Finding Fitness With Lower Back Pain
The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise. I frequently meet people who report their fitness efforts have been hampered by low back pain. I have five recommendations that can help fitness clients with lower back pain have more success in the gym.
#1 Do not exercise first thing in the morning: Ergonomic experts have found that many more industrial lower back injuries happen in the morning. The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge. Give your lower back one or two hours of walking around time before starting an exercise session.
#2 Isometric strengthening of the spinal stabilizers: The function of your “core” muscles is to limit movement of the lumbar spine and pelvis. Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries. Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.
#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities. Greater lumbar spine range of motion is associated with more–not less, lower back pain problems. Learn how to foam roll and mobilize the hip flexors and gluteal muscles. Prolonged sitting and most popular “cardio training” deadens these muscles. Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back. Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.
#4 Focus on single leg strength training: Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats. Swear off the lower lumbar deranging leg press. Reduce spinal compression and train the legs, one at a time. Single leg training reveals the right / left side movement asymmetries that drive lower back pain. Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain. You will need some guidance on exercise selection and execution- this brings me to #5.
#5 Get some help: Exercise is the most powerful medication on the planet. Nothing else comes close. Take the proper dose of appropriate training and the results will be amazing. Take the wrong dose of an inappropriate activity and the results can be devastating. This is especially true for people with a history of lower back pain. Find a qualified physical therapist to guide you through your fitness journey. One way or the other, you are going to spend time and money on your health. Proactive spending is always cheaper and more beneficial than reactive spending.
Michael S. O’Hara, PT, OCS, CSCS
Movement You Should Master
Modern medicine is keeping us alive longer, so now we need to put some effort into staying lively longer. Mastering specific movements will improve our quality of life and help us stay independent and injury-free. I have come up with several exercises you can use to make yourself stronger, more durable, and develop a healthier, more functional body. An exercise that I have found to be efficient and effective is a Weighted Carry.
Very few things are more functional than a carry. You’d be hard pressed to get through daily life without having to carry something at least a few times per week. While basic, a carry is an efficient and effective full body exercise. Depending on the carry you choose, the load is virtually limitless. Performed for time or distance, carries will always improve gait and core stability. Depending on which version you use, they can also be an effective tool for improving shoulder mobility/stability, grip strength, balance, and overall awesomeness. Watch the video and give it try: https://youtu.be/PaP4-IlVAOA
Coach Chad demonstrates my top four carry picks:
1) Farmers Walk (gait, core stability, grip strength, upper back, legs)
2) Suitcase Carry (gait, core anti-lateral flexion, grip, upper back, balance)
3) Waiters Carry (gait, core stability, shoulder stability, balance)
4) Double Waiters Carry (gait, core stability, shoulder mobility, shoulder stability, balance)
-Jeff Tirrell, CSCS, Pn1
Hamstring injuries are on the rise. In this month’s newsletter, Mike O’Hara, PT provides information on preventing hamstring injuries and includes videos of the recommended exercises. Learn what it is to be “farm boy strong” and what you can do to become a “functional farmer”.
We all want fitness results, and we want them now. We want to look, move, and feel better in two weeks. We know it took us years to get into this overweight, weak, and de-conditioned state, but we have a wedding in three months, a reunion in six weeks, and a date next Friday.
Unfortunately, many of the physical problems that slow our progress toward specific fitness goals will not resolve with two or three exercise sessions a week. Postural deficits, faulty motor control, mobility limitations, and joint restrictions require daily attention to elicit any meaningful change. Short bouts of focused training, interspersed throughout the day, will produce the best results. In physical therapy rehabilitation, we prescribe home exercise programs that are performed up to every two hours to reduce pain and restore function. Fitness clients will more rapidly reach their goals with some daily Nano Sessions of exercise.
Shakey Shoulder Nano Session
Your shoulder is held onto your body with a basket weave of muscles that connect the shoulder blade to the rib cage. They function in a highly coordinated fashion to isometrically fix the upper arm to the body. As infants, this scapula on thorax muscle control develops as we master crawling. It reaches higher levels of integration with pulling and pushing activities found on the long forgotten monkey bars and the litigated away ropes of gym class. A sedentary lifestyle and postural breakdown erode away the strength and coordination of our scapula stabilizers. Poor scapula on thorax stability reduces performance and leads to shoulder and neck problems.
When the inside border of the shoulder blades projects up off the body, we call it “winging.” Scapula winging is a hallmark sign of poor shoulder girdle stability and the first thing you need to remedy in your training program. Upper extremity strength needs to be developed from the center out. If you are unable to hold a solid push up position plank then performing Olympic lifts and bench pressing is getting the cart before the horse.
Push Up Position Plank 101
Basic Push Up Position Plank
Place the hands under the shoulders with the elbows extended. Pull your shoulder blades down your back and keep your neck long. Lift your pelvis so that your body is supported on the feet and hands. The feet should be at least shoulder width apart. Your body is held in one long line from the ears to the ankles. Do not let your hips sink or rise up—check your position in a mirror. The critical part of the exercise is creating tension in the core stabilizers by tightening the gluteal muscles and keeping the shoulder blades tight to the rib cage. Hold for at least twenty seconds and work up to longer hold durations. A good goal is a sixty-second plank.
Elevated Feet-Push Up Position Plank
Once you can hold a sixty second push up position plank with the feet on the floor, progress to elevating the feet on a step or exercise bench for more resistance. Work up to a solid sixty second hold.
Alternate Arm Lift-Push Up Position Plank
This variation adds an anti-rotation stability component to the exercise. Get into the push up plank position with the feet up on a bench. Shift slightly over the left arm and then lift the right hand up off the floor. Reach the right arm out at a 45 degree angle and hold for five seconds. Lower the right hand back down and repeat with the left arm. Perform three to five repetitions on each arm. Work up to longer hold times instead of more repetitions. Five repetitions on each arm with a ten second hold is a good goal.
If you are new to this exercise, use a dumbbell, and as you get stronger, you can progress to a kettlebell held in a bottoms-up position. Using a strong grip, position the implement with the shoulder flexed approximately 85 degrees. This should place the upper arm in front of the body and the elbow just below the shoulder. Maintain a strong hold and pull the shoulder blades down the back. Try to keep the biceps muscle from working too hard. Keep a tight and tall cervical posture and perform a steady walk. Do not allow the lower back to arch and keep the front of the rib cage flat. Switch the implement to the other hand and walk back.
Shoulder Carry Regressions and Progressions
Many people can only travel fifteen feet before they must rest. Start slow and build up to a thirty yard carry with each arm.
Keep the weight you use light and work on maintaining a stable shoulder posture with a steady gait.
Start with a dumbbell and progress to an inverted kettlebell.
Walk greater distances to build up more isometric strength endurance in the shoulder.
The task of balancing an unstable upside down kettlebell while you walk creates a reflex activation of the rotator cuff and scapula stabilizer muscles. This exercise teaches your shoulder girdle muscles how to work as a team.
The repetitive shoulder stress of throwing, swimming, and overhead racquet sports often leads to the development of muscle imbalances in the shoulders. The bottoms-up kettlebell carry will train away those imbalances.
Many athletes and fitness clients have difficulty keeping the neck relaxed when they use the shoulder muscles. This exercise will help resolve this abnormal movement habit.
If you have a shoulder winging problem you need to retrain your motor control with frequent sessions of exercise. Perform the push up position plank (PUPP) and the shoulder carry twice a day for the next six weeks. Work on greater duration of the hold on the PUPP and start with a light weight on the carry, gradually adding distance. Thirty yards on each hand is your goal.
To view video demonstration of the above exercises, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS