Low Back Pain Prevention tips & Strategies during Exercise and Treatment
Low back pain (LBP) is one of the most prevalent medical conditions treated throughout the western world. LBP is estimated to affect nearly 80% of the population at one time or another. And worse yet, once you have experienced an episode of LBP you have a 90% chance of experiencing it again.
The good news is that this is a completely preventable problem. Most of us already know that we need to work on proper core strength. However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP. A properly designed training routine which incorporates proper core training combined with eliminating known risk factors is the most effective way to avoid LBP and injury.
Common Risk Factors for Low Back Pain (LBP):
- Sitting too much.
- Slouched sitting.
- Prior episodes of LBP.
- Poor core and back extensor muscle strength.
- Lack of a proper warm up and a cool down.
- High training volumes with inadequate rest (over training syndrome).
Sitting is a major risk factor for LBP. In today’s modern world, even exercise enthusiasts tend to have jobs that include sitting. Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments. It also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function. Now combine all of these risk factors with a poor warm up and a heavy squat. You’re likely to experience back pain, and it’s not because your squatting is poor. It was everything else that accumulated prior to performing the squat.
- Limit your sitting. Limit the amount of sitting that you spend at one time. Move from your sitting position every hour, and ideally, walk. If you aren’t able to walk, then try to shift your position at least once every twenty minutes. Frequent position changes can help to avoid LBP.
- Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.
Often when we hear about low back pain, we also hear about core muscles. Core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine. The core actually consists of two separate groups of muscles, the inner and outer core muscles.
The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine. When this is performed, it is known as the Valsalva maneuver.
The other muscles that help to support the spine are known as the outer core muscles. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement. The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). The glutes, hamstrings, and quadriceps may also be referred to as outer core muscles by many people. The rectus abdominis, “the six pack” muscles which are responsible for lumbar flexion, don’t aid much in spinal stability although they look cool!
Check out this video for more information on the “core” muscles and for a sneak peek into my Treating Low Back Pain during Exercise and Athletics Video Package.
The development of strong core muscles in combination with the right stretches and movement patterns can eliminate most episodes of mechanical low back pain. Lumbar extension strength is critical to avoiding LBP. Certain studies report that as little as ten minutes per week of focused lumbar paraspinal muscle strengthening is an effective method to control and prevent low back pain. I recommend that you start with the superman and bridge exercises demonstrated in my 10 Minutes per Day Low Back Pain Prevention Guide.
As part of your low back pain prevention strategy, I also recommend performing the following exercises:
- Perform press-ups. Lie on your stomach and perform 10 to 20 press-ups. I also recommend press-ups as part of a warm up and cool down strategy. Move slow and easy, but work your way up to full motion. I encourage performing this multiple times a day as time allows. When possible, press-ups are preferable compared to standing back extensions.
- Perform standing back extensions. After any prolonged sitting, stand up, and perform standing back extensions. I encourage performing at least 10 repetitions each time you stand. As you spend more time slouched or flexed, it is critical that you also counteract with extension biased movements. The spine is designed to move in all directions, not just forward. The repeated movement into extension also helps to improve circulation and blood flow into the spinal discs. This allows for vital nutrient exchange and provides a gentle range of motion of the spinal structures.
- Stretch your hip flexors. After performing standing back extensions, it’s time to stretch your hip flexors. The hip flexors tend to tighten during prolonged sitting. Spasms in this particular area can cause LBP because the hip flexors attach directly to the spine. Stand with upright posture, with your feet straight ahead, and bend your front knee until you feel the opposite hip flexor stretch. Hold for 30 seconds, and then repeat two to three times on each side.
- Stretch your hamstrings. A great static stretch for your hamstrings is known as the doorway stretch. Find a doorway and stretch your hamstrings. I recommend at least one minute per side and preferably two repetitions per side. There are other more active methods of stretching your hamstrings that are more appropriate before a work out. Static stretching may impede performance and should be performed either after prolonged sitting or after a workout as part of a thorough cool down.
LBP Prevention Strategies during Exercise
The following strategies are designed not only to avoid episodes of LBP, but to enhance sport performance and recovery. A warm up should be a multifaceted approach in order to prepare the body for movement and activity. If the exercise or activity is performed first in the morning or after a day of sitting or sedentary activity, then the warm up is even more important.
- Cardiovascular warm up. The idea is to increase blood flow throughout the body, but particularly in the core muscles and spine. This allows for improved mobility and also promotes healing as movement is necessary to bring in nutrients. Walk initially, and then progress into a light jog for 3-5 minutes in order to increase the heat rate.
- Dynamic warm up. After the initial cardiovascular warm up, progress into a dynamic warm up series which involves warming up the muscles and joints of the spine, pelvis, and lower legs. Adequate mobility in the hamstrings, hips, and pelvis will insure lower leg mobility in order to perform your specific exercise or activity. Perform exercises such as forward and backward leg swings, side to side leg swings, and running specific drills such as butt kickers, strides skipping or bounding. Utilizing a foam roller as part of a warm up is acceptable. However, I don’t advocate static stretching before activity as it has been shown to decrease force production and performance.
- Cool down. After performing your specific exercise or activity, be sure to take extra time to cool down and stretch. This is an excellent time to utilize the foam roller as well as perform static stretches and press-ups.
Implement these prevention strategies during exercise in order to avoid episodes of LBP. Avoid prolonged sitting and work on strengthening your core muscles. Seek help early from a physical therapist if you are experiencing chronic pain or just struggling with an aspect of your training. Exercise, weight lifting, running, and fitness is a lifelong pursuit. If you are injured or just not having fun, then you will not stay engaged and motivated in the long term.
If you are prone to LBP and want to dig deeper into self-treatment options, I highly recommend reading my eBook, Treating Low Back Pain (LBP) during Exercise and Athletics. I have designed this complete guide and system to help exercise enthusiasts just like you (and me) prevent, treat, and manage LBP so that you don’t have to waste additional money and training days because of ineffective treatment measures.
If you handle your pain and symptoms quickly, LBP can be safely self-treated. If you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your medical professional for an assessment and help in managing your LBP. For additional information on common injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.
Ben Shatto, PT, DPT, OCS, CSCS is a doctor of physical therapy in the United States. He is a board certified Orthopaedic Specialist as well as a Certified Strength and Conditioning Specialist. His website, www.ThePhysicalTherapyAdvisor.com, is dedicated to helping proactive adults of all ages to understand how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions in a timely manner so they can reach their optimal health.
For more great advice, visit Ben Shatto over at his website by following the link below. Ben has a lot more useful and informative information here, and he is always happy to help. So drop by and say hi