Conquering Low Back Pain
I used to work as a Physical Therapy Tech, and there was one problem we saw in people of all ages, backgrounds, and ailments:
Low back pain.
It was what we treated most often in the clinic, and the causes always varied.
Low back pain does not discriminate. It’s the number one cause of disability worldwide, and the leading cause of missed workdays in the US. The onset of back pain can be caused by many different factors, but here are a few:
- Poor posture
- Sedentary lifestyle
- Accident or injury
- Heavy lifting in the workplace
Over the next few weeks, we will walk you through specific steps you can take to recover from low back pain or a low back injury. For now, here’s the #1 thing you need to understand:
Low back pain is typically caused by an imbalance of the muscles in or around the back.
This imbalance in tension can create issues in other areas of the body by pulling the spine or adjacent structures out of alignment, resulting in uneven loading and potential damage.
The Solution to Low Back Pain
For the reason mentioned above, the solution to many low back pain cases is this:
Strengthen the weak/underactive muscles and loosen the tight/overactive ones.
Whether for rehabbing an injury or preventing future problems, the goal of rehabilitation for low back pain is to target the muscles supporting the spine. These include:
- Back extensors, like the erector spinae muscles and gluteals
- Spinal flexors, like the abdominals and iliopsoas
- The obliques, which are deeper layers of the abdominal wall
These muscle groups work together to keep the spine safe and functioning optimally. When one or more of these muscle groups is neglected or abused, low back pain can arise.
Another part of preventing or healing low back pain is building and maintaining flexibility in the shoulders, hips, and hamstrings.
Staying flexible in these areas decreases the tension that can result in muscles incorrectly pulling on the spine. When these muscles are strong, balanced, and flexible, the spine is supported and healthy.
The 3 Best Exercises for Low Back Pain (Based on Pain Level and Experience)
Once a medical care provider has cleared you to exercise, it’s important to choose the right exercises in the right doses. That’s where a more specific clinician or experienced personal trainer comes in.
Where you start generally depends on your experience and pain level, so if you’re looking to get started today, here are some symptoms and corresponding tips to get you going.
If you're just coming out of therapy or have not been exercising regularly, start here.
People in this stage have high levels of pain/sensitivity and lower levels of mobility. If your pain wakes you up throughout the night, or you find it difficult to move without pain, start here. If your back pain radiates down your legs or around your hips, start here.
Generally, if you notice yourself holding your breath at the thought of movement, start here!
Again, at this point, it is important that you’ve been cleared by a medical professional to return to exercise. Once you’re there, the best starting point is bodyweight exercise. My #1 recommended exercise for this stage is the bodyweight glute bridge. This exercise allows your spine to stay in a neutral position while the hips are moving.
To perform the bodyweight glute bridge:
- Lie on your back with knees bent and feet flat on the floor, hands at your side. Push through your feet to lift your hips into the air as high as is comfortable, without eliciting any pain.
- In a controlled manner, lower back to the mat.
- Repeat for the prescribed number of repetitions (8-15 reps) or stop before any pain occurs.
In the intermediate stage, you’ll experience a low to moderate amount of pain. Everyday movements are doable, but your back may feel stiff. You may occasionally wake up at night because of discomfort, and you’ll typically still have some restricted movement.
In this phase, you can incorporate light to moderate weight training and begin training core stability.
Bird Dogs are my #1 recommended exercise for the Intermediate level.
To perform the Bird Dog:
- Come to all fours on a mat: hands under shoulders, knees under hips.
- Extend the right leg in line with the right hip while extending the left arm in line with the left shoulder.
- Extend through the heel of the right foot.
- Lower the arm and leg back to the start position, repeat with the left leg and the right arm for a prescribed number of repetitions (8-12 reps) or stop before any pain occurs.
If you have low to zero pain and have a normal or nearly normal range of motion (or if you are an experienced exerciser), you’re in the advanced category.
In this stage, the primary goal is strength.
Exercises in this phase strengthen the glutes, hips, and back and incorporate whole body upright exercises. This is where we include more traditional strength exercises such as the deadlift.
The Kettlebell Deadlift is a key component of any fitness or performance routine and promotes all-around strength, a stable spine, and mobile hips.
To perform the Kettlebell Deadlift:
- With feet hip-width apart, hinge forward, bend at the knees, and make sure your back is flat as you grab the weight. Keep the back flat as you lift the weight.
- Once you’re standing tall, hinge forward from the hips and bend your knees as much as you need while keeping your weight in your heels.
- Keep the chest out and the gaze slightly forward as you lightly touch the kettlebell to the floor.
- Focus on lifting with your hips and thighs as your return to the start position.
In this phase, you want to increase weight or reps, but do this conservatively. As your core muscles build strength and resilience, it may be tempting to progress rapidly, but be patient. Overcoming low back pain and returning to regular training takes time. Your patience will be rewarded with improved resilience and less injuries in the future.
Here’s the key to managing back pain:
Understand what you’re doing (or have done) that is causing the pain. Then identify the best starting point of the exercise to help alleviate current pain. Increase weight, reps, and intensity slowly to return to normal and prevent future pain.
In the next article in our 4-part series on low back pain, we’ll show you the exact steps you should take in the first few weeks after returning from a low back injury. Stay tuned!