Low Back Pain?

Help!  My low back hurts!

Working where we do, low back pain is extremely common.  I have friends and family ask me what they can do to help with their low back pain.  I have met many people at gatherings who, after finding out what I do, ask what they can do about their pain.

The first thing you need to do when it comes to low back pain is pay attention to the symptoms.  Is it an achy pain localized to your low back?  Or does the pain radiate down to your backside or down your legs?  Does it radiate around the front into your hip flexors or quads?  Is there weakness, tingling or numbness in your lower extremities?  What aggravates the pain?

There are so many questions that need to be answered but I will try to keep things a bit more general.  It is a good idea to see a doctor if you have long term low back pain that does not seem to be getting any better.  If there is a pars defect (spondylolisthesis or spondylosis), it is important to avoid extension type exercises.  However, this does not mean you cannot exercise.  Having an idea of what is or may be the cause of the pain will go a long way in deciding what types of exercises to do…or avoid if necessary.

Having your flexibility checked will tell us quite a bit.  Too many times a person tells me that his hamstrings are “really tight” as he bends forward and easily puts his palms on the floor!  There are two proprioceptors in the muscle that can affect how your muscles feel.  The muscle spindle and the Golgi tendon organ (GTO).  The muscle spindle helps to keep muscles from over stretching and the GTO helps to relax the muscle.

When you begin to perform a stretch, your muscle spindle activates to help protect the muscle from injury.  With a gentle, static hold, after approximately 20 seconds, the GTO will kick in and allow the muscle to relax and stretch.  So, when you hold a stretch for 30 seconds, you are actually only getting about a 10-second stretch on that muscle.  Performing this stretch a second and third time, you will notice it does not have that tight feeling you had during the first stretch.

Now, if you are in a stretched position for a long period of time, the muscle spindle will say, “Hey!  Wait a second.  This is too long.”  It will kick in slowly to protect the muscle again.  Think about a long car ride.  You are driving and 2 hours into the drive, you feel achy between your shoulder blades and maybe your low back.  You pull off at a rest stop and get out.  The first thing you do is to bend forward and reach your hands to the ground.  What you are doing is putting yourself into nearly the same position you were just in.  Your low back was in a stretched position and your shoulders were protracted while holding the steering wheel.

To counteract the effects of the muscle spindle engaging, you will want to activate those muscles.  Going back to the person who says their hamstrings are tight but can put his palms on the floor, a good exercise would be something that activates the hamstrings.  I would even take this a step further and activate the low back core muscles.  Bridges or planks would be good exercises to help engage these muscles.  For the driver with pain between his shoulder blades, some shoulder flares or row-like activities would help to activate the middle traps and rhomboids.

This is not to say that anyone should stop stretching.  Flexibility is just as important in low back health.  However, if you feel that tight feeling, remember that it could be from stretching too much.  A solid balance between flexibility, stability and strength will help you maintain a healthy back and help you reduce the incidences of back pain and decrease the duration should it occur.

Now, let’s go through a good routine to help your back.

We will focus on the core.  This is key to good back health.  The core is not just your abdominal muscles.  It involves your pelvic muscles, lumbar muscles, and abdominal muscles as well as support from muscles below and above these areas.  So, doing abdominal work every day but ignoring muscles around your pelvis and lumbar regions are only doing part of what needs to be done.

Core strengthening

Bridges:

If you do not have a pars defect, bridges are very beneficial and will work your whole core.  With a pars defect, you will need to talk to your healthcare provider about performing this exercise.  This exercise will activate core musculature as well as lower extremity muscles.

  • Lay on your back with your knees up, feel flat and toes pointed straight forward.
  • Raise your hips toward the ceiling as high as you feel comfortable and hold this position 5-10 seconds.
  • Lower slowly back to the floor or mat.
  • 3-5 sets of 10-20 of these each day will help with stability of your core.

Planks:

This is an excellent total core exercise.  If you have a pars defect, again, see your healthcare provider about this exercise.  However, this is an exercise that is very modifiable to each person’s ability.  This, too, will activate lower extremity muscles as well as core musculature.  They can be done with fully extended arms, on your elbows, knees rather than full plank, arms raised on a chair, bench or the wall, various versions of side planks, etc.

  • With this exercise, you get into position face down with your hands or elbows directly below your shoulders.
  • Raise your hips toward the ceiling until your spine is in a neutral position head to tailbone and in line with your lower extremity.
  • Squeeze those cheeks! As one instructor once said, “Wink at the ceiling!”
  • Hold this position for the desired time (10 seconds, 15 seconds, 30 seconds, 1 minute, etc.)
  • Rest and repeat.

You can set a goal for this to be able to perform 3 planks of 1 minute each.  If you start with a modified version, you can progress until you are performing a fully extended plank for 1 minute each.  Beyond this, there are variations you can do to increase the challenge.

Ceiling reaches:

This exercise focuses on your abdominal muscles.  It is important to attempt to maintain a neutral spine during this exercise.

  • Lay flat on your back, knees up, feet flat and toes pointed straight forward.
  • Raise your arms directly in front of your chest and pick a spot on the ceiling directly above your hands.
  • Reach up toward that spot until your shoulder blades leave the floor or mat.
  • Focus on trying to have this movement occur at the hips.
  • Do not “throw” yourself toward the ceiling. Rather, gently raise yourself up and down.  Do not drop back to the mat.  Stay in control the entire time.
  • 3-5 sets of 10-20 each day is a good goal.

Neutral Spine Abdominals:

If you are not able to perform ceiling reaches due to pain or weakness, this exercise is a great starting point.  This will exercise your abdominal muscles while you maintain a neutral spine position.

