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Getting Better...Better - Part 8 - The Spine


TL;DR

  • Low back pain affects most people at some point in their life.

  • The spine’s ability to maintain active stability is highly influenced by Intra-abdominal pressure(IAP).

  • Intra-abdominal pressure is regulated by the diaphragm

  • Diaphragm function is determined by breathing mechanics

  • Diaphragmatic breathing promotes proper IAP which positively influences active stability strategies at the spine. Chest or “paradoxical” breathing can reduce the diaphragms ability to regulate IAP, resulting in poor or compensatory stabilization strategies at the spine.

  • Failure to address breathing mechanics can often undermine the long term success of an otherwise well-intentioned rehab or S&C program.

Low back pain is an epidemic. Over 80 percent of the population with experience LBP at some point. It is the second most leading cause of disability among adults in the US.


As we covered earlier in the series, injury occurs when a load is placed on a tissue/tissues that exceed its load bearing capacity, resulting in tissue damage.


The spine is no exception. When injury happens at the spine(or any tissue), there are two potential components - Movement Capacity and Movement Quality.


Movement Capacity - The ability to to perform functional movements at the volume and frequency required without exacerbating symptoms or causing tissue injury - is usually well addressed by most well informed strength coaches, PTs, Chiros and other fitness and healthcare related professionals.


Movement Quality - An appropriate combination of mobility and stability resulting in appropriate co-contractions surrounding the joint - This has been the theme of our series and is most often influenced by the brain’s stabilization strategy when it comes to managing load. High Quality movement correlates to higher movement capacity.


Active stability of the spine is dependent on the dynamic coordination of numerous synergist and antagonist muscles and intra-abdominal pressure(IAP).


Kolar describes this as the integrated spinal stabilizing system (ISSS). The diaphragm, pelvic floor and transverse abdominis regulate IAP and provide anterior lumbopelvic postural stability. These intrinsic spinal stabilizing muscles provide spinal stiffness in coordination with IAP, which serves to provide dynamic stability of the spine.


McGill describes this in his texts as “superstiffness.” Panjabi would refer to this as an actively stable spine. This is key when addressing movement quality at the spine.


As we strive to identify the passive stabilization strategies that accompany LBP, we must first identify whether or not the individual can properly regulate IAP.



Breathing mechanics highly influence the diaphragm’s ability to properly control IAP. The average person takes upwards of 20,000 breaths in a single day. These breathes can play a huge role in diaphragm function, either positively or negatively.


In a well functioning ISSS, the diaphragm functions as the primary respiratory muscle along with regulating IAP. This is know as cylindrical or diaphragmatic breathing. During inspiration(breathing in) the diaphragm contracts and flattens, increasing pressure in the abdominal cavity, and resulting in a circumferential expansion of the lower abdomen and lower rib cage.


Faulty breathing patterns often develop in compensation for injury or pain, along with a variety of other biopsychocial factors. In most primary respiratory faults the rib cage lifts, and the chest moves as opposed to the lower abdomen.

This is often refers to as paradoxical breathing - instead of expanding upon inhalation, the abdomen draws in.


When this happens, the diaphragm and its ability to regulate IAP become comprised, and is often a primary contributing factor to the inability to create active stability at the spine.


In order to have any long term success in addressing and managing low back dysfunction, breathing mechanics MUST be addressed first and foremost. Failure to do so, will result in continued dysfunction and compensatory patterns, and will most often undermine the results of an otherwise well-intentioned rehab or strength and & conditioning program.


Obviously it depends on the context - different people have different goals, different anatomy, and different medical histories. If you are having pain, please, PLEASE go talk to a qualified medical professional who can evaluate YOUR problem. In part 9 we will discuss positional and practical organization and stabilization strategies in order to maximize active loading strategies in the low back. As always the goal is to help make you better. Better.

If there is any specific topic you would like to see addressed or if you have any questions feel free to reach out to me(Jon) directly at jh@summitrehabkc.com or contact our clinic at 816-554-6003.


Thanks for reading!!


#getbetterbetter #physicaltherapy


Freburger, Janet K. et al. “The Rising Prevalence of Chronic Low Back Pain.” Archives of internal medicine 169.3 (2009): 251–258. PMC. Web. 25 Oct. 2017.


Cook J, Docking S “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians Br J Sports Med Published Online First: 08 August 2015. doi: 10.1136/bjsports-2015-094849

Frank C, Kobesova A, Kolar P. DYNAMIC NEUROMUSCULAR STABILIZATION & SPORTS REHABILITATION. International Journal of Sports Physical Therapy 2013;8(1):62-73.


McGill, S. (2009). Ultimate Back Fitness and Performance (2nd ed., p. 116). Backfitpro Incorporated.


Perri, M. (2007). Rehabilitation of Breathing Pattern Disorders. In Rehabilitation of the Spine A Practicioner’s Manual (2nd ed., pp. 369-387). Baltimore,


MD: Lippincott Williams & Wilkins.


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