As a Doctor of Chiropractic, I see people regularly who are looking to find relief from their low back pain. From sudden injury to insidious pain, our culture seems to be riddled with problems involving the low back. So why is low back pain so common? And why do we have such a hard time fixing it?
Back pain is so common because most of us are in a state of imbalance. We spend a large amount of our days sitting. Excessive sitting brings our hips, legs, and backs into muscular imbalance. Sitting, in itself, shortens the hamstrings and hip flexors, and neurologically shuts off the glutes. In addition, many of us slouch, which imposes high amounts of mechanical stress on the joints, ligaments, tendons, and discs in our back. Our body can put up with this stress for only so long, before something gives way and we are in pain.
So what is excessive? Any amount that brings us out of balance. If you work at a job where you sit, it is probably too much. If you must sit, there are proper ways to sit to avoid excessive strain. It is also imperative to be on a regular exercise program and stretching routine to combat these forces.
Repairing these imbalances can take time. It is important to remember that the problem has been building for quite some time (before you ever experienced pain). And therefore, it is going to take some time to reverse these issues. I know we all want the quick fix. Unfortunately, popping a pain relieving pill is only a temporary fix and does not solve the real issue. It is important to be diligent in your low back pain relief quest and know how not to aggravate the problem.
Below are some helpful exercises, stretches, and precautions that may be helpful to do on your own for a painful low back due to muscular imbalance. If you are experiencing low back pain it is also important to see a health care provider that is trained in this area for a proper diagnosis. This advice is not meant to be a substitute.
Stretching seems to be easily dismissed by most people, but it can make a world of difference with muscular imbalance. It is important that you stretch when your muscles are warm, to avoid injury. Stretching after a workout is best. Once you are in the stretching position, hold the stretch for at least 30 seconds. It should be uncomfortable, but not painful. A major contributor to low back pain, which is often overlooked, is tight and imbalanced hip musculature. Both hips should be able to turn inwards (internal rotation) and outwards (external rotation) at least 45 degrees and symmetrically. If you notice that one hip is different from the other, you have some work to do! It is helpful to stretch all of the following muscle groups (YouTube or Google pictures for specific stretches for each group):
- Hip Flexors
- Gluteus Muscles
- External Rotators
After elongating shortened musculature, it is important to build strength in weak areas. Typically with low back pain, we see weakened gluteal muscles, abdominal muscles, and the stabilizing musculature of the spine. With this type of strength training, it is encouraged to use slow controlled movements. This ensures maximal isolation, which will help neurologically “turn” the muscle back on (after long-term inactivity or old injury).
#1. Gluteal Exercises
To start I would recommend donkey kicks, for isolation. Limit engaging the back musculature as you want to “force” your glutes to work on their own. I recommend performing this exercise until fatigue, or when you notice you start recruiting your back muscles. Once you find this exercise is getting easier, graduate yourself into squats. Squats are one of the most beneficial, functional exercises for your legs and low back. Stand with your feet shoulder width apart and toes turned out to 30 degrees. Slowly sit back like you are sitting onto a chair. At no point should your knees travel over your toes. Lower yourself so that your butt is near the floor. Push off by engaging your glutes. Make sure that you keep your knees out, they should not be traveling in towards your midline (this is a sign of weak gluteus medius muscles). Repeat until you feel like you cannot do another repetition (and you are doing them properly).
#2. Abdominal Exercises
Typically when your gluteal muscles are weak, so are your abdominals. There are 3 sections you need to address, rectus abdominus, obliques, and transverse abdominis. I recommend dead bugs to start (because it also trains both sides of your brain to communicate more efficiently) for your rectus abdominus, then progressing to a ball pike. Wood chops with an exercise band are great for your obliques. And lastly, planks for the transverse. Start with 30 seconds, and increase the length every time. Perform each exercise with proper form and until fatigue.
#3. Stabilizing Musculature
The most forgotten muscles are the ones that actually stabilize the low back, such as the erectors and multifidus. For proper form and movement, I recommend learning about Foundation Training by Dr. Eric Goodman. There are easy to follow videos on YouTube, DVD’s for purchase and seminars so that you can learn how to teach others.
Lastly, it is important to modify the things that aggravate your back. We talked about how detrimental sitting can be for your low back. The best way to sit is to scoot to the edge of your chair and roll your pelvis forward. This will naturally allow your spine to fall into correct alignment. There are also special chairs that can help such as exercise ball chairs and kneeling chairs. Or you can change your work setup altogether and go for a standing desk (which more and more people are opting for).
The next place that will wreak havoc on our backs is the car or plane. The seats force your low back into the opposite curve placing exponential stress on your joints, ligaments, tendons, and discs. The best option for this type of seating is placing a firm pillow in the small of your back to help maintain the curve. This is especially helpful if you are in the car for long periods of time or fly often.
The last thing we are going to talk about modifying is your sleeping position. Sleeping for 8 hours a night in a “bad” position can do lasting harm to your musculature. The best position to sleep in for your low back is on your back with a pillow under your knees. Sleeping on your stomach places added stress onto the joints of your low back, so this is not recommended. The other position that can cause problems is sleeping on your side with your one leg bent towards your chest. This places your leg into external rotation and can shorten these muscles, bringing imbalance into your hips. I highly recommend modifying your sleeping position if you have low back problems.
It is estimated that 31 million Americans experience low back pain at any given time. With the above stretches, exercises, and life modifications, you can help prevent or relieve some of this pain.