Injury Management Update

Joshua C. Dubin, DC, CSCS, CCSP

617-471-2444
www.dubinchiro.com
Number 1 in a series

Low Back Pain

Most people suffer from low back pain at
some time in their lives. Common cases
of low back pain include people who
work in a prolonged flexed posture while
sitting at a computer, or the weekend
warriors who attempt to participate in
activities such as golf, biking, and
basketball without a proper training
program.
Understanding the biomechanics of
the lumbar spine and pelvis while bending forward and returning to the neutral
position will illustrate why the loss of
strength and flexibility in particular
muscles predispose individuals to the
development of low back pain.

Fig. 2A

Neutral Position

Fig. 1 Functional Unit

Vertebra
Facet
Joints

Forward Flexion 45 Degrees

45 flexion
lumbar spine
Pelvis

Pelvis

Hamstring

Movement 1: Anterior Flexion of the

Lower Back
The low back consists of five functional
units. A functional unit (Fig. 1) consists
of two vertebra, an adjoining disc, facet
joints, and the surrounding musculature,
ligaments and fascia.

Fig. 2B

point of motion in forward flexion of the

low back is the point at which a person
bends forward and can go no further
without pain. If the ligaments, fascia,
and muscles of the low back are not
flexible, this endpoint of motion will be
decreased and will result in a strain/
sprain injury of the low back when
attempting to bend forward to 45 degrees. In order to bend forward past 45
degrees, the pelvis has to rotate forward

Hamstring

(Fig. 3).
The anterior motion of the pelvis is
dependent on the flexibility of the hamstrings and the gluteus maximus musculature. If the hamstrings and gluteus
maximus musculature are not flexible,
the pelvis will be limited in anterior flexion (Fig. 4). When this limited endpoint
of forward flexion is exceeded, one will
usually suffer from an acute onset of low
back pain.

Disc
Fig. 3
Flexion with Pelvis
Rotating Forward

Ligaments attach bone to bone, and

fascia is a sheath of fibrous tissue that
encloses muscles and muscle groups.
There is approximately 9 degrees of
flexion at each functional unit, allowing
up to 45 degrees of forward flexion (Fig.
2A & 2B).
At 45 degrees, the fascia, muscles,
and ligaments of the low back are taut
and no more flexion is allowed without
forward rotation of the pelvis. An end-

Fig. 4
Pelvis Does Not Rotate Forward,
Resulting in Low Back Pain

Pelvis
Hamstring

Movement 2: Return to Neutral

Position from Flexion of the Low
Back
When returning from a flexed low back
posture, the gluteus maximus muscle
(Fig. 5) will contract, derotating the
pelvi s from its an terio rly rot ated
position. At the same time, the abdominal musculature contracts, tightening the fascia surrounding the low
back musculature, adding more stability to the lumbar spine.
Movement 1 and Movement 2 illustrate why f lexibility of the lower
back and hamstring musculature and
proper strength training of the gluteus
maximus and abdominal musculature
are important in the prevention of low
back pain. Having flexibility of the hip
flexors and external rotators of the hip,
as well as strength in the quadracep
musculature, can also aid in the prevention of low back pain.
Case Study
Bob came to Dr. Dubins office for care
with complaints of low back pain. He
stated that he worked as a stockbroker
and sat looking at a computer screen all
day. His low back pain came on grad-

Rectus
abdominus

Latissimus
dorsi

External
obliques

Gluteus
medius

Tensor
fasciae
latae

Vastus
lateralis
(1 of 4
quadracep
muscles)

How to Relieve Low Back Pain

Repeated, prolonged stress to the back and shoulders can
lead to a multitude of injuries down the road. Most jobs require
a prolonged (sitting or standing) slumped forward position,
which results in a postural overstretch and eventual low back
pain. Decrease and prevent lower back pain by doing a 15 to
20 minute daily stretching routine using a FlexBand. These
exercises will help prevent your low back pain.
Hamstring Stretch
Using a FlexBand in a toe
hold on the right foot, on your
back with your knee bent, foot
on floor. Hand over hand,
slowly bring the right leg up in
the air. Keep
knee straight.
Hold position
for 5 breaths
(inhale and
exhale 5
times), 3
repetitions.

ually and became more severe with

time. He did not belong to a gym, nor
did he do a strength and flexibility
training program at home.
Dr. Dubin conducted a thorough
exam on Bob's lower back to diagnose
his condition. The treatment techniques utilized by Dr. Dubin at his
office included: specific deep tissue procedures (active release technique) applied to the muscles in the low back to
free up soft tissue motion; adjustments
to free up joint motion; and combotherapy to help to relax the muscles,
restore normal muscle tone, and break
up scar tissue. Dr. Dubin tailored a
home flexi bility pro gram for B ob
involving the FlexBand and a proper
strength training program. Bob was also instructed on how to ergonomically
correct his workstation to help alleviate the repetitive strain on his low
back. Bob now does stretching exercises with the FlexBand for 15 minutes a day (see below) and a regular (1-2
times a week) strengthening program
for his low back. Bob's low back pain
has resolved, and his ongoing workout
routine will continue to help in the
prevention of future low back episodes.

Fig. 5
Lateral View of the Low Back and Surrounding Muscles

IT Band/Glutes/External
Rotator Stretch
Using the FlexBand in a toe hold
on the right foot,start with right leg
straight up in the air. Pivot the right
leg to the left side of the body. Hold
position for 5 breaths (inhale and
exhale 5 times), 3 repetitions.

Gluteus
maximus

Biceps
femoris
Iliotibial
band

Groin Stretch
Use the FlexBand in a toe hold on the right foot,
left knee bent, left foot on the floor. Starting with
the right leg up in the air, pivot the right leg to
right side, keeping left leg at 90 degrees in
original position. Hold position for 5 breaths
(inhale and exhale 5 times), 3 repetitions.

Quad Stretch
With the toe hold on right foot and
holding FlexBand with right hand,
turn onto your stomach and swing the
band over the head. Hand over hand,
bring right ankle into the right buttock.
Hold for 10-12 breaths.

Low Back Stretch/Erector Spine Stretch

Sit with the FlexBand around both feet
and the legs fully extended in front. Reach
down hand over hand on the band until
feel tension in calves, hamstrings, and
erector spine/low back musculature; let the
band pull you forward. Hold tension for 1012 breaths.

Dr. Joshua C. Dubin, DC, CSCS, CCSP, is a licensed chiropractor specializing in the management of musculoskeletal
disorders as well as sports and work-related injuries. Dr. Dubin graduated magna cum laude from Palmer College of
Chiropractics in 1995. In 1999 he published a paper on the treatment of low back injuries in Dynamic Chiropractic.
He is a member of the Team USA Triathlon Medical Staff, a certified strength conditioning specialist, and a certified
chiropractic sports physician. To schedule a consultation, please contact:

Dubin Chiropractic
1250 Hancock Street, Suite 106N
Quincy, MA 02169
617-471-2444
www.dubinchiro.com

2002 Dubin Chiropractic