Are you one of the 25% of Americans that suffered from low back pain in the past three months? Do you chronically suffer from low back pain? If so, then read on and discover what you need to know to live pain free.
The core is more than just a 6-pack that people typically think of. It is a group of muscles that move and stabilize the spine and hips. People with low back pain typically have imbalances among these muscles which creates back spasms and pain. Back spasms mostly occur when lifting an extremely heavy weight, or when lifting an extremely light object. The reason for this is that a core stabilizing muscle gives out causing the rest of the stabilizers to compensate for it throwing the muscle synergies off balance. When lifting an extremely light weight you may neglect to use these stabilizing muscles, thus only using muscles to move the spine without first stabilizing your body.
More often than not, even after the pain goes away there will still be signs of an injury as the spine is less stable when you are in certain positions as a result of a weak stabilizing muscle. An example of this would be being able to balance on the left side of your body, but not your right side. Some good tests to do would be an extensor endurance test (see how long you can hold yourself horizontal with only your legs supported by a table/bench), a flexion endurance test (hold approximately a 45% angle to the floor with your upper body), and a lateral endurance test (right and left side bridges). If you have a healthy back, you should notice that your extensor endurance is greater than your flexion endurance (your extension strength should also be stronger than you flexion strength), and your right and left side bridge endurance times should be very similar.
Before I get into how to fix your low back problems lets talk quickly about proper biomechanics. This is essential to fixing your stabilization problems and for preventing herniated discs. First, the only way get a herniated disc while exercising is to fully flex or over extend your back. As long as your spinal curvature is within reason, close to your neutral position, you will remain safe during exercise. However, just because you are not at risk for a herniated disc does not mean that you are exercising properly. To use your body properly you must keep a neutral spine with very few exceptions to this rule. In order to find out what position is neutral for you, since everyone is unique and there will be discrepancies, stand up straight. Slightly flex your spine then slightly extend it. The position where you feel the least amount of pressure on your spine and you are at total ease is the neutral position of your spine. Some of you may have such severe muscle imbalances that this task is impossible and I would advise you to seek professional assistance. Don’t put it off, this is a problem that can get worse over time, stop reading since you are hunched over right now recruiting muscles that are already too tight. I recommend that you go see a qualified doctor, physical therapist, or personal trainer.
Back pain often goes hand in hand with tight hamstrings and week glutes. The glutes, cross-sectionally (the functional part of your muscle) are the strongest muscles in the body. If your glutes aren’t firing properly, known as gluteal amnesia, then your lower back and hamstrings must pick up the load in order to extend your hips. You will have lost the strongest and most powerful part of your body so get ready to experience pulled hamstrings, low back pain, and a butt that hangs to the ground. You must eventually add in some form of squats (I recommend single leg squats so that you are forced to stabilize and fire the glute medius), and deadlifts into your routine. Make sure you get deep, parallel or beyond, in both exercises or you are wasting your time.
Before you add the exercises into your routine though you need to first learn to stabilize and move your hips and spine properly. You should always flex and extend at the hips. The spine should stay for the most part in its neutral position, with the exception being some movement in the thoracic vertebrae. I recommend Stuart McGill’s “Big 3” exercises. These include a curl up and deadbug, side bridges, and the birddog or quadruped. For the curl up you should only focus on moving the thoracic spine don’t flex the cervical spine or move your head and shoulders very high off the ground. This is to train the rectus abdominis, be careful not to fully flex your spine for this exercise like I would say 90% of people do. If this is the case for you then look for the old guy in the gym with the hunch back and see what you will look like in the not too distant future.
If you experience pain in your neck while performing a curl up then most likely you are overusing your sternocleidomastoids. Try pushing your tongue into the roof of your mouth and close your teeth. This will activate the digastrics and should alleviate the pain. If pain persists then incorporate isometric neck extension exercises into your routine to strengthen your neck.
For the side bridges there are many variations. Start on your forearm with your legs straight or bent at your knees with your legs stacked on top of each other. Lift your hips off the ground toward the ceiling in a slow and controlled manner. Slowly lower them and repeat. If you notice an imbalance do twice as much work on the weak side.
There are many progressions for the birddog as well. If you haven’t done this before start off on you hands and knees. Extend your opposite arm and leg and stabilize yourself. Slowly come back to the center without touching the ground and repeat. Switch and do the same amount of reps on the other side. If you notice an imbalance perform twice as much work on the weak side. Once you have mastered this, start extending the arm and leg on the same side. Again if you notice an imbalance do twice as much work on the weak side.
For all three of these exercises you should perform them at the beginning and possibly end of your workout. If you have a history of back pain they may very well be your workout until you are ready to progress into a more formal resistance routine. Depending on your level of fitness complete anywhere from 1-3 sets ranging from 8-20 repetitions per set. Hold each position for anywhere from 1-10 seconds based on your program design.
Low back pain affects nine out of ten people at some point in their lives. If this is a persistent problem then I would not recommend waiting another day to get the help you need. Rest will not make the problem go away, it will simply delay it from resurfacing. Do yourself a favor and begin addressing your lower back issues today.
If you have any specific questions or if you are interested in developing an individualized pain relief program you can contact me at email@example.com.
Jon Feinman, CSCS, CPT