FIX YOUR LOWER BACK PAIN: EXACTLY WHAT YOU SHOULD DO
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YOU CAN FIX YOUR LOWER BACK PAIN FOR GOOD:
In my personal and professional experience, you can probably fix that lower back pain for good. You can manage it using evidence based protocols. Now, there are a number of exercises and stretches that I can just throw your direction and hope that something sticks. But the more efficient and better approach is to initially have an assessment from your movement professional. I do free 30 minute one on one online consultations if you're interested in working one on one together. If you don't have the liberty of getting an assessment done, then one thing that I can tell you that will absolutely make your lower back pain worse is to absolutely do nothing. Studies show that sedentary behavior or complete bed rest can actually make your lower back pain worse, and it simply prolongs your recovery.
Motion is lotion and exercise is medicine, so we definitely want to promote as much movement as early on as possible. Now, let's first take a look at some of the possible reasons for your lower back pain in the first place, because depending on the mechanism of injury, that will dictate what your exercise prescription should be. Please read until the very end of this blog, because we're going to get more and more specific about certain lower back conditions.
Now, with any of these lower back conditions, you may have difficulty bending down to pick something up off the floor, getting up out of bed and even sleeping with lower back pain. Having the ability to wreak absolute havoc on your day to day activities. It's really, really important to have a thorough approach and even more importantly, to stay positive through your recovery process. We have to manage your expectations from the beginning, and this can help you avoid any unnecessary anxiety and even depression when it comes to your lower back pain. But you do have to understand that you can come back so much stronger from this.
And then oftentimes I find that most patients have an appreciation of the privilege that comes with being able to move pain free, as well as getting back to the things that you love to do on a daily basis. Now let's break down some of these potential reasons and what we can potentially do for this lower back pain.
COMMON REASONS BEHIND YOUR LOWER BACK PAIN:
Now, while there's a lot of possible reasons for lower back pain, let's cover three of the most common.
Sprains or Strains
First, one of the more common reasons for lower back pain is either a sprain or strain to the lower back region. The difference between the two is that a strain involves muscle tissue, and that a sprain usually involves the joint and or its associated ligaments. With this type of injury, your lower back pain can be considered either acute or chronic, where with an acute injury that onset, or it happened within the last 72 hours and it's usually the result of one significant event. So for example, lifting something heavy and you suddenly feel a sharp pain that would be considered an acute injury. Chronic injuries are the result of compounded stress that has occurred over a significant period of time, where there might not be a sudden onset or we don't really know when the symptoms first began. This stress just occurs repeatedly over time.
Speaking very generally, your exercise prescription could look like:
- first managing the pain and inflammation
- gentle stretches and gentle mobility exercises for the area
- strengthening all associated musculature, including the deep core, glutes, hamstrings, adductors, you name it.
Poor Posture
A second reason for lower back pain, and one that I tend to see most commonly in my practice is poor relative posture. Now I have to say relative because there is no perfect posture, but per the individual, their posture is not ideal for their day to day activities. Poor posture can look different on every body, but what I tend to see is lack of movement variability in the pelvis and in the rib cage, for example, being stuck in interior pelvic tilt. This usually results in lordosis or in excess lower back curvature, which can approximate the abdominal musculature, meaning your core muscles are getting weaker over time because they lose their mechanical leverage.
Because the pelvis is stuck in interior pelvic tilt, this also can lengthen associated muscle groups, for example, the hamstrings and the glutes, which is providing further instability and weakness to the whole core system. Lastly, this presentation can cause reduced intra abdominal pressure control and add further strain to the lower back and the lumbar spine.
An example of an exercise prescription here could look like:
- inhibiting and or loosening the lower back and stretching it
- strengthening the core muscles including the deep abs as well as important hip stabilizers
- improve the ability to manage your pelvic orientation, so learning how to posteriorly tilt your pelvis, which is a necessary movement capability This is going to give you more movement variability for all of your daily activities. t
- teaching your body to manage itself under the forces of gravity is going to give you the best optimal posture for your daily activities. Being able to withstand all sorts of postures that you endure on a day to day basis should be your long term goal.
3. Arthritis, Pinched Nerves, Herniated Discs, etc
The third and final reason for your lower back pain tends to be a little bit more complicated, and this can be the presentation of any sort of arthritis or pinched nerve. Herniated disks and sciatica continue to present a host of symptoms which can be difficult to manage from person to person. Now these conditions require often diagnostics such as an MRI or other imaging to help you come to that conclusion that you do, in fact have a pinched nerve, for example. But the disadvantage here is that it often takes a long time to get these images scheduled. And while it is helpful to have that imaging done, you're left waiting until you actually get the MRI and you're in pain and unable to really move forward or pursue any sort of therapy until you have that diagnosis ready.
