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
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”.
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
In this issue, Mike O’Hara, PT discusses the importance of strong, well-functioning upper back muscles. Exercises, including video, are presented. Jeff Tirrell gives us ways to keep all those New Year’s fitness resolutions, and Mike gives fitness tips to make your program more successful.