Defined

Muscular tightness in the lumbo-sacral region (L1-L5) causing pain.

Symptoms

The patient will complain of a dull aching and stiffness in the lumbar region (discs L1-L5).  Standing for long periods of sitting in the same position may worsen the pain.

Biomechanical Aetiology

While there are various factors contributing to low back pain (eg. congenital and injuries), a common condition is a rotated hip and most commonly bilateral excess subtalar joint pronation; which internally rotates the tibial and femoral shafts with anterior tilt of the pelvis as an outcome.  When the pelvis tilts (forward), a forward shift of the body's centre of gravity occurs and results in increased lordotic curvature (sway back) and compensatory muscular tightness of the lumbo-sacral region.  A secondary kyphotic curvature to the upper body (thoracic region) commonly develops.  Functional short leg [coming soon!] can occur from pelvis rotation/twist, however both structural and functional short leg can be a major contributing feature to low back pain as the sacro-iliac joint may be impinged causing pain and discomfort.  As the pattern begins, the muscles on one side of the body become dominant and as they become stronger they rotate the hip (ileum) pulling the leg up higher into the hip socket (acetabulum) producing a "functional shortage".  Unilateral excess subtalar joint pronation lowers the vertical distance of the foot to the ground, therefore creating a functional short leg, causing hip mal-alignment.

Treatment

ICB Orthotics control internal rotation of the tibial and femoral shafts by reducing excess pronation thereby limiting anterior pelvic tilt and secondary muscular tightness of the lumbo-sacral region.  Use ICB Full Length Orthotics for best results with cross trainers.

An ICB Heel Lift can be used to raise structural short leg.  DO NOT use heel lifts without first assessing and prescribing orthotics as the pronation factor affecting the longer leg needs to be controlled.  Additionally, improvement of body posture - standing and walking up straight can assist.  Office jobs - sit with back straight and head up.  Use gas charged office chairs to reduce coccyx injuries.  Soft tissue therapy and adjustments by a qualified practitioner could be of value.  Stretching exercises together with ICB Orthotics can be very helpful in reducing the pain.  The stretching will relieve the gradual shortening of the affected muscles and the ICB Orthotic will prevent the functional shortening of the leg by maintaining the normal biomechanics and posture of the foot and leg.

Exercises

• Strengthening of the abdominal muscles - "safe" sit-ups (lift head and shoulders off the ground whilst keeping the neck straight and eyes focused on the ceiling).
• Push-ups (legs and pelvis stay flat on the ground).
• Hamstring and lumbo-sacral stretches.

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