Lower Back Pain
One of the most common complaints among athletes and the general population would have to be lower back pain. Many factors contribute to increased rates of lower back pain including prolonged sitting, standing, frequent bending and twisting, and inflammatory foods to name a few.
Considering many of our athletes labour or do factory work which often involves repetitive loading and frequent bending and twisting it is important that we address risk factors and assess movement patterns to try and reduce lower back pain away from the training that we do together.
Many common recommendations can actually make lower back pain worse and prolong time to recovery. Things such as stretching the lower back and doing sit ups are normally recommended but don’t do anything to really help the problem, often they cause more pain. Having had back problems most of my life I have had to do many different types of rehab over the years but until I learnt some things for myself it used to take me a long time to get over my disc bulge flare ups. Currently, I don’t hurt my discs as regularly and when I do I can get back to training a lot quicker than in the past. After breaking my L3 transverse process I returned to playing footy in 2 weeks. Below I will talk about some of the things I have addressed that have helped my lower back.
FMS and Structural Balance
This is where we always begin. If you don’t know what your weaknesses are, then you don’t know how to correct them. Once you know what your limiting factors are you are able to start to move better in daily life which reduces the load on your spine and other areas of the body. This is done through corrective exercises that you can do in your own home. Whilst we all think that our hips or hamstrings are tight and are causing a problem, it is funny to see how often a tight upper back can be the actual cause. I didn’t believe it until Gemma Smith, THP exercise physiologist, gave me my corrective exercises to do and after a few weeks realized I could full squat. This was without doing any hip flexor stretches which I thought is what I needed. I was wasting my time. I have spoken about the fms and structural balance in other articles so click on the links to find out more information.
Stop doing sit ups
This is very simple to implement. Many physios and the average gym trainer will tell you that you need to strengthen your “core”. While I do believe you need a strong core I think the way they go about it is wrong and leads to more back pain. For example, the sit up compresses the spine with about 3300 N, many occupational safety companies set limits for low back compression at 3300 N because repetitive loading above this limit is linked with higher rates of injuries among workers. As you can see this is the same amount of compression on the spine with each rep of the sit up.
I don’t do any “core” training. I get mine from squats, deadlifts, chins, bench, farmer’s walks etc. Once I stopped doing sit ups and core work my back health improved massively.
Another reason why I believe not doing sit ups or core movements helped my lower back pain was because it was tightening my already tight hip flexors even further. Many people will say this is why you should bend your knees when doing sit ups thinking that the psoas is realigned to reduce compressive loading or that the shortened range reduces forces. McGill has found that even though the psoas is shortened with hip flexion, its activation level is actually higher during bent knee sit ups.
Many athletes will say I need some core exercises to get abs. This is a myth, diet is what gets you to see some abs not so much the amount of sit ups you do. If an athlete feels they need some direct core work or if we find a weakness we will prescribe some direct work but it involves better exercise selection and it is usually only for a limited time, until we fix the discrepancy.
Check out this article for more on ab training:
Avoid full flexion especially in the morning
Bending over and touching the toes as soon as you get out of bed can lead to back injury. When you lie down at night the discs expand and the ligaments are tighter. Adams, Dolan, and Hutton estimated that disc-bending stressors were increased by 300% and ligament stresses by 80% in the morning compared to in the evening.
This is important to remember if you wake up and rush to work or if you work out first thing in the morning. It takes about 30 minutes for the back to regain 54% of its end of day status. Sitting puts you in flexion too so when you get out of the car you have 30 minutes from that point. Be careful first thing in the morning with how you move.
Don’t lift heavy after prolonged flexion
This goes hand in hand with the above. If you have been sitting for 20 minutes it takes 2 minutes to regain 50% of your intervertebral joint stiffness (McGill and Brown 1992). Even after 30 minutes there is still some joint laxity.
With athletes this applies when you are sitting on the bench waiting to go on. You should try to avoid sitting with a flexed lumbar spine, get up and move around every couple of minutes, or at least stand up at times instead of sitting. This way the ligaments will regain some protective stiffness. This also applies to many other jobs such as police officers, ambulance drivers, truck drivers, labourers after smoko etc.
Don’t sit for too long
Sitting tightens the hip flexors and puts pressure on the discs. Sitting in the car puts even greater pressure on the discs due to the vibration. The solution to this is changing your position throughout the day, using different sitting postures and standing. So if you have a job where you are seated for long periods you can:
Buy an ergonomic chair. Change the settings to have three or four preferred angles that you can sit in
Get out of the chair. Don’t bend over and do toe touches. A rest break has to use the opposite activity to what you have been doing to reduce stress on the back. So in this case, extension exercises would be a good choice. Stand up for 20 seconds, then move the neck and arms around to relieve shoulder and neck discomfort, follow this by raising the hands over head and reaching for the ceiling.
Exercise at lunch time. Performing exercises to enhance back health. Here would be a good time to do your corrective exercises based off your FMS.
Avoid inflammatory foods
Since inflammation plays a role in back pain it makes sense to try and limit the amount of inflammation we are exposed to. Our modern diet is highly inflammatory. Some foods that you may want to avoid include wheat, grains, dairy, and cheese. We cover all this for our clients by running their BioPrint.
Stop stretching your lower back
Research has shown that spine flexibility doesn’t predict future back troubles. For injured backs I wouldn’t work on spine flexibility until the client has improved endurance and strength, and even then I wouldn’t be hugely concerned with spine flexibility. Some people will never reach that stage. I have had and seen more success with spine stabilization techniques using a neutral spine, while focusing on mobility at the upper back, hips, and knees. Again this is individual and the best way to know your limiting factor is to get screened. Exercises such as toe touches and pulling the knees to the chest can make back pain worse, especially if performed first thing in the morning, as mentioned above. Sadly they are still prescribed.
These are just some of the things to consider for the health of your lower back. There are many more strategies you can implement. In general if you want to avoid back pain you should try to reduce repetitive work that uses the same movement pattern or prolonged postures such as sitting and overloading of the tissues which could be accumulative over time. Varying your positions and type of work you do is your best bet. Hope this can help you find some relief.