Those muscles are the ones that usually get very guarded and tense.
• 8:23
  Speaker 1: So we have to work on those, you know, and that makes sense that they're all lit up.
• 8:27
  Speaker 1: If we just do, if a person just gets massaged over and over and over again, they just massage out their low back.
• 8:34
  Speaker 1: Usually we find that people don't get better.
• 8:35
  Speaker 1: It's because the muscle guarding and the muscle spasming that's just a tertiary problem.
• 8:41
  Speaker 1: That's not the problem.
• 8:43
  Speaker 1: The muscles usually follow suit because of underlying joint irritation and compensation patterns biomechanically and the muscles that are being overused chronically they will get guarded, intense and tender and lit up and irritated and on defense mode and super guarded.
• 8:58
  Speaker 1: And that's the tertiary problem.
• 9:01
  Speaker 1: If we just work on that the superficial muscle guarding people don't get better.
• 9:06
  Speaker 1: We have to work on solving the underlying root problem which for this situation, is a movement system impairment.
• 9:15
  Speaker 1: There's a recipe of several things all playing together that led to this pain and it's a repetitive microtrauma of issues that lead up and accumulate over a long period of time, where finally the straw that built the camel's back comes out for the chickens to roost no pun intended with the straw that built the camel's back.
• 9:37
  Speaker 1: So, with that being said, one of them you can't leave out of this talk is you got bones, you got ligaments, you got tendons, you got muscles, but you got hurt.
• 9:46
  Speaker 1: Discs are in there which we've had.
• 9:48
  Speaker 1: We've at length to talk about herniated discs.
• 9:49
  Speaker 1: So we can check out that podcast.
• 9:51
  Speaker 1: I've did before and I'll send it to you if you want.
• 9:54
  Speaker 1: But the last thing we got, that's probably the most important, because you also have nerves.
• 9:58
  Speaker 1: You have nerves everywhere.
• 9:59
  Speaker 1: Nerves innervate all over the place.
• 10:00
  Speaker 1: You have trillions of nerves all over the place and they're super aware, alert, and they're sensitive and they're ready to send signals.
• 10:06
  Speaker 1: And when somebody's in pain, those nerves are going to be hypervigilant and they're going to be ready to send signals back oh, don't do that, oh, be careful, oh, I'm nervous, right, all that stuff.
• 10:17
  Speaker 1: So there's nerves, nerve roots, that exit from the spinal cord through every vertebrae, at every facet joint in the lumbar spine, throughout your whole spinal cord or your spinal column, your vertebrae, every single vertebral segment joint, all the way down and through your sacrum.
• 10:34
  Speaker 1: There's nerve roots that exit from the spinal cord through those facet joints and so they pass right through the joints and imagine what do you think the nerves are going to be like when the joints that they pass through are very irritated and inflamed and lit up.
• 10:50
  Speaker 1: They're going to be super sensitive and they're going to be ready to send signals and those signals would be referred pain, referred pain or pain patterns.
• 10:57
  Speaker 1: And those signals would be referred pain, referred pain or pain patterns.
• 11:00
  Speaker 1: And the trashcan term of including all that as it relates to back pain is sciatica.
• 11:05
  Speaker 1: All right.
• 11:06
  Speaker 1: So sciatica is a trashcan term that collects.
• 11:08
  Speaker 1: There is an issue with the pathway of the large nerve called the sciatic nerve that passes from a collection of nerves through the nerve roots in your lumbar spine and your sacrum as it passes down the back of your butt and your glute region down your hamstring.
• 11:22
  Speaker 1: So that would a large nerve is called your sciatic nerve.
• 11:25
  Speaker 1: So sciatica would be like a pathology of the sciatic nerve.
• 11:28
  Speaker 1: All right, that gets involved.
• 11:30
  Speaker 1: The question is is like it's not always.
• 11:32
  Speaker 1: It doesn't paint a good picture.
• 11:34
  Speaker 1: It just represents referred pain down the glutes and the hamstring region, the back of the thigh right.
• 11:40
  Speaker 1: It's a super common area for referred neural pain, all right.
• 11:44
  Speaker 1: So really, what educate people is?
• 11:46
  Speaker 1: Like it's just nerves that are sending signals down the leg that um is informing everybody that they're in, they're lit up, right, and they're, they're, uh, sensitive and they're getting some danger signals and, uh, and they want to let you know.
• 12:02
  Speaker 1: Right, that's just a fire alarm to let you know there's a problem, all right.
• 12:05
  Speaker 1: So that referred pain and pain referral pattern that tells us a story.
• 12:12
  Speaker 1: It lets us know, maybe, what segments are involved, the severity of the problem and maybe when imaging might be, you know, advised, right, it's not always just straight up sciatica and it's not always representation of a herniated disc causing the referred pain.
