Low Back Pain and the Woes of Andy Murray
This article is by Jo Knock the physiotherapist in London at Islington's Angel Wellbeing Clinic.
Back pain is one of the most common presenting problems that a physiotherapist will see on a day to day basis. UK figures show that up to 80% of us will suffer from an episode of low back pain in our lifetime. Being a physiotherapist in London I get to see patients with low back pain from playing sports and I get to see patients with low back pain from poor ergonomics in the workplace. Despite this statistic the general population are not well educated about their back or how a physiotherapist can help!
The spine is a very complicated structure comprising of many joints, segments, discs and muscles which all protect the spinal cord and support trunk mobility. As such there are many anatomical structures which are susceptible in high intensity activities if one's muscular stability is not up to scratch. On the flip side, long hours sitting at a desk and commuting are what I'm sure we can all agree are low intensity activities, however again a lack in muscular stability can lead to overloading spinal structures, inevitably resulting in low back pain and patients seeking physiotherapy. As a physiotherapist in London low back pain is a condition that I commonly see.
Andy Murray needs to see our physiotherapist!
Recently, Andy Murray retired from the Madrid Maters tennis competition due to his ongoing intermittent Low back pain. There are large forces put through the lumbar spine during any sporting activity, even more so in a sport such as tennis.
Murray gets through after losing the first set 1-6 against Finland's Jarkko Nieminen in the second round of the French Open.
"It was tough. I was obviously struggling at lot particularly at the beginning of the match. I don't know how I won to be honest.
"I think my back went into spasm. It was sore this morning when I got up and practised and it was sore 20 minutes after I finished practice.
"I couldn't put weight on my left leg. I had it in practice a couple of times.
"The guys were telling me to stop after the first set, we talked about it briefly before the match and I just decided to play. Sometimes guys can get nervous and you feel better, and a combination helped me get through." Murray told ITV
Why do players on the professional tennis circuit suffer with a high volume of spinal injuries and intermittent low back pain when they have access to physiotherapy? To answer you first need a small understanding of the biomechanics of tennis. When contemplating spinal loads in the different shots in a game of tennis, the serve is understood to place more stress and higher load on the spinal structures than any other stroke.
"the serve is understood to place more stress and higher load on the spinal structures than any other stroke." Jo Knock, Phsyiotherapist in London
When the racket moves over head and behind the body the spine flexes laterally and hyperextends. To smash the ball, acceleration of the racket before ball impact is produced by huge muscular forces bringing the trunk into rapid flexion accompanied by a very high velocity rotation (from right rotation to left rotation for a right-hander, vice versa for the left hander). This corkscrewing motion transfers the force of its torque to all the spinal segments. The repetitive trunk hyperextension we see in the tennis serve is understood to be a predisposing mechanism of lumbar arthritis.
Tennis players may also be at an increased risk of lumbar disc injuries due to the shearing effects of the forces from high velocity rotation from a position of lumbar hyperextension to lumbar flexion. This is as true for a professional at the French Open or at Wimbledon as it is for the average club player at the Islington Tennis Centre in London or at London’s Regent’s Park Tennis Centre.
You can now see why a lot of pro tennis players suffer with low back pain. If muscular control and dynamic stabilization around the spine is not up to scratch, injuries will result. Additionally, an individual could potentially have brilliant core dynamic stability, but other factors such as fatigue, general poor health, overload of schedule with looooonnnnnngggg hours spent training and the simple fact there are massive repetitions of the same movement or activity can all lead to spinal dysfunction.
Causes of low back pain in tennis players
In my experience of being a physiotherapist with experience of treating tennis related injuries, Low back pain is common. Frequent issues involved with tennis players suffering from low back pain.
• Lumbar disc abnormalities
• Muscular strains secondary to under trained or over loaded muscles
• Facet joint pain
• Pars injuries in adolescents including Pars fractures / Pars interarticularis
As a physiotherapist I am very aware of the heavy involvement of lower trunk muscles in tennis and indeed many sports. This reinforces the importance of abdominal and lower back exercises in strength and rehabilitation programmes. The strengthening of the lower trunk muscles not only will enhance performance, but both athletes and weekend warriors alike can benefit from preventing low back injury and pain. And as a clinical Pilates practitioner and physiotherapist I know how to get the trunk muscles and low back muscles to function better!
So for Andy Murray fans (I myself am one – I just want to see him lift that grand slam winner's trophy over his head one day, come on Andy you can do it!) it is not time to despair. We can be confident that he is surrounded by some pretty special sports physiotherapists and sports physicians who would be working around the clock on his treatment, which would no doubt involve rehabilitation exercises to build dynamic muscular stability to support his spine. And who knows, coming up we have Roland Garros, Queens and Wimbledon so watch the space for some trophy lifting!
If you want to get better you can!
Fear not, these strength and rehabilitation programs are not exclusively limited to those professional athletes – anyone in London suffering an episode of low back pain can come to see me for physiotherapy at Islington’s Angel Wellbeing Clinic and I will be able to work with you to address the cause of why your back has broken down – 9 times out of 10 this is due to muscular imbalances / deficiency and poor posture – then provide a program to get you back on your feet in no time, significantly reducing the chance of recurrence.
If you haven't already deduced by now, LONG gone are the days where the physiotherapist would suggest lying flat on your back for an episode of low back pain. It is important to keep active, lying on your back for extended periods can actually stiffen your spine more and lead to prolonged low back pain and maybe sciatica too. Most individuals respond famously to treatment comprising of manual therapy from a physiotherapist followed by a tailored rehabilitation exercise programme including clinical Pilates.
The long-term outlook is positive! You do not have to suffer with constant low back pain however it is not a magic wand trick. As a physiotherapist in Islington I know only too well how important the patient’s attitude is. I may be as good a physiotherapist as London has to offer but I cannot click my fingers and heal your back, I will guide you with your rehabilitation and it will involve co-operation and discipline on your part, by participating regularly in your exercises. These rehabilitation exercises are core and Pilates based movements and functional exercises – going to the gym and pumping iron nor 500 sit ups a day won't cut it!!
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So whether or not you are a tennis player and have a bad back or if you are a keen sports person and are constantly troubled with low back pain or you notice that you get a niggle in your spine every time you increase you activity levels, it may be time for you to visit our physiotherapist in London and invest your efforts into building core strength and dynamic stability so you can have a happy spine. If you want an appointment with our physiotherapist in London at Islington’s Angel Wellbeing Clinic click below.