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
Your brain is a master of physical manipulation. It has the capacity to move your body by any means necessary. If your hips and thoracic spine are stiff, weak, and unable to rotate, it will demand rotation from your lumbar spine. Frequent and excessive rotation at the lumbar spine is never good. The five lumbar vertebrae are only able to handle 10-13 degrees of total rotation before bad things start happening. In our treatment of patients with chronic lower back pain, our physical therapists work to restore thoracic spine/hip mobility and reduce rotational movement in the lumbar spine. Lower back pain can be trained away with control of lumbar rotation and restoration of thoracic spine and hip rotation.
Three simple exercises you can implement in your training program are the Pallof Press, half- kneeling row, and the lateral rotation lunge. They may require a little coaching to achieve mastery, but once you learn them, they are a very rewarding series of lumbar spine relief activities.
The Pallof Press is a great cure for our epidemic of SNSS –Soggy Noodle Spine Syndrome. It will strengthen the abdominal/back muscles that resist lumbar spine rotation and enhance hip stability. Nearly everyone can perform a Pallof Press. Physical therapy patients start with light loads and usually progress quickly. The Pallof Press also develops the proprioceptive awareness you need for better posture.
You need a cable machine or resistance tubing set at mid torso level. Position your body at a 90 degree angle in relation to the pull of the cable. Assume an athletic posture with the feet at least shoulder width apart and the spine neutral. Push the hips back a little and keep a slight bend in the ankles and knees. You should look like a tennis player preparing to return your opponent’s serve. Use a strong overlap grip on the handle and set the hands in the middle of the chest. Brace the midsection and hips and move the handle out in front of the body and then back to the chest. Select a resistance level that permits execution of all repetitions without losing the set up posture. If one side is more difficult, start the exercise on that side. Perform fifteen repetitions on each side.
This exercise teaches you how to rotate through the thoracic spine and at the same time hold the lumbar spine stationary. The half-kneeling position improves reciprocal hip extension/ flexion. Rotational rows in half-kneeling strengthen the series of muscles and fascia that connect your hip to the opposite side shoulder. While this exercise can be performed with a cable unit, I have found resistance tubing to produce a more user friendly force curve.
Assume a half-kneeling position with the right knee on the ground and the left foot in line with the left hip. An Airex pad under the knee can increase comfort. The right hand holds the resistance tubing set at head level in the half-kneeling position. The right arm is fully extended and the right side of the body is rotated toward the tubing. Pull with the left hand in a rowing motion and simultaneously rotate the torso. Keep the neck relaxed and eyes straight ahead. Imagine a cup of water is on the left thigh, you want to keep the left leg as still as possible. Return to the starting position and repeat. Perform ten repetitions on the right and then switch legs and repeat on the left.
LATERAL ROTATION LUNGE
Lateral rotational lunges help restore hip rotation. When you swing a golf club, throw a ball, or transfer out of the car, the rotational component of these movements is supposed to happen at the hips. Lose hip rotation and your gait deteriorates into old age as you lose the primary driver of propulsion- the gluteals. Rotation is then passed along to the lumbar spine and this creates the destructive forces that lead to spinal dysfunction.
Stand tall with a “hip wide” foot position. Keep the bottom of the left foot firmly Velcroed to the ground. Step out to the side and rotate open to the right. Keep the left knee pointed straight ahead and bend at the right ankle, knee, and hip. Push back up off the right leg and rise back to the starting position. Perform five to ten repetitions on each side.
To view video demonstration of the above exercises, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
The pelvis and spine must be able to stay stable during reciprocal hip (one hip flexed and the other extended) movement patterns. Walking, running, and sprinting are all reciprocal hip movement activities that require core coordination and isometric strength-endurance. You can improve this skill with the Half-Kneeling Pallof Press.
Exercising from the half-kneeling position has multiple benefits: It will improve your posture when you walk or run. You need the split stance position to get up off the floor. Becoming stronger in the half-kneeling position makes you a more efficient athlete and improves balance. It creates a buffer zone of functional mobility and strength so you are less likely to suffer an injury. Half-kneeling is the antidote for the physical damage produced by prolonged sitting.
Half-Kneeling Pallof Press Performance
Assume a half-kneeling position: Place your left knee on an Airex pad and position the right foot in line with the right hip. The left foot is dorsiflexed and the toes dig into the floor to stabilize the leg. Keep the torso tall and the lumbar spine in neutral.
Resistance tubing is the most convenient tool for this exercise, but you can also use a cable column. In the half-kneeling position, you set the tubing at chest level. Align your body so the tubing is directly to your left. Use a double overlap grip on the handle. Start with the handle against the sternum and press the tubing out to arms-length and then back to the chest. Stay tall and stable and do not let the resistance from the tubing pull you into rotation. The legs should not move. To encourage stability, imagine you have a cup of water resting on the top of the right knee.
Select a resistance level that permits execution of all repetitions without losing the set up posture. Switch to half-kneeling on the right and repeat the exercise. If one side of the body is more difficult, start the exercise on that side. Perform two sets of fifteen repetitions on each side.
I have found that this exercise works well when programmed with the Bird Dog exercise (see post from 5/12/15). The Half-Kneeling Pallof Press is an upright Bird Dog that progresses the demands of rotation control. For better posture, improved performance, and injury prevention travel through this exercise series two times:
1. Bird Dog x 10 repetitions each side- hold ten seconds
2. Half Kneeling Pallof Press x 15 each side
3. Stir the Pot x 30 seconds
Physical Therapist, John Pallof – We Thank You!
To view video demonstration of the Half-Kneeling Pallof Press, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS