Your lower back hurts. Maybe it just feels tight after youve been sitting/standing for a while, maybe its a specific movement that causes it to hurt, or maybe it just goes out without warning. Its irritating and unpleasant at best, and debilitating at worst, even forcing you to take time off work, or from activities that you enjoy.
And you might have even gone to a chiropractor, massage therapist or physiotherapist, and although it might feel better for a few hours or a day or two after you get treatment, it never fully resolves. I hear ya. A lot of our clients were in that position before they started working with us, but we help them through it more or less permanently. We cant claim 100% success rates (no practitioner can), but in this article, Ill outline the methods we use to improve or eliminate lower back pain in a majority of our clients.
In this article, were going to cover:
- Different reasons for lower back pain
- The biggest mistakes when it comes to lower back pain
- Assessments we use to figure out why the back hurts.
And if you want to skip all the guesswork, and just get a program personalized to your back, we have a special program called happy, healthy back. To see if we can work together, just email me with the words Back Pain in the subject line.
Different Reasons for Lower Back Pain
My readers and audience often ask me what exercises they should do for lower back pain. Thats a challenging question to answer, because lower back pain is a symptom, and not a diagnosis. The fact that theres pain tells me nothing of the origin of this persons pain, so I have to ask a bunch of follow-up questions to figure out what will work for any one person.
Here is just a short list of what can cause lower back pain:
- Degenerative disc disease/degenerative joint disease
- Sacroiliac joint pain
- Spinal stenosis
- Sciatica
- Spinal fusion
- Facet joint syndrome
- Hernia
- Muscle strain
- Deconditioning
And again, this list or problems is just scratching the surface. Do you think that the same series of exercises applies to all of these problems? If you said no, youd be a smarticle particle. The series of exercises that makes one of these conditions better can make another one worse. So it takes some detective work, and a thorough knowledge of anatomy to make things both safe and effective.
The Biggest Mistakes When it Comes to Lower Back Pain
Mistake #1: Only Seeking Passive Therapies
As I outline in my article on how to deal with injuries mentally, one predictor of how long an injury will stick around is how active you are in the treatment. If all you do are passive treatments (like chiropractic, massage therapy, lasers, hot packs/cold packs, etc.), youre used to having stuff done to you. Youre not doing anything. Thats not to say that these therapies are worthless. Far from it. In fact, I often refer my clients to the aforementioned practitioners.
What I am saying, however, is that passive approaches are only part of the approach. Theyre not the full approach. You need to be an active participant in your own recovery. How? Exercise!
When you start to combine passive therapies with exercise, you get results much faster, and theyre more long-lasting. Likeour client, Carole, whose hip pain from arthritis decreased by 90% in the span of a few months. So much so that she almost completely stopped using her cane, and pain medications. OrPat, who after years of having arthritis was able to prevent a hip replacement surgery with only a couple months of exercise. A lot of the strategies we used with both Carole and Pat came from my article on exercise for osteoarthritis.
Mistake #2: Doing the Same Exercises for Different Lower Back Problems
As you can understand from the previous section, different back problems require different exercises. Doing the same exercises for all these conditions, without precision will make some conditions better and others, worse. Do you want to take a gamble with your recovery, and see whether the series of exercises that you picked up on the internet will make your pain better or worse? Or do you want a more precise approach?
Mistake #3: Doing Abdominal Exercises
This mistake piggybacks on the previous one. People often hear that lower back pain happens because of a weak core. So they start doing every abdominal exercise known to man crunches, planks, bicycles, you name it (never mind that the core is more than just abdominals, as I cover in my article on core strength myths). Sometimes core strengthening helps, but sometimes it doesnt. And sometimes, it actively hurts.
Again, you have to assess your need for core strengthening. If your core is weak, strengthening it will help. If your core is strong, additional strengthening will probably not do anything for you. Unfortunately, rather than assessing core strength, people just assume that their core is either weak or strong. But as we know from my other articles and speaking engagements, if youre not assessing, you are guessing.
Mistake #4: Stretching
Somehow, stretching gained this halo effect in our society. That its good. For all people. All the time. For every muscle.
Stretching is a tool in a toolbox. Tools arent good or bad. Its how you use them. A hammer is a tool. Is it good or bad? If you use it to hammer in a nail where its supposed to go, thats good. If you use the hammer to break a window, thats not so good. Did the hammer change? No. The way you use the hammer changed.