• 12:28
  Speaker 1: It's actually I mean, this is controversial to say according to the literature and the research it's usually not the disc.
• 12:35
  Speaker 1: There's a whole other podcast on that prior, previously, that you can check out about hernia disc and referred pain and neural pain patterns.
• 12:43
  Speaker 1: But anyway, it's just referred pain and a classic sign for that is down the glute, down the hamstring, the posterior thigh, the back of the thigh region, and that just reflects referred nerve pain Because the joints in the lumbar spine that they passed from originally, those joints are very irritated and they're inflamed and they're lit up and all the muscles that connect to those joints are also guarded and tense and very spastic, all right.
• 13:10
  Speaker 1: So the question is, it's is why did it happen in the first place?
• 13:12
  Speaker 1: And that's how we're going to fix it.
• 13:14
  Speaker 1: Does that make sense?
• 13:15
  Speaker 1: So that's just a little bit of education on before I land this plane because I wanted to be quick.
• 13:20
  Speaker 1: I just wanted to introduce this real fast like a short, concise information on low back, segmental mobility, muscle guarding, referred pain.
• 13:29
  Speaker 1: But the recipe for how we fix that is a combination of manual therapy to improve the disparities in joint mobility of the lumbar spine, the hips, maybe the SI joint, the sacroiliac joint and the thoracic spine.
• 13:44
  Speaker 1: So manual therapy to intervene and improve the mobility disparities of those joints and those segments, followed by some soft tissue work to get things to settle down, bring some blood flow for sure, stimulate some hyaluronic acid and blood flow, some synovial fluid in the joint spaces.
• 14:00
  Speaker 1: And that could be achieved with just straight stripping, cupping I'm not really a fan of Graston, I don't really do that much and then dry needling can be really helpful too.
• 14:09
  Speaker 1: Dry needling is super helpful for this, maybe not right away at the acute stage on the site because it's going to be tender and it's going to be sensitive, but neighboring it can be really helpful.
• 14:19
  Speaker 1: It also helps with nerve or fur pain too.
• 14:21
  Speaker 1: So dry needling it's a really effective soft tissue of effect.
• 14:24
  Speaker 1: Neural nerve and soft tissue intervention that followed up with corrective exercises.
• 14:31
  Speaker 1: The corrective exercises is what solidifies the changes we're looking for.
• 14:36
  Speaker 1: The manual therapy sets it up for success so that things are moving better and they feel a little bit better right now.
• 14:40
  Speaker 1: And then the corrective exercises lock it in place and solidify the changes that we're looking for.
• 14:44
  Speaker 1: But we ultimately have to fix the compensation patterns, the recipe of biomechanical compensation patterns that led to the problem in the first place.
• 14:51
  Speaker 1: If we don't, then things aren't going to get better.
• 14:54
  Speaker 1: And that's when people come see us because they've been doing it for a long time, battling this pain.
• 14:58
  Speaker 1: I had to rest for a little bit.
• 14:59
  Speaker 1: I try to just back it down, I ice it, I rest, I take some Advil, I feel a little bit better.
• 15:05
  Speaker 1: Then I get back into my activity If it's exercising golf, tennis, lifting weights, whatever.
• 15:09
  Speaker 1: If it's exercising golf, tennis, lifting weights, whatever.
• 15:10
  Speaker 1: And then it comes back again.
• 15:11
  Speaker 1: And then I had to rest and then I'd try to go back into my exercises again, my workouts and my golf and it comes, my pain comes, returns again, and that cyclical rollercoaster of like it hurts and I rest, it hurts and I rest.
• 15:24
  Speaker 1: That's when people come see us, because we're the specialists that are going to take care of it.
• 15:28
  Speaker 1: And we're only saying that in confidence, because we've done it a thousand times and we've had a good track record, right.
• 15:33
  Speaker 1: You don't see all those five-star Google reviews just from.
• 15:36
  Speaker 1: They're not fake, right.
• 15:37
  Speaker 1: But that's the high five moments we get when people stick to a plan of care and we're able to progress things appropriately, with good intention and communication through the process over a couple weeks, a handful of weeks.
• 15:56
  Speaker 1: At the end of that, in the high five moments that we get, that's the Google reviews we have, right, and the testimonials and stuff.
• 16:00
  Speaker 1: But the corrective exercises is what solidifies the changes, because the pain, the problem, that is the underlying root cause of the problem, which the pain won't resolve unless that root cause problem is fixed.
• 16:11
  Speaker 1: And then, guess what?
• 16:11
  Speaker 1: The muscles will follow suit with feeling better too.
