Finally the finishing touches to my back pain series. This was prompted by the epidemic of back issues that have been posted all over my social media lately. It seems that this winter many people have decided to “throw out” their backs. And this is something that is completely avoidable. The problem lies in that you’ve already likely done it to yourself. Now we have to make sure that it doesn’t happen again.
In July I wrote two articles on back pain. The first one which you can find here was about identifying what and why back pain typically occurs. The second one, which you can find here was about movements you can use when you’re feeling stiff or sore to help provide relief for general stiffness and soreness.
This part is about the exercises. Now, most therapists and trainers would identify that you need “more core strength”. What does that actually mean? Many people will think that yoga, pilates or even just simple crunches will do the trick. As I said in Part Two, the “core” is a very complex thing and can’t be isolated into one or two muscles. You have to strengthen the entire complex, and this stretches from the pelvis all the way up to the shoulders and even down into the legs.
So how do you begin? Well, a good place to start is by working on movements that you have to perform daily anyway.
My number one exercise to develop and improve back strength and resolve symptoms of back pain: The Deadlift.
In fact, if you were only allowed to do one exercise for the rest of your life, this would probably be my first recommendation.
Pretty simple, right? Picking something up and putting it down. This is not actually true. There is a lot of proper technique and intention behind this movement and I strongly suggest you have a competent coach (not your “brother-in-law who lifts”) teach you the movement and all of its’ parts. It includes the ability to squat, hip hinge and also keep your spine engaged throughout the movement, all individual components that you need to be aware of.
The good thing about this exercise is that it can be regressed so that my 103 year gold Grammie can do it, or progressed to an Olympic lifting level. It is very versatile and hits most of the muscles in your body in a very good way. One of my goals with any of my clients (even those with compromised backs) is a good solid deadlift.
My second choice for back strength actually involves the hips more than anything. Strong hips (and you can feel free to think “glutes” here) are essential for spinal integrity. Therefore my number two is: Hip Thrusters.
Now, this can be an uncomfortable position for many so I typically suggest starting this movement on the floor, then progressing to a Swiss Ball for mild loads, then a bench or modified floor position for heavier ones. You also need to make sure that your legs are in the proper position and you can actually hinge at the hips before you can do this properly. Again, please consult a professional coach to help give you the right technique.
Easy regression is an isometric hold in the up position (on the floor or a mat) for 15-20 seconds to start. Focus on pushing through the heels and pretending you’re holding a pencil between your butt cheeks and not letting it go.
Now, we also need a movement that takes place in the frontal plane – which means up and down if you’re standing up. This makes sure that the spine is being trained with forces that it will experience frequently. One way that people frequently hurt their backs is by extending a load over their heads they have no business lifting.
Most people also have very little upper body strength in relation to their lower body or vice versa. Men are horrible at this because they want to have a big upper body and never make their legs strong so their poor spine is like a pipe cleaner balanced with a big rock on top of it – and easily collapsed.
Therefore my next exercise for proper back health is very simple: The Pull-Up.
I realize that most people can’t do one full pull-up properly. Therefore I’ve given you two pictures that show easy ways to do these assisted in a gym or at home. If you need more ideas feel free to email me or google it and you’ll find a few more. I have at home clients do this with a bed sheet and a door frame sitting on the ground.
This movement not only is great for loading your spine in a frontal plane, it also hits those often neglected upper body pulling muscles that don’t get a lot of use. I encourage all of my clients to get to the stage where they can do pull-ups without much assistance. There are also a variety of choices in terms of grips and adjustments to enhance the strength in your shoulders without wrecking them. Please be careful and progress things appropriately.
Oh, and yes there is some debate over whether this is a frontal or sagittal plane movement. I believe it is a frontal plane movement. If you want to debate it, feel free to call me out.
There is a long list of complimentary exercises that I would add to this list. Some of them include:
- Overhead Pressing
- Romanian Deadlifts
- Back Extensions and Reverse Back Extensions
- Loaded Planking with movement
- Lateral Side Flexion
- Loaded Trunk Rotation
- Split Squats
And the list can go on. However, if you want to get started on the path to good spinal strength, these three are your first and best bet towards good spinal strength.