Same with stretching. If you stretch the right muscles for the right duration, at the right frequency (number of times per week), you get good results. Stretch the wrong the muscles, and you can either slow down your recovery from the injury, or make the injury worse.
Stretching is only beneficial if there is a proven need to stretch. How do you prove the need to stretch? You assess range of motion. No limitations in range of motion, no need to stretch. But how do you know unless you test? You dont.
Mistake #5: Not Addressing Ergonomics
Sometimes people do all the right things in the gym or clinic, but the way their workplaces are designed arent right for their bodies. Maybe their chair is too high or too low. Maybe their computer monitor is too high or too low. There are a number of things to look into when it comes to ergonomics.
Just think about it if youre spending 8+ hours per day in a certain position, and that position isnt right for your body, you could be undoing all the good work youre doing in the gym/clinic.
Mistake #6: Not Assessing
As alluded to earlier, all the previous mistakes really come from one big, fundamental mistake: not assessing. And as you know by now, if youre not assessing, you are guessing. (am I getting repetitive? )
If youre not measuring whats wrong, then you dont know what to fix.
Which brings me to the next section, on
Assessments We Use to Figure Out Why the Back Hurts
First, let me say that as fitness professionals, we are not allowed to diagnose. But we certainly can identify muscular imbalances. If we see limitations in range of motion, were allowed to correct them, and if we see deficits in strength, we can fix those as well.
So what assessments do I, and my staff use to assess why the lower back might be hurting? There are really 5 main categories of tests we use:
Category #1: Hip Range of Motion
We assess the different ranges available at the hips:
- Flexion
- Extension
- Adduction
- Abduction
- Medial rotation
- Lateral rotation
Why does that matter? Because if the hips are immobile, the lower back must become mobile. But the lower back was not intended for mobility. It was intended for stability. Each one of the vertebrae in the lower back should only be able to move 2-3 degrees. The vertebrae in the neck, by contrast should be able to turn 8-9 degrees. But if the hips are stiff, the vertebrae of the lower back move more than theyre supposed to, and you get pain
Category #2: Glute Activation
This is a test of whether your butt works. A lot of activities in daily life involve hip extension. For instance, getting out of your chair involves hip extension. And how many times do you get off your chair/couch/toilet/car seat throughout the day? Dozens.
There are 2 major muscles that can do hip extension: hamstrings and glutes. But theres a third muscle that can mimic hip extension: the spinal extensors. They cant actually extend the hip. But the spinal extensors sure can extend the spine.
So what happens when your glutes are inactive (by the way, inactive is not the same thing as weak)? You start to use your lower back. Now, your lower back is working instead of your glutes, and its doing the job of 2 muscles. No wonder your lower back hurts.
Category #3: Thoracic Mobility
Thoracic means mid-back. Remember back to our category #1 section that the lower back isnt supposed to move much. But the mid-back does have that capability. Unfortunately, if the mid-back doesnt use its potential, and it stiffens, another part of the body has to loosen to acquire the range of motion that the mid-back lost. Thats the lower back. And again, the lower back shouldnt be loosey-goosey. It should be relatively stable and tight.
Category #4: Core Endurance
Here, we test the endurance of the large muscles of the core:
- Abdominals
- Obliques
- Spinal extensors
Because remember, the core is more than just the abdominals. And we want to see the ratios of those muscles relative to each other. The right ratio of abdominals to obliques is 4:3 (so if you can hold a plank for 60 seconds, you should be able to hold a side plank for 45 seconds). The right ratio of abdominals to lower back is 2:3 (so if you can hold a plank for 60 seconds, your lower back should be able to do 90 seconds). And of course, the right ratio of the left oblique to the right oblique is 1:1. If both the absolute amounts are off, and/or the relative ratios to each other are off, that could predispose someone to lower back pain.
Once weve gone through all these assessments (and possibly others), we have a much more direct, clear, and fast path towards speeding up their recovery from the pain, so rather than continuing to struggle, they get better, and get back to the activities they want to do, pain-free. If youd like to have these assessments done on you, just email me with the words Back Pain in the subject line, to see if you qualify.
Or, if there’s a personal trainer that you’re considering for your own lower back pain, and you don’t want to use my team or I (I’m very sad 🙁 ), you can use the article that I wrote about how to find and evaluate a personal trainer for back pain.