• 16:14
  Speaker 1: So even if we didn't do any soft tissue work which is common oftentimes, we just focus on the joint manual therapy we don't even do soft tissue work like stripping dry, needling, cupping or whatever.
• 16:24
  Speaker 1: We'll just do manual therapy in the joints and then we'll do corrective exercises and super common, people leave and they feel a lot better, they feel looser, they feel good and I'm like we didn't even touch your soft tissue, we didn't even touch your low back muscles and like work them out Right.
• 16:39
  Speaker 1: Um, it's because once we get things feeling better in the joint level and fixed compensation patterns, the muscles will follow suit.
• 16:45
  Speaker 1: So the muscles aren't the problem, the muscles pain and the spasms.
• 16:48
  Speaker 1: It's not the the problem, it's just a fire alarm.
• 16:49
  Speaker 1: But we have to fix it, only cause, otherwise it's going to keep coming back.
• 16:53
  Speaker 1: So a thing that we have like that we judge, we um I don't want to say that a thing that we um grade the clinicians that come mentor with us, with me.
• 17:03
  Speaker 1: Well, in the fellowship program for continuing education we have a lot of mentor mentees that come in the physical therapist docs that are trying to improve their level up their clinical game.
• 17:15
  Speaker 1: They come mentor with me and one of the things I ask is, when you work with an athlete and it's been a couple of sessions they should be feeling better.
• 17:21
  Speaker 1: Several sessions later, a couple of weeks later, and they're like hey, you're good to go back to your sport or your activity, 100%.
• 17:27
  Speaker 1: What's the likelihood of that pain returning?
• 17:30
  Speaker 1: If the pain comes back, that means you didn't solve the problem.
• 17:34
  Speaker 1: That's the bottom line.
• 17:35
  Speaker 1: My pain came back and they're doing everything you're telling them to do.
• 17:36
  Speaker 1: They're not doing anything outside of, out of system that they shouldn't be, that they're not telling you which that doesn't really happen.
• 17:43
  Speaker 1: That often People don't come see us unless we, unless they're like motivated, like let's just fix this fricking thing.
• 17:48
  Speaker 1: 'm going to do everything you tell me.
• 17:49
  Speaker 1: Perfect, let's get after it.
• 17:50
  Speaker 1: If the pain doesn't come back, that means you solved the problem.
• 17:53
  Speaker 1: If they return to their sport and the pain returns, that means you didn't solve the actual underlying cause of the problem, which means the diagnosis wasn't accurate and the whole trajectory of treatment also wasn't as best as it could be.
• 18:03
  Speaker 1: That's kind of how these pieces all fit together.
• 18:06
  Speaker 1: So anyway, that is the best recipe for actually solving this problem.
• 18:14
  Speaker 1: I wanted this to be super quick and short.
• 18:15
  Speaker 1: Just a concise info on lumbar spine, biomechanics, segmental mobility, pain, referred pain, neural referred issues and then muscle pain and the recipe on how to fix it.
• 18:23
  Speaker 1: This is what that was about.
• 18:24
  Speaker 1: If you have any questions, don't hesitate to reach out.
• 18:26
  Speaker 1: You can check back all the other podcasts we've done, especially on herniated discs, because we did that before too at length, and we're always open to questions, comments, concerns, conflicting opinions and if y'all want to come on the podcast, let me know.
• 18:38
  Speaker 1: I'm always open to ideas.
• 18:40
  Speaker 1: And if you have any pain or things that you want to get fixed, don't hesitate to reach out.
• 18:44
  Speaker 1: We can at least talk on the phone and figure out what the best direction for care for you is.
• 18:51
  Speaker 1: If it's not with us, it's somebody else, so at least we can point in the right direction.
• 18:53
  Speaker 1: So at least give us a call.
• 18:53
  Speaker 1: We can at least talk on the phone.
• 18:54
  Speaker 1: The best number to reach us on is 561-899-8725.
• 18:58
  Speaker 1: We're located here in West Palm beach, just East of I-95, next to the Palm beach outlet mall, the Tanger outlet mall.
• 19:05
  Speaker 1: We're right here and we work with active, athletic individuals that are motivated to get improved, their situation All right, and they're enthusiastic about wanting to get better.
• 19:14
  Speaker 1: If they're 85 years old or if they're 11 years old, we've worked with both.
• 19:18
  Speaker 1: We've actually worked with a 95 year old before it.
• 19:20
  Speaker 1: Just if you have a body and you're active, right, you're an athlete, what we would say, and we just work with people that are active and they want to improve their life and improve, decrease their discomfort and improve their functionality, and it gets some answers.
• 19:33
  Speaker 1: That's who we treat and that's what we work with and that's what we have the best results with, so don't hesitate to reach out.
• 19:39
  Speaker 1: We'll catch y'all next time.