You might also notice that none of these first three exercises are traditional “core” exercises. However, all of them load your spine quite nicely and give you the benefit of adding strength in a bunch of other places as well. This is essential for total body health.
All of these exercises can be progressed and regressed by a competent coach. Always remember that exercise is tailored to the individual, and a good coach will adjust your program based on need and result (and goal).
I’m planning on putting together a proper E-Book on Back Strength coming soon. If you would like a free copy, feel free to subscribe to my site by adding yourself to the list at the side, or follow me on Twitter at @strengthottawa, Instagram at @strengthrehabottawa and on Facebook at Strength Rehabilitation Institute of Ottawa. I’m also always interested in your thoughts and feedback, so feel free to Share this as well on any social media.
Take care of your backs!
Last time we discussed the origins of back pain and some quick fix solutions if you have issues in this area. For this article I want to get into a bit more detail on what you can do to be more aware of your back issues and some real solutions in terms of restoring mobility and keeping your muscles firing well.
First of all, most people will tell you that the reason you have back pain is because you have a weak “core”. What does that mean?
In simple terms this means that the muscles that support your spinal column, especially as it relates to your pelvis in the lumbar area, are weak and need strength. Most practitioners will have you start to work on things like spinal bracing movements, hip stretches and lower back strengthening. However, this brings me to my first point when it comes to back pain, and one of the most important principles:
You need to know what the source of the issue is!
Imagine a person with a weak ankle due to spraining it several times as a kid. This person stops being active and loses a lot of their ability to fire their leg and back muscles, and eventually every time they take a step their body is slightly tilted to take load off the ankle. This throws off the pelvis slightly each time, and this throws the lower back out of line and therefore causes the supporting muscles on one side to fire too much. If the ankle is the source of the issue, strengthening the muscles in the midsection will help, but it doesn’t ultimately fix the problem. It’s like taking an Advil for a headache.
So rule number one is get properly diagnosed. I don’t diagnose, I tell people what in my experience things are and (99% of the time I’m right), but it is always confirmed by another party preferably with doctor in front of their name after they get referred. Many practitioners will not look past the pain area – find one that will.
I’ve had clients come in with back pain that we have resolved by treating their shoulders. Or feet. Or even simply practicing walking properly. It can be that simple.
So what is the “core”? Well, the way I explain it to clients is that you want to stop thinking of “core” and start thinking of SPINE. More specifically you want to start thinking of how it relates to your pelvis (mostly) and also things like your rib cage and shoulder complex. There’s many more muscles involved than just your TVA, or just your lower back. In the deep abdominal area alone there are five layers mostly overlapping each other. And, when you move one joint, you affect every muscle that crosses over it – and your spinal column is made up of lots of joints. If you move your hip, you’re affecting your spine. If you move your shoulder, you’re affecting your chest, back and shoulder (and a bunch of other things). Take this into consideration when performing any type of mobility movement.
Before I get into how to strengthen these areas (which will be for Part 3), I want to instead address mobility. This is the ability to move these joints without strain or compromising the muscles that control them. Typically this requires movement without a ton of load or force behind it. One of the biggest pieces of advice I can give here is:
Respect your body and allow it to move (or not move) as it wants to – don’t force it.
One major flaw people make with mobility work is that they push their muscles too hard and create even more strain. Instead of thinking of it as stretching, I invite my clients to instead think of it as allowing their muscles to achieve a longer range of motion within the involved joints. This goes across both sides of the muscle, the long and the short. If you lengthen or shorten a muscle too much, it is weak in that position and will often fire in order to try to get out of that position – which defeats the whole purpose of lengthening one side while you shorten another.
For example, if you are in a typical hamstring stretch you are lengthening the back of the leg, but you are also shortening the front (allowable to a certain extent until your knee reaches terminal extension). Always move within a point of mild resistance – never pain.
With the lower spine, the usual culprits for lack of mobility are the hip complex (especially in the front of the body) and the spinal erectors. General ranges that are restricted are spinal extension, pelvic movement, hip rotation and extension and lateral flexion (ie side bending – but be careful here – I don’t side bend anyone until they are much better).
