Key Areas to Addressing your Lower Back Pain
If you're human it is likely that you have experienced lower back pain at some stage in life, and we know back pain is super multi faceted and the pathology doesn't always equal pain and vice versa. That being said lower back pain can often be the result of mechanical stress as a result of our bodies adapting to what we do. If we sit too much, we get tight hip flexors and weak glutes. If we always cross one leg but don’t do that on the other, one glute might get used to being overstretched. If we use one leg more than the other when it comes to day-to-day tasks that leg might get stronger, while the other gets weaker. The caveat to this is if you are born with a major asymmetry that affects how one side of your body moves compared to the other.
However, if we spend time strengthening our bodies in a well-rounded program and working on stability and mobility then our body is likely to remain in a metastable state.
In this article we are going to highlight and discuss 3 ways to improve mechanical/non-specific lower back pain. This advice does not take the place of an in depth physical assessment by an allied health professional and if you are suffering acute or chronic back pain that has restricted your physical capabilities it is recommended that you seek professional consultation to address this.
We can really hone in on 3 ways to improve lower back pain.
First up is Mobility
There are certain areas of our body that are prone to developing limitations in range of motion or mobility. Here’s a few suggestions that may help you improve areas of restriction that are causing your lower back pain:
1) Roll your thoracic spine: Place the foam roller in your mid back around your shoulder blade level. Place your hands behind your head, keep your buttocks on the ground and keep your ribs down. The test is this: Does it feel comfortable to extend over the roller here? Move the roller 1 inch higher or lower and retest. Do this a few times, never going lower than your bottom rib, and ask if there are any areas of your upper back that feel restricted… If so, work on it using this method!
2) Test your pigeon pose and piriformis stretch: Left vs. Right. Get on top of a softball and work into your piriformis and glute medius test left vs. right. Does one side feel more sore than the other? Work on releasing tension in the tighter side and work on opening up the range of motion on this side. A hot tip here is to note which side the back pain is on i.e. if you have left lower back pain.. 80% of the time your left glute tends to be tighter than your right.
3) Test your hip flexors: Go into a hip flexor stretch on the left and right side, then get into the hip flexors with a softball and test left vs. right. Does one side feel more uncomfortable than the other? If so, work on this too similar to how you have worked on the problem areas in number 2.
The second way to improve your lower back pain is by improving how well your muscles coordinate movement
Muscle coordination refers to how muscles work together to create movement. Whenever we plan to move in a certain way (for example if we want to do a push up), our brain determines in advance how we must contract our muscles and in what sequence to do this so that we don’t fall on our face! The brain comes up with a program that looks at which muscles it needs to contract, when the muscles must contract and how much intensity the muscles must contract with. It’s a pretty complex program that must be created quickly and helps us to perform well and reduce our risk of injury.
One of the by-products of feeling pain is that our brain makes coordinating our muscles much more difficult by inhibiting our ability to implement the desired program that may be desired. In the back this could be experienced in the form of a muscle spasm. If we ever want to return to a state of normalcy, we have to relearn how to move through both basic and complex ways.
Here’s a few ways to work on muscle coordination:
1) Improve how well you can breathe with your diaphragm
The Diaphragm helps to create spinal stability. It sits underneath the rib cage and looks similar to an umbrella spanning from your sternum and lower ribs to your lumbar spine. The diaphragm increases intra-abdominal pressure as a means of providing more stability to the spine. Using a technique such as block breathing can assist in improving diaphragmatic breathing - this involves lying on your back placing your hand at the upper portion of your abdomen and breathing into your hand without raising your chest on a count of 4 seconds in/hold/out/hold.
Getting a grasp of this will assist so much when it comes to bracing to increase your intra abdominal pressure before performing a lift with load such as picking up shopping from a trolley or performing deadlift.
2) Spinal flexion/extension (cat/camel), side flexion
It is important to be able to move through the segments of your spinal (flexion, extension, lateral flexion). In our spine there are very small muscles that allow us to control each vertebrae’s movement in relation to the vertebrae above and below it. It is ideal that we have control of these independant joints because if we don't it compromises our ability to find the best spine position to achieve certain movements.
Cat & Cow is a good place to start to learn how to control the segmental movement of your spine through flexion and extension. Another suggestion would be to perform lateral flexion, where you bring your pelvis to your ears from one side to the other whilst on all 4’s.
3) Improve on coordination without spinal movement
A third option for working on coordination is by not allowing your spine to move, but purposefully moving through your hips. The goal of these exercises is to be able to attain control of your hips (femur on pelvis) without any movement being initiated from the spine. Examples of exercise that we would use to work on this control include the Fire Hydrant, Bird Dog, Dead Bug, Glute Bridge and Hip Hinge.
Bird Dog - describe the exercise here
The third way of improving your lower back pain, which is to start to load the spine and train stability.
We can train our body in 3 different planes of movement: Sagittal (flexion/extension), Frontal (lateral) and Transverse (rotational) plane. The primary function of our core muscles is to work as anti movers across the 3 planes of movement, it is not to create abdominal flexion until your abs are burning. If we can train our body to resist force in a variety of different directions, it will assist in our ability to create output required from our extremities required for athletic performance or activities of daily living.
Some examples of an Entry, Intermediate & Advanced stability exercise for each of planes are outlined and demonstrated on the Train. Perform. Recover. Youtube channel.
Entry - Curl-up
Intermediate - Ab Wheel
Advanced - GHR Iso Hold
Entry - Side Plank
Intermediate - 1 Arm Farmers Walk
Advanced - Copenhagen Plank
Entry - Bird Dog
Intermediate - Renegade Row
Advanced - Pallof Press
If you notice that it is much harder to perform an exercise in one particular plane compared to the other then you might want to double down on it. This means bringing in a bit more volume and training it multiple times a week or for multiple sessions a day. If the exercises get easier then increasing difficulty can be as easy as increasing time, load, offsetting your centre of gravity or reducing base of support.
In Summary
We must remember that lower back pain is multi-faceted and the pathology doesn't always equal pain and vice versa, one solution doesn't fit all. That being said we were able to discuss and identify 3 different ways for you to improve your lower back pain. The low hanging fruit is to improve the mobility of tight muscles and joints through rolling and stretching. The second stage is to add in exercises that improve your muscle coordination of both your spine and your hip control. Lastly, once you are starting to feel some improvement in your level of pain and function, you should add in exercises that challenge you in various planes of movement/stability. Further progressions in the form of a functional movement approach to your stability, control and strengthening programming is required however it is another topic all on itself and will be addressed in another blog.
*This article was an adaptation of Episode 2. 3 ways to address lower back pain from Train. Perform. Recover. and was a collaboration with Jacob Carter Physiotherapy.*