Nearly 80% of Americans will experience some sort of back pain. Plug that first sentence into google and start to read the multitude of articles and blogs highlighting this unfortunate trend. While most of us can tell when back pain is bad requiring immediate medical attention, the majority of back pain is low-grade and more of an annoyance. So how does one improve or eliminate lower back pain that presents mildly but frequently? The majority of stress placed on the lower back, aka the discs, is seen at 30 degrees flexion. This is what pressure on the discs looks like with bad posture in 30 degrees of flexion:
When you add compressive loads or repetitive stress, this will cause the discs to fatigue. Guess when your back is typically in 30 degrees flexion? When you are sitting! (hence the whole sitting is the new smoking trend). From an exercising perspective, this excessive load can be seen during crunches and sit-ups (switch to proper planks), bent-over rows, poor form squats and poor form deadlifts. Over time, these repetitive loads placed on the back under high disc tension create lumbar pain syndromes and can lead to even worse disc injuries such as herniation’s.
So how do you fix this? The easiest and most challenging way requires commitment to retraining the spine to be comfortable in a neutral position. This includes myofascial work, adjustments to alleviate pain and corrective exercise to re-enforce the new movement or positioning of the body. Where people go wrong and give up too early lies in trying exercises without proper coaching, or failing to seek help with the initial correction.
If your body has been “neurologically comfortable” in a certain position for years, it would make sense that it will take some time to retrained the muscles and nervous system. Most initial gains in any rehab or exercise program are a result of neuromuscular adaptation. This process typically takes about 4-6 weeks to occur. During this time, the body learns to coordinate its already existing muscle into new movement patterns as well as recruiting more motor units in the muscles. Motor unit is the term used to describe the neurological firing to make muscle work. This is why most Chiropractors and Physical Therapists recommend treatment regimens lasting about 4-6 weeks.
So how does a person learn to groom everyday movement patterns while maintaining neutral posture? For example, if getting up and down from a seated position is performed while bended slightly forward, an individual is back to re-enforcing a repetitive load in a flexed position causing the undue stress on the back. This is why someone will also have tight hamstrings. The hamstrings are fighting to perform a stabilizing role where the core should be doing the stabilizing while rising. Tension on the hamstrings is ok, but you do not want repetitive excessive strain. The core can only do its job if the spine is in neutral or proper position for the correct muscle to work. The challenge is to develop a correct hip hinge.
What is a hip hinge versus bending forward? Think of bending forward to tie your shoes from a seated position. That is the lumbar flexion position you should NOT use when rising. It would be challenging to get up from that position. Now imagine yourself pushing your butt out while you are sitting, then standing up form that position. When pushing your butt out, your body naturally embraces the core and hinges the hip. It may sound silly, but practicing getting up out of a chair is the easiest way to retrain that movement. Another easy step by step process to follow is as such:
- Brace your abdominals
- Stick your butt out –this helps put the spine into neutral posture
- Do not let your chest go beyond your knee when rising
While at home there are also 4 main exercises one can do to build proper stability and help retrain the body to be in a better position. They are as follows:
- Pelvic tilts
- Dead bugs
- Bird dogs
- Side planks
Here is a link with a demonstration for each. It is recommended to start with 2 sets of 10-12 for each and work up to 3 sets of 15-20. These should be completed for a 4-6 week period performing the exercises every other day to start and progressing to a daily routine. This is especially important if you sit all day at work. Make sure you are loose before starting. A warm shower or cup of coffee to start your day works just fine.
In conclusion, if you are one of the 80% of folks dealing with lower back pain, I recommended a 4 step process that has been very effective for most patients.
- Get evaluated, treated & instructed on long-term exercises to fix the problem. This should include the following:
- A proper assessment: history, everyday movements, orthopedic assessment, functional screening if needed
- Soft tissue work to loosen fibrotic and tight muscles: Active Release Technique, Hawk Grips Therapy
- Manual mobility/adjustments to help aide movement in areas that are not moving
- Corrective exercise to re-enforce the new and improved movement patterns
- Lastly, the elephant in the room: follow a proper eating regime to help maintain a healthy weight. If you are at a loss, start with whole foods and eliminate anything that comes from a box or can.