So here are the top 5 mobility movements I prescribe to pretty much everyone with back pain as a start. Remember that as with any exercise program, a mobility program also needs to be tailored to you specifically – don’t necessarily take this as gospel. It is a good start for most of the population. As with anything else, if it makes your body uncomfortable or causes pain – DON’T DO IT.
Number One: The McKenzie position.
Stuart McGill, who is one of the most prominent back care specialists in the world advocates this as the number one movement, and I do as well. Place the hands under the shoulders and extend up, moving slowly until pressure is felt in the lower back and focus on dropping the hips into the ground. Repeat with movement but can also be done as a static hold if you have facet issues.
Number Two: Cat/Camel position
This can also be a good transition into childs’ pose for upper back mobility. Focus on moving the entire spine starting from the tailbone, not just the upper back as many people tend to do.
Number Three: Kneeling Hip Flexor stretch with movement
This movement may be difficult for those with knee problems. If you cannot get onto one leg a good modification is to do it standing up with one leg behind you. Oscillate the hip forward and back. Another fantastic stretch along this line is one popularized by Kelly Starrett – you can see it here but it is very advanced and should be modified for most people.
Number Four: Windshield wipers with feet on the ground
For some people with advanced back problems this gets removed immediately because it can cause tilting. Also, if you have diagnosed SI Joint issues please take this one out until they are resolved. This puts rotational torque through the hips, which for many is a good thing but for some is not.
Number Five: Standing Glute/Piriformis stretch.
This movement can also be done lying down, but is more effective standing. Again as with the others, don’t hold position, lift and lower the knee until a pull is felt in the hip/glute area. If one side is tighter, do that side twice. For example, if your left is tighter you would go left, right then back to left.
This covers 85% of the bases for most people who have issues. Again, for some with severe mobility issues all of these might have to be modified. Feel free to comment or message me for modifications if you need them.
So the next question begs – how often? My recommendation is always twice a day to start, ideally morning about twenty minutes after rising so you have moved a bit and established blood flow, and then before bed or after work – whatever works for your schedule. It can be a great way to decompress at night and focus on yourself after turning off all of your electronics and is a great way to establish good sleep hygiene. Think of this as general maintenance and even just by doing these movements – within what your body will allow – you can experience some relief almost immediately if you have the beginnings of problems in your spine.
Oh, and if you tell me you don’t have time, this whole routine takes about 5-10 minutes. You have the time. You choose not to use it in the right way. Choose to help yourself.
In Part Three I will be going over exercise. Again, we often think about “core” work as something simple and straightforward but for most people finding out what area needs the most help is essential. This can allow us to build an exercise routine that will work for that individual and bring a solution to the issue. Like I said in Part One here, if you’re at Stage One then these should help a lot. Stage Two or Three might need some help. but you’re starting in the right place.
If you liked this please feel free to subscribe on my main page, comment and share on Facebook and on Twitter at @paradigmottawa. I look forward to any feedback you may have.
I’ve been in the physical fitness industry for over fifteen years and dealing with injuries and special conditions for most of that time. I’ve dealt with some of the most extreme cases you can think of and wanted to put together some comprehensive answers for people who need help figuring out how to help themselves with injuries.
Over the years the case I see most often is lower back pain. This can manifest itself in various different ways for different people. The typical stages of this type of injury are:
- General stiffness, usually upon waking up where it feels like you need to move around a bit in order to get blood moving again. This might also happen during the day at work or after driving in your car for a period of time. I call this Stage 1. Think of this as a check engine light coming on in your car.
- Constant stiffness and losing the ability to move quickly without a sudden jolt of pain. Often this is the stage where people start to seek help from some form of practitioner. There may be occasional sciatic pain down one leg or positions that cause discomfort, especially lying down. Sleeping may be difficult some nights. This is Stage 2. This is where you really need to start paying attention, although you really should have at Stage 1.
- Pain when moving. Typically this is sciatic referral pain (ie numbness or tingling down one leg or both) or sometimes SI Joint pain (beside the tailbone near the pelvis) and the whole joint area in the hip and lower back is stiff and sore constantly. Sometimes this can mean a disc herniation or bulge or an SI Joint displacement. This is Stage 3 and can render you unable to move properly at all, sit for periods of time and you will be in pain and likely have to resort to pain drugs to function.
