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
Learn how to keep your spinal stabilizers strong by performing side planks. Mike O’Hara explains this in his article, “Learning to Lean”, and includes video demonstration and explanation of the importance keeping your stabilizers strong to stand up to the demands of daily life. It’s time for another Fenton Fitness Love Your Jeans Challenge–see page 3 for more information. In his article, “The Periodization of Nutrition”, Jeff Tirrell gives tips on optimizing dietary intake.
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 very helpful in restoring the capacity to get up and down off the floor is the Step Up.
The ability to go up and down steps will almost always be needed. Losing this ability is a sure sign that one’s quality of life and independence are quickly fading. Step Ups can be done in a variety of different directions and loaded a number of ways making them easily progressed or regressed based on goals and fitness level. Step Ups improve balance and strength in the glutes, quads, and hamstrings. Depending how you load, they can also challenge the core and shoulders. The average step in the United States is 7 inches tall. Strive to work up to a 14 inch box so that no flight of stairs will ever intimidate you.
Here Coach Katie demonstrates two different versions we like to use and the benefits of each along with some progressions. Watch the video and give it a try: https://youtu.be/iGXtKyGlKMg.
1) Anterior Step up (Progression: Anterior Step Up with Racked Kettlebell hold)
2) Lateral Step Up (Progression: Lateral Step Up with one side loaded)
-Jeff Tirrell, CSCS, Pn1
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
Standing desks are great for posture and health, but many people have difficulty when they first start using them. In this issue, Mike O’Hara, PT gives exercises that can help you stand for longer periods of time. Watch the video for instruction on these exercises. In his article, “The Biomechanics We All Need To Know, Mike agrees with the advice given by Stuart McGill. Be sure to read about Fenton Fitness Member Jan Pilar and her success with her program.
In this issue, Mike O’Hara, PT gives ten reasons to love lunges. Video of lunge exercises/progressions are included. In Going Grizzly, Mike presents the exercise combination of Crawls and Sandbag Carries; a combination that helps you train more efficiently and move better. Watch the video for instruction on these exercises.
Renegade Rows and SHELC
When designing programs for rehabilitation patients and fitness clients, I often pair up exercises. This practice is commonly called super-setting and it has multiple benefits:
Train efficiently—You get much more work done during your training time.
Abolish performance deficits—Most physical therapy and fitness clients need to work on glaring right vs. left movement asymmetries, postural restrictions, and stability limitations.
Lose weight—Fat loss is a primary goal of most fitness clients. Pairing exercises ramps up exercise intensity and creates the hormonal response that improves body composition.
Move better—Training neurologically related movement patterns improves motor control.
Renegade Row-SHELC Combo
The renegade row starts in the top position of a push up. Rubber hex dumbbells work the best for this exercise since they do not move on the floor. Place the dumbbells on the floor and position the hands on top of the dumbbells. Try to align the dumbbells directly under the armpits. Maintain a strong grip on the dumbbell handle during the exercise. Spread the feet at least shoulder width. Tighten the shoulder blades down the back and create total body tension. Without allowing the torso to turn, row one dumbbell up so the thumb approaches the armpit. Lower the dumbbell in a controlled manner and repeat with the other arm. Perform five repetitions on each arm.
Supine Hip Extension Leg Curls
Set the TRX straps so the bottom of the strap is at the mid-calf level of your leg. Lay supine and place the heels in the foot straps of the TRX. The feet should be directly under the overhead attachment point of the TRX. Place the arms on the floor at a 45 degree angle. Brace the abdominal muscles and keep the head down. Push the arms against the floor for stability. Lift the hips off the floor and keep them up for the duration of the set. Bend the knees so that the feet travel toward the body. Keep the hips up and extend the knees in a controlled manner. Perform ten to fifteen repetitions. Common mistakes are turning the feet outward and allowing the hips to fall toward the floor as the knees flex and extend.
The anti-flexion and anti-rotation core stabilization demand created by this pair of exercises produces some interesting next day abdominal muscle soreness. The ability to link the hips to the shoulder and produce movement is what everyone tries to accomplish with functional training. Move through three sets of the Renegade Row – SHELC combo and let me know how it goes.
View video of Mike performing these exercises here: https://youtu.be/2_fT0zShTSo
-Michael S. O’Hara, P.T., OCS, CSCS
Halos And Around The Worlds Are The App For That
Much like the collision avoidance computer systems built into automobiles, our brains run neural software that prevents us from overloading and damaging the spine. If we are unable to adequately stabilize the spine, our neural injury avoidance system prevents us from loading the arms and legs in positions that will produce a spinal injury. Developmentally, we master the capacity to control the muscles in the middle of the body first. What this means for the average fitness participant is that hip/shoulder exercise activities have little value if we do not possess adequate spinal/pelvic girdle stability. Training that enhances the coordinated control of the “muscles in the middle” enables our neural system to produce more efficient, graceful, and pain-free movement.