Regardless of the diagnosis, improving your strength, stability, and retraining your movement patterns is going to be your long term goal and the key to managing your pain. As these conditions are a little bit more complex, a general prescription here could look like:
- first managing the level of impact, so for example, no jumping and running until pain is managed
- improving your core and your overall strength
- managing your stress
- performing good mobility exercises to help you again improve your movement variability
YOUR EXERCISE PRESCRIPTION TO FIX YOUR LOWER BACK PAIN: SPRAINS & STRAINS
Now that we've gone over the potential reasons for your pain, let's review a more specific exercise prescription for all of these conditions.
So with the first reason that we were talking about sprains and strains, we reviewed that a general exercise prescription would be to initially help manage the inflammation and pain. This may have you reaching for the anti-inflammatory drugs, but this is actually no longer recommended. Things like aspirin and Tylenol will simply mask your pain, leading you to think that you're better when you're actually not.
Instead, these other means will have your lower back feeling more protected against further injury or aggravation once the pain and inflammation is managed. Gentle mobilization is great. Now moving forward, if any exercise gives you pain or aggravates your symptoms further, you should either scale back or completely stop the exercise and then consult a movement professional.
For a gentle mobilization exercise, I do love Lumbar Cat Camels ; it a little bit more mobility safely while also working the deep abdominal muscles and the pelvic floor:
The lower back may feel a little sticky. Then you know that this is an area that requires a little bit more motion. You should feel the core working really well with this exercise, moving really, really slowly and breathing well throughout the entire exercise. You could do one set of 15 to 20 reps, but almost with this exercise you can probably do as many reps as you like.
Hip hugging is another fantastic example of an exercise that helps to gently, gently stretch the lower back and putting it in mild, mild flexion. Putting it in mild flexion may be alleviating for your lower back symptoms, making sure that you take deep breaths as you perform this exercise. And this can be held anywhere from 30s to a minute with both legs or one leg at a time.
Now, with lower back pain, you never want to loosen the area and then not do any core work to supplement with that. The back muscles are really, really tight because it feels that it doesn't have enough stability to begin with. So we need to retrain that stability using the core and core stabilizers.
Dead bugs are often prescribed in physiotherapy and chiropractic care because they work the transverse abdominis muscle, which is your deepest ab muscle and one of its main jobs, is to assist in stabilizing the spine and protecting the pelvis. It also assists with breathing and bracing your core strength, so it makes sense that this is a perfect opportunity to also practice good respiration while training the transverse abdominis. This is a key, key thing that I find a lot of people miss.
Optimal alignment on the left and less than ideal alignment on the right. Without proper use of the diaphragm, it becomes difficult to have a functioning transverse abdominis (deep abs) as well as a responsive pelvic floor. All of these muscles work together to create intra-abdominal pressure and to stabilize the spine, ribcage, pelvis, and head. On the right, having a weaker diaphragm muscle will create tightness in the lower back and weakness in the transverse abdominis and pelvic floor.
And the great thing about Deadbugs is that there's so many variations from complete beginner to absolutely advanced fitness level, so there is room for progression with this one. This exercise is all about control and engagement.
Now with core strengthening, it's not just the transverse abdominis that we need to be concerned about. This also includes your obliques and your erector spine, a muscle group which is your lower back. All of these muscles work together in a system to help promote overall fluid movement. Therefore introducing the McGill Big Three exercises, which include the Side Bridge, the McGill Curl Up, and The Bird Dog. These exercises were coined by low back researcher Doctor Stuart McGill. He expresses that these three exercises are super important for generating core stiffness. This essentially teaches you how to stabilize and how to breathe and breeze through day to day activities, including exercises such as squats. These exercises are fantastic and I definitely give them to my clients a lot.
One of the final pieces of the equation when it comes to strengthening and managing your lower back pain is to not neglect the glutes. I'm going to talk more about the glutes, hamstrings, and other muscles to be strengthened in the other recommendations and exercise prescriptions.
YOUR EXERCISE PRESCRIPTION TO FIX YOUR LOWER BACK PAIN: POOR POSTURE
The plumb line showing that the pelvis and center of gravity is too far forward, creating stress and tightness to the lower back, hamstrings, neck, calves and shoulders.
If your lower back pain is due to poor relative posture, for example, you may be exhibiting an interior pelvic tilt or a sway back rib flares and your low back just gets really, really stiff from sitting or standing long periods. Then you want to address the position of your rib cage to the pelvis.
You could go ahead and strengthen the glutes, hamstrings and core, for example, but without addressing the relative position of your rib cage and pelvis, the results are only going to last short term. This is because the muscles will lose their mechanical leverage for as long as their muscle attachments are so far apart from one another.
Optimal alignment will allow these muscles to function well, and they will also coordinate with one another as a unit. This is why I love exercises from the Postural Restoration Institute, because they address the common culprit, which is the diaphragm.
The diaphragm muscle, like any other muscle, can become weak and super tight, and due to where it's attached, this tightness can influence posture over time.