This article is a series for letting you know why this pain happens, what you can do about it yourself without having to spend tons of money on physiotherapy, and how to prevent it in the future.
So to begin with, why does this pain happen?
Pain is a signal from your body telling you that something is either out of place or unable to support what it needs to. I wrote a previous article about pain and your body here if you would like to read about the concept of pain as a signal.
We spend hours each day in positions where our spine has to bend in ways that it is unsupported and doesn’t like to sit for periods of time. The most typical place for this is work – sitting in a desk chair hunched over a computer. As you sit forward, your lower spine and pelvis rotate and flex into the opposite position that they should be.
Basically when you’re standing your lower back has a curve (like it is supposed to), and when you sit it doesn’t – which puts pressure on and between the discs. It also means that some muscles have to work more to maintain the position and get tired, while others don’t do much work at all. Imagine at work you had two employees who did all the work, and two who showed up but never did anything. The two who did all the work would eventually get either burned out or pissed off. Muscles like to work together.
Stiffness is your body’s way of saying either “I don’t want to move” or “I can’t move well” – either way it isn’t a good thing. This can be muscular and can also be fascial restriction as well. It is a good idea to address both because without a very experienced imagining tech you’re not going to know for sure which one is the problem, and it is easy to address both issues.
What eventually happens when your joints and muscles tire and your fascia doesn’t allow movement is pain. Remember always that this is a warning signal and therefore should be looked at when it happens, not ignored like many of us tend to do.
So if I am starting to get these warning signs and have entered Stage 1 of the process, what should I do?
Awareness here is key. There are multiple avenues for relief at this stage, which is a good thing. In my next blog post I’m going to outline the best stretches and movements that you can use in order to bring relief to this area but for now let’s work on the immediate things.
However, in the meantime what you can do immediately is assess your position when doing things like sitting, moving around and even simply relaxing on the couch. Are you in a compromised spinal position? This means that something is usually twisted, flexed or positioned in a way that isn’t optimally aligned and eventually will cause a problem.
Example: recently I worked with an anesthesiologist who stood on the same side of his patients and bent and rotated to do his job – every day for hours. He didn’t realize that his spine was literally starting to twist into a new position. Bringing awareness to this and asking him to simply move to the other side of the table half the time brought him instant relief.
If you are a desk worker this can be as simple as moving your work station to a better position. It can also mean getting up frequently throughout the day and getting out of a bad position. I tell my clients to set a timer and stand up ideally at least every 30 minutes, and more often if they can. Walk in a circle or visit a colleague, do a lap around the floor or whatever you can do for a minute or two.
When standing, figure out if you’re always putting weight on one leg. Public transit riding is terrible for this. So is standing for long periods of time cooking, or doing any other type of work where you stand for periods of time. This shift onto one side creates a slight tilt in the pelvis and more load onto one hip, resulting in fatigue on one side. If you are, simply focus on shifting onto the other side once in a while.
If you’re driving long distances and have back pain when driving, try reclining your seat a bit more to open up your hip angle and decrease your lumbar spine flexion. It’s not a solution, but it can help with symptoms.
If necessary, even keep a log, writing down when you feel stiff. Is it after every day at work? Is it when you wake up or lie down? Is it after you have done three hours of gardening (which is probably normal)? Again, the awareness is important, especially if you want to figure out the source of the issue.
I’m always telling my clients to be more proactive and invest in their bodies. It really doesn’t take that much to be aware of when and why things are happening.
If you are already in Stage 2 or 3 then you need help. Go ahead and invest your time and consult a competent physiotherapist (sports therapists are generally best), chiropractor (ideally not a back cracker but a good ART specialist) or a good rehabilitative strength trainer (with credentials and education) like myself. Almost every day I help people reduce and eliminate back pain in a short period of time with simple solutions that you can perform on yourself with minimal time investment. However, you need to do the first steps first.
In my next article I’ll discuss the mechanics of back pain and your “core” and some simple movements and solutions to help you if you’re still experiencing problems. Feel free to like this article, subscribe to my site on the main page and follow me at @paradigmottawa on Twitter or Paradigm Personal Training on Facebook. And, of course if you have any questions I’m only an email away at email@example.com. See you next time!