Halos and Around the World drills improve the coordinated control of the pelvic girdle and spinal stabilizers. They act as a “neural reboot” of the software that controls stabilization of the spine and pelvic girdle. These exercises are easy to learn and require minimal equipment. An Airex pad under the knees makes the exercise more comfortable and you can use a kettlebell, sandbag, or an Iron Grip weight plate for resistance.
Kettlebell Halos in Tall Kneeling
Assume a tall kneeling position on the Airex pad. The knees are under the hips and the toes should grip the floor. Grip the kettlebell by the horns in an inverted position. Make the shoulder girdle muscles active by pulling out against the horns of the ‘bell.’ Brace the gluteals and abdominal muscles and maintain a tall and stable posture during the exercise. Start with the ‘bell’ in front of the chest and circle the kettlebell slowly around the head in the shape of an angel’s halo. Perform three to five halos in clockwise and then three to five counter clockwise.
Sandbag Around the World
Assume a half-kneeling position on the Airex pad. The left knee is under the hip and the toes of the left foot should grip the floor. The right knee is in front of the hip and the foot is flat on the floor. I like the unstable “shifting resistance” provided by a sandbag for this exercise but you can also use an Iron Grip weight plate. Make the shoulder girdle muscles active by pulling out against the handles of the sandbag or Iron Grip plate. Brace the gluteals and abdominal muscles and maintain a tall and stable posture during the exercise. Start with the bag or plate in front of the body at belly button level. Take the implement around the body in a very slow and steady fashion. Each repetition should take at least six seconds to complete. Do not permit the body to shift or shake. Perform three to five cycles in clockwise and then three to five counter clockwise. Switch the leg position and repeat with the right knee down and the left leg forward.
For the next six weeks, perform one of these exercises at every training session. It is surprising how many people report improved capacity to squat, lunge, overhead press, and get off the floor with some dedicated neural retraining of the “muscles in the middle.”
Video demonstration of kettlebell halos and sandbag around the worlds can be seen here: https://youtu.be/LGodn9ImRqc
Michael S. O’Hara, P.T., OCS, CSCS
Fitness training for those of us past 40 years of age is more complicated. Physical performance and recovery capacity are dramatically different. If you need proof, look for the forty year olds in the NBA or NFL. The good news is that with proper planning, consistent performance, and the wisdom that comes with age, we can stay fit and active for a lifetime. I have compiled a collection of tips for the forty plus fitness client.
Improve Your Balance
Balance, just like functional mobility, strength, and muscle mass, starts declining at around age thirty, and unless you do something, it gets worse as you age. The older you get, the more likely you are to have some degree of balance impairment. As the American population ages, injuries from falls have become a bigger concern. The good news is that no other parameter of performance can improve as quickly as balance.
The recommendation from researchers and clinicians at Too Fit to Fracture (osteoporosis.ca) is that we perform some balance training every day. The training takes no more than five minutes, but to achieve the best results it does need to be an everyday event. My suggestion is to integrate balance training into daily chores. Practice standing on one leg while you brush your teeth. Perform three or four twenty second holds on each leg. Stand on one leg when you fold the clothes, iron the shirts, or wash the dishes. Another great reason to use a standing desk is that it gives you the opportunity to practice some single leg balance as you are working.
Balance is a team effort between the sensors in our joints, the inner ear, and our vision. You want to challenge all aspects of the sensory system during your training. When you go to the gym make sure you exercise in a standing position and always include single leg biased balance activities during your workout. Exercises such as step ups, lunges, and medicine ball drills will all help improve your balance.
-Michael S. O’Hara, P.T., OCS, CSCS
I am often asked about my favorite “core exercise.” My response is Stir the Pot, an exercise I learned at a lecture given by spine biomechanics expert, Dr. Stuart McGill. Most people have never heard of this exercise, and I have never witnessed it performed in a commercial gym. It is a challenging drill that is worthy of your training time.
But first I need to make a disclaimer: If your training goal is to reduce the layer of fat across your abdomen and develop a six pack, the Stir the Pot exercise is far from the most beneficial exercise. The best exercise for that is the table push away. One strict repetition of the table push away, performed midway through each meal, is the only exercise that will make the six pack visible. If your training goals are to improve your posture, reduce back pain, and function more efficiently, try adding Stir the Pot to your training program.
The abdominal muscles operate as a team to reduce, not produce, spinal motion. They hold the torso upright and transmit forces from the lower to the upper extremities. You need to develop the isometric strength/endurance that enables the team of abdominal muscles to turn on, and stay on, for an extended period of time.
Stir the Pot Performance
You need a properly inflated physioball for this exercise. Place your elbows on the physioball with the shoulders directly over the elbows. Dig your toes into the floor and set the feet at least shoulder width apart. Lift up into a solid plank position—one long line from the ear to the ankles. Tighten up the gluteal muscles and the pull the shoulder blades down the back. The pelvis should not drop or rise up during the exercise—a mirror and some instruction can help with this common problem. Rotate the ball with the arms clockwise and then counter clockwise for five repetitions, each direction. Try to perform this exercise for time. Work up to sixty seconds of Stir the Pot, and as you get stronger, try elevating the feet on a bench.
-Michael O’Hara, P.T., O.C.S., C.S.C.S.