For example, by using postural restoration exercises such as the Wall Supported Reach, I can inhibit and relax my lower back and pull my ribcage back over my pelvis. This will help me engage my core, loosen my diaphragm, and improve my breathing all at the same time.
This exercise is super challenging because neurologically you're trying to tell your tight muscles to relax and trying to wake up the muscles that have been asleep. Depending on the individual, other postural restoration exercises may be warranted. To see more exercises from Postural Restoration, click here.
In addition to following up with other core strengthening exercises for strengthening the hips and managing this anterior pelvic tilt presentation, Glute Bridges and its variations are classic because they are also an essential movement pattern for day to day life.
Anti hip extension exercises, such as an Ab Pullover or also fantastic because they're going to challenge your endurance in hip extension, where you have to keep your hips extended without resorting to arching the lower back and disengaging the core muscle.
Copenhagen plank variations strengthen the core, but they also bias the adductor muscle groups or your inner thighs, which are again an often neglected muscle group when it comes to managing lower back pain.
In this exercise, you're performing a normal side bridge, except the top leg is straight where you're going to use that top leg adductor muscle group to help you lift your hips off the floor. This exercise is fantastic and I have the tutorial here for all fitness levels.
YOUR EXERCISE PRESCRIPTION TO FIX YOUR LOWER BACK PAIN: COMPLEX PAIN, DISCS, NERVES, ETC
The third and final exercise prescription that we're talking about today, where the cause of your injury could be due to a disk herniation or a pinched nerve. Because these are a little bit more complex, you definitely want to go with the guidelines prescribed to you by your movement professional. And due to the complexity of these injuries, it is difficult to come up with a more general exercise prescription. But I will say this complete avoidance of moving the spine is not ideal as this is not sustainable in the long run. We are faced with daily tasks that require us to move the spine without compensation.
We are often led to believe that if we can’t touch our toes, that it’s due to tight hamstrings.
While the hamstrings feel tight, it’s more likely due to the fact that our pelvis is sitting in anterior pelvic tilt. This lengthens the hamstrings, giving the sensation of tightness, when really, it needs to be strengthened, not stretched.
Your long term goal should be to be able to restore the range of motion that you currently don't have. So if touching your toes is impossible right now, that lack of movement variability is going to hinder your day to day activities, so your training should involve trying to touch your toes or exercises that mimic this motion.
Also, what's often coupled with lack of range of motion in the spine is a lack of rotation in the spine. Here are a few ways in which you can gently mobilize the area to be able to flex the spine, as well as rotate the spine.
EXERCISES FOR THESE CONDITIONS:
A gentle and relaxing stretch would be the Supine Trunk Rotations, where you're laying on your back with your knees together and your arms are outstretched to your sides. You want to try to lightly engage your core and gently inhale as you very much so. Slowly drop both knees to your left side to start. For example, the goal is to try to do this without arching your lower back and keeping your core engaged throughout. You don't want to push range of motion that isn't quite there yet. You want to go as far as you can, and then slowly exhale as you return back to the start and simply alternate between side to side.
Another exercise that many people find helpful with these conditions is the McKenzie Lower Back extension. This is to help you increase your tolerance with hyperextension of the lower back. You can start by simply laying prone on your stomach for up to one minute, and then you can progress to slowly coming up on your elbows, exhaling as you do so for approximately ten reps. Now, while you may not be able to tolerate spinal flexion just yet, it should be something that you work up to.
Spinal flexion tends to be a trigger for those with these type of conditions in terms of their disk. So you want to work with your movement professional to determine your rate of progression. You can start with something really simple, such as a Cat Camel on all fours. This is a really popular exercise where you're trying to integrate the abs with spinal flexion, where you can gently hold this pose and perform repetitions.
This can be progressed to exercises like Static Beast Shoulder Tap and eventually a Jefferson Curl where under load you are maximally flexing the spine. This is also working your pelvic floor and your hamstrings. So it's not just the lower back that's being worked here.
Remember that with all rehabilitation programs, some discomfort is to be expected as well as warranted. And it's for this reason that you always want to perform every exercise with control and at a slow pace. That way you can gage your tolerance to the exercise. Always breathe well through every rep and the moment that things start to feel a little bit uncomfortable, you can stop and scale back. Or this is probably your sign to consult your movement professional for additional help.
I hope that this information was really, really helpful to you to manage your pain. If so, do like, comment and share this blog and video so that it can get to people who are in need of this as well. If you need further customized help. Just as a reminder, I do give 30 minute free online consultations or you can send me an email here.
I also have an entire exercise library where I'm adding exercises as often as I can, including some of your favorite core exercises and mobility exercises. Let me know if there’s an exercise that you would love to see featured in my next tutorial!
Explore the FitFx Training Exercise Library for other tutorials! FitFx Training Exercise Library