  • Lay on your back with one leg extended straight and one knee up with the foot flat.
  • Place one hand just under your low back on the side in which your knee is up. Do not force your hand under your back, just slide it until it is in support of your back.
  • Raise your head off the mat as if you are attempting to push your chin straight up to the ceiling.
  • Lower back to the floor or mat in control.
  • 3-5 sets of 10-20 reps each day is the goal progressing to the ability to perform the ceiling reach exercise.

Superman/Rocketman:

This is an exercise anyone with a pars defect should not do.  The purpose of this exercise is to extend your back and focus the attention on the lumbar muscles.

  • Lay face down on the floor or mat.
  • For Superman, your hands are straight above your head. For Rocketman, your hands are at your sides.  Palm down in each.
  • Raise your head and chest off the floor/mat. Superman: arms move up and squeeze your shoulder blades while your palms stay facing down. Rocketman: as you raise, your thumbs rotate toward the ceiling and squeeze your shoulder blades.
  • Hold this position 5-10 seconds and return to starting position in control.
  • 3-5 sets of 10-20 each is the goal.

Hip Flexor:

This exercise is for the iliopsoas muscles in particular but may activate quad muscles as well.  This will help to strengthen and stabilize the hip and pelvis.  There are variations on this but here is one simple way to go about this exercise.  It can be performed seated or standing.  Here, we are in the standing position.

  • Using an ankle weight and standing in front of a mirror, you will march in control.
  • Your knee should reach parallel to your hip.
  • Each raise and lower should be in control with your knee tracking in a straight line and holding good balance with the other leg.
  • By alternating legs each time, you are forcing your body’s proprioceptive skills to learn as well.
  • 3-5 sets of 10-20 steps is a good goal before increasing the weight or moving to a more challenging exercise.

Hip extension:

This is another exercise designed to strengthen and stabilize the hip and pelvis region.  This, combined with the hip abduction exercise below, will work your gluteal muscles.  This can be done with bands or ankle weights.

  • Standing and using a chair or wall as a balance check, have the band or weight on your ankle.
  • With your whole leg straight, push your ankle straight back, tightening the glute muscle on that side. Your knee should not bend at all and your foot should remain pointing forward throughout this exercise.
  • Return your foot to the starting position in control.
  • 3-5 sets of 10-20 reps each leg.

Hip abduction:

This is the second exercise designed to strengthen your glutes and help to strengthen and stabilize your pelvis.  You can move directly from the hip extension into this or do a circuit utilizing both exercise in succession.

  • Standing and using a chair or wall as a balance check, have the band or weight on your ankle.
  • With your whole leg straight, push your ankle straight to the side to about 45 degrees. Your toes should point straight forward during this movement.
  • Return your foot to the starting position in control.
  • 3-5 sets of 10-20 reps each leg.

Stretching

As mentioned, a good balance between activation and stretching muscles is what will be most beneficial to good back health.  The following are stretches to help keep your muscles flexible and moving efficiently.

Hamstring stretch:

There are many ways to accomplish this, but the most simple is described here.

  • Lying on your back use a stretch strap to pull one leg up at a time keeping your knee straight. Your opposite leg should be bent to help relax lumbar muscles.
  • Another option is trying it in a seated position
  • Make sure you keep your spine straight and
  • Hold either position 30-60 seconds.
  • Slowly return to standing.
  • 3 sets

Hip flexor/Quad stretch:

  • Lay on your back near the edge of a low table or bed.
  • Hang one leg off the side with the other leg on the bed knee up and foot flat.
  • Bring the foot of the leg off the bed back as if trying to reach it to your backside but rest your toes on the floor.
  • You should feel a stretch at the crease of your hip and/or down the front of your leg.
  • Hold 30-60 seconds.
  • Slowly return to starting position.
  • 3 sets each leg.

Single knee to chest:

  • Lay on your back knees up and feet flat
  • Bring one knee to toward your chest and, using your hands or arms, squeeze your knee to your chest.
  • You should feel a stretch in your glutes and/or low back.
  • Hold 30-60 seconds.
  • Return to start position and perform on other leg.
  • 3 sets.

Figure 4:

  • Lay flat on your back, legs straight.
  • Place one foot across the knee of the other leg.
  • Slowly raise the knee of the opposite leg by dragging your heel along the floor/mat.
  • Raise until you feel a comfortable stretch deep in your backside of the crossed leg.
  • Hold 30-60 seconds.
  • Slowly return to starting position and perform on the other side.
  • 3 sets each.

Cobra stretch:

This is not a stretch to be performed by someone with a pars defect.

  • Lay face down hands in push up position.
  • Push your chest up and move your head back until you feel a comfortable stretch in your abdominal muscles.
  • Hold 30-60 seconds.
  • Slowly return to starting position.
  • 3 sets.

Supine spinal twist:

  • Lay on back with knees up and feet flat.
  • Extend arms straight out to sides (forming a “T”).
  • Allow both knees to fall, in control, to one side as far as comfortable.
  • Turn head the opposite way.
  • Hold position 30-60 seconds and slowly move to the opposite side.
  • 3 sets each side.

 

This may seem like a lot of work.  You can pick and choose which of these you would like to do each day.  Do try and perform some sort of core exercise and stretch routine each day to help maintain good back health.

If you have any questions on how to progress or modify any of the exercises, please ask below in the comments sections.  If you are concerned about exercising with an injury you have or had, we are happy to help.  If we cannot answer outright, we have a clinic filled with providers who are willing to let us pick their brains.

Next week, we will discuss disabilities.  It will focus on those born with disabilities and the physical, mental and emotional challenges faced.