Got lower back pain? You’re not alone. You are one of the eighty percent of adults who will suffer lower back pain at some point. But you can do something about it.
The following is not a substitute for medical advice. It is meant for educational purposes only. Always consult your medical professional before changing your exercise and physical activity program.
There are two general types of lower back pain—acute and chronic. Acute lower back pain is when the onset of pain is sudden and immediate. This is what happens when you “tweak” your back. At this point, proper first aid should be utilized immediately.
1. What to do when you injure your back.
Kelly Starrett of www.MobilityWod.com has a great video on what to do when you “tweak” your lower back.
After about 48 hours, the acute phase is over. Activity can then be resumed with medical clearance.
However, lower back pain has a tendency to become a chronic problem. Once you have an injury or painful episode, it is very likely to recur. But you can take action to prevent this.
2. Remain as active as possible, avoiding exercises that cause immediate pain.
Physicians used to recommend bed rest for those suffering with lower back pain. That treatment has fallen out of favor, however, because of poor patient outcomes. Research has shown that bed rest actually stresses the spine.
Most experts on spine health agree that moving around is really good and sitting still too long is really bad. In fact, a job that requires sitting for long periods of time is considered a factor that increases the risk of developing lower back pain. Get as much pain-free movement as you can to beat lower back pain.
Source: Low Back Disorders, Second Edition
3. Keep your spine in neutral postition when lifting weights.
Neutral spine is the spinal position where all your natural curves are maintained. Your spine (pictured below) has four curves: sacral, lumbar, thoracic and cervical.
The natural curve in the lower back is described as lumbar lordosis. Lordosis means concave when viewed from the rear. Maintaining this lumbar lordosis is important when you’re lifting weights or other heavy objects.
The joint structures of your spine can more safely accommodate forces when your spine is in neutral position. Bending and twisting stresses your spine. Lifting a heavy weight while bending and twisting too far from neutral is a recipe for injury. Keep your spine in neutral position when lifting weights. (See illustration below)
Source: Low Back Disorders, Second Edition, by Stuart McGill
Neutral Lumbar Spine
You can move your spine out of neutral position for many everyday activities like tying shoes. However, neutral spine is the safest position when you lift something heavy. Sometimes keeping your spine in neutral posture is impossible because of weakness in the muscles of the core or tightness in the muscles of the limbs.
For example, when performing the Romanian deadlift (shown above), weak spinal erectors, tight hamstrings, or a combination of both will cause a loss of the neutral spinal position.
The exerciser is demonstrating the Romanian deadlift with neutral spine (top) and without neutral spine (bottom). He is clearly able to perform the exercise properly. However, not everyone can do this. Sometimes flexibility restrictions, which prohibit the desired range of motion, create poor lifting technique.
In the example with the Romanian deadlift above, tight hamstrings limit the amount of forward bending at the hip joints. The body must then rely on forward bending of the spine to reach the weights. This takes the spine out of neutral position and stresses the joint structures. Another common movement flaw is the hyperextending your spine in the overhead press (shown below).
Sometimes this technique deviation is merely caused by an attempt to gain leverage and use more weight. You can correct it by lightening the load to one that can be handled in proper form. Sometimes though, lack of mobility in the thoracic spine, pectoral muscles (pectoralis major and minor), and lat muscles (latissimus dorsi) keep you from being able to perform any overhead movement properly.
When this happens, undue stress is placed on the lumbar spine, which must hyperextend to compensate for the lack of mobility in other areas. When you have any of these muscle imbalances, you need corrective exercise.
4. Use corrective exercises to fix imbalances.
A skilled professional can assess imbalances by observing your movements. Corrective exercise expert Gray Cook has developed a system of assessing and analyzing these imbalances by observing your movements. It is called the Functional Movement Screen. This website has a feature you can use to search for a professional in your area certified in the Functional Movement Screen.
Another great resource for using corrective exercise to beat lower back pain is the book by Anthony Cary (www.functionfirst.com), The Pain-Free Program: A Proven Method to Relieve Back, Neck, Shoulder, and Joint Pain.
The corrective exercise approach for preventing recurrence of lower back pain typically includes stretching tight areas such as the hips and thoracic spine, along with strengthening and activating weak areas such as the core.
5. Improve hip mobility and flexibility.
Mobility and flexibility training are crucial for lower back health. The first inclination after suffering a lower back injury or “pulling something” for most people is to try to stretch the back muscles. This is not advisable.
Usually, lack of mobility in the areas of the body adjacent to the lumbar spine is what causes undue stress on the lower back. Working on the mobility of the hips is the way to spare the lower back.
7. Work the core—PROPERLY!
Adding a few crunches at the end of your exercise session isn’t enough. Crunches are the most commonly performed abdominal exercise, but they are probably the least useful in promoting lower back health.
In fact, for many people who have bad posture, crunches can exacerbate the accompanying muscle imbalances. So which core exercises should be emphasized in order to prevent lower back pain or injury?
According to Stuart McGill, spinal biomechanics expert, the muscles of the abdomen and lower back protect the spine by stopping movement rather than causing the spine to move. The following video is what he recommends:
Another core exercise strategy from the book Therapeutic Exercise for Lumbopelvic Stabilization is to activate the transverse abdominis, or TVA. The TVA is a muscle that lies underneath all the other abdominal muscles.
The TVA connects to the fascia, or connective tissue, which encases all the front abdominal muscle and also the fascia which encases all the lower back muscles. It works with all of the other abdominal and lower back muscles to hold the torso and spine in stability when the limbs are used for movement.
Normally, the transverse abdominis will contract milliseconds before the contraction of the main working muscle in any limb movement. However, lower back pain seems to change that firing pattern.
In people who have had lower back pain, it seems that the TVA is late in contracting and/or underactive. This is believed to lead to perpetuation and recurrence of the lower back pain. (The reasons for this phenomenon are beyond the scope of this article but are well explored by Richardson and Hodges in Therapeutic Exercise for Lumbopelvic Stabilization .)
Practicing TVA contraction can improve this deficit and improve outcomes for people with lower back pain or a history of it.
The TVA can be contracted by actively pulling the abdominal wall inward. Pull your bellybutton in toward your spine. Hold it, but don’t hold your breath.
Continue to breathe normally while drawing the lower abdominal wall inward. Contracting the pelvic floor muscle can help facilitate a good contraction of the TVA. To contract the pelvic floor, pretend that you are stopping the flow of urine.
Do this exercise for 30-60 seconds at a time at least once a day. Performing this exercise can help improve the motor control deficit in the deeper abdominal muscles that is associated with lower back pain.
8. Brace the abdominal muscles while lifting.
Because of the research involving the link between TVA contraction and lower back health, drawing in the abdomen during exercise has become a common recommendation and practice.
However, research by Stuart McGill Ph.D., author of Low Back Disorders and Ultimate Back Fitness and Performance has shown that doing the abdominal pull-in maneuver alone actually has the opposite of the intended effect. It destabilizes the spine.
Based on his research, Dr. McGill recommends activating the TVA by pulling in, in addition to activating all the other muscles of the lower back and abdomen. With this abdominal bracing technique, there is no movement of the abdominal wall.
A good way to do this to pretend someone is about to punch you in the stomach. This will achieve the desired abdominal bracing.
9. Get some aerobic exercise.
Aerobic exercise is very useful in reducing the incidence of lower back injury and in treating lower back patients. Emphasize lower impact forms of activity such as walking. The ACSM recommends 3-5 sessions per week with duration of 20-60 minutes.
Source: Low Back Disorders
10.Utilize one-leg variations when working legs.
Squats and deadlifts are great exercises for strengthening your entire body, especially your legs. But as you get stronger and stronger, the load required to really work the legs becomes quite a compressive force on the spine.
So how can you continue to strengthen the legs while reducing the compression on the spine? One-leg variations of traditional exercises are the answer. They require only the weight of your body for starters and very little external weight as you progress.
11. Don’t use a lifting belt.
If you are a competitive power lifter and using a belt helps you achieve your goal of maximizing the amount of weight you can lift, then by all means use the belt. Everyone else should not. Even competitive power lifters will avoid belts when performing their lighter lifts. According to Paul Chek, founder of the Chek Institute, relying on a belt to support your mid-section during exercise leaves the muscle of the core weak and untrained. Aside from that, there is not much evidence that back belts decrease the risk of injury.
Source: How to be Back Strong and Beltless, by Paul Chek
12. Avoid sitting for long periods
Sitting causes adaptations in the body that leave you at risk for developing and maintaining low back pain. Here is Kelley Starrett of Mobility Wod explaining why:
13. Eat some anti-inflammatories.
If you are in the habit of reaching for anti-inflammatory medications, then rethink your approach. What you eat has a huge impact on inflammation in the body. The modern western or Standard American Diet promotes inflammation. A style of eating that more closely resembles the “paleo” diet is better for reducing inflammation. This includes more vegetables and eliminating processed carbohydrates such as most grain products. In addition, add wild and pasture-raised animal protein sources and eliminate grain-fed, factory farmed meat. For more info on this style of eating check out the following website: www.RobbWolf.com
Source: Low Carb Paleo Diet Reduces Inflammation
Another great source of information on anti-inflammatory eating is Dave Asprey, the Bulletproof Executive.
Source: Bulletproof Diet
14. If you smoke, quit.
Smoking cigarettes has been linked to the injury mechanism of chronic low back pain. Researchers believe this is linked to the deterioration of vascular and circulatory function in smokers. If your want help beating this addiction check out Nicotine Anonymous.
Source: Does Smoking Cause Low Back Pain?
15. Use stress management techniques.
Stress is a huge factor in lower back pain that is often overlooked. You can choose any method of stress management you like. Some of the most powerful techniques are the breathing exercises of yoga, or pranayama. Try this method:
- Inhale for a silent 4 count.
- Gently hold your breath for a silent count of 7. Be sure to gently stop your breath and avoid strain. Feel free to shorten this part if holding until a 7 count creates strain.
- Exhale for a count of 8.
- Repeat 4 to 8 times.
Source: Breathing: The Master Key to Self-Healing, by Andrew Weill MD
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Author: Nick Ortego is the owner of N 2 Action, a wellness studio in Baton Rouge, Louisiana, offering personal training, health coaching, yoga, and assisted stretching.