Managing Back Pain

Lower back pain is the leading cause of disability in America and worldwide. 31 million Americans experience low back pain and experts claim 80 percent of all Americans will experience back pain at some point in their lives. It is the leading cause of work missed and is the second most common reason for visiting the doctor. Sounds like a lot of bad news, right? Well, on the bright side, most causes of back pain are mechanical, and not due to a serious injury. Improper mechanics such as tight muscles, an imbalance in strength, weak gluteus, or not firing muscles in the correct pattern. These are typically reversible and not associated with any kind of serious condition. Serious conditions include; bone fractures, disk bulge or herniation, inflammatory arthritis, etc.

If back pain is such a common problem, why isn’t the solution to fix it common knowledge at this point. Among the dozens of clients that I have seen with back pain and another several people in my day to day life, a large majority of their back pain was a result of the same issue and very reversible. It is important to figure out the source of where the pain is coming from and work to fix it as soon as possible, often through a prescribed exercise program. What was once easily fixable, over time can lead to more damage, making it more and more difficult to overcome. Improper posture and form in different movements puts added pressure on the lower back and can lead to sprains/tears or wear and tear on the disks. This can lead to bulges and herniations in the disks, which are harder to treat.

Common Causes of Back Pain 

So what are the most common causes of low back pain? There are several reasons, and typically they happen in conjunction with one another. Muscle imbalances between the quads and the hamstrings, weak glutes, and tight muscles.

Sitting for long periods of time has become more common and more common. When the body is in a seated position the quadriceps and hip flexors are in a shortened state. Over time in this position, these muscles can shorten completely, not just when seated. Since the quad and hip flexors attach to the pelvis, when the muscles shorten, it creates a pull on the pelvis, causing it to tilt. This tilt forward intern causes the back of the pelvis to rise, and the muscles in the lower back to shorten. This places added pressure on the lumbar spine and its discs. All the while the tightening of these muscles displaces the bodies weight forward and into the feet and quadriceps. With the body’s weight displaced forward and into the toes and quads, the quads get overworked. This causes the hamstrings and gluteus to turn off, creating an imbalance in strength.

Adopting a stretching program to help mobilize your hips is step one. Along with a strength training program to build strength and balance in your core and hips. By stretching the quads and hip flexors, they can begin to stretch back to their proper length. By strengthening the glutes and hamstrings those muscles can have the strength to do their job, rather than the quads doing all the work. We want to reset these two muscles back to their normal strength/length ratio. This will take the downward pull out of the pelvis allowing it to re-aline, and in-turn allows the muscles in the lower back to return to their normal length.

Fixing Imbalances in Strength 

It is also likely that other imbalances are going on. The gluteus medius muscle, one of the three muscles in the butt located on the outer surface of the pelvis, typically gets weak and tight as well. This shortening of the glute medius muscle causes the legs to externally rotate. This external rotation of the legs puts added strain on the hips and knees. Having this type of gate, with your toes pointing out is a very common reason for knee pain. Stretching and strengthening the glute medius to internally rotate the legs to their proper gate is important.

Resetting the strength/length ration between these large muscles can take time, but is vital. Here is a simple routine to get the ball rolling.

Exercises to Overcome Back Pain 

Muscles to strengthen- Gluteus Maximus, Gluteus Medius, and Hamstrings.

Hamstring Curls-

Hamstring curls are a good place to start. This exercise does a great job isolating the hamstrings/glutes without activating any anterior thigh muscle. It is also a great warm up. It pumps large amounts of blood into the legs and loosens up the muscles without putting pressure on the knees. This is a great prep for a more compound leg movement exercise. Going with a lighter weight and higher rep count in this workout is most effective. Being able to hit around 12-18 reps is where you want to be. Heavier weight with lower reps does not do as good of a job getting blood pumped into the hamstrings.

One Legged Pistol Squat- The pistol squat is a one-legged squat. It is can be a more difficult exercise, but there are plenty of ways to modify the movement to make it easier. This workout is also highly effective. It is important to incorporate one-legged exercises into your leg routines because similarly how the strength imbalance between the hamstrings and the quads can occur, so can an imbalance in strength between the right and left leg. When one leg is weaker than the other, when performing a squat, that person often recruits the stronger leg more to compensate for the weak leg. Over time the dominant leg gets stronger and stronger. Splitting the legs up and doing one-legged exercise can level out and prevent any imbalances that you might have.Keep a big chest, with your shoulders back. Your back should be straight and the weight should be in the planted legs heal. Your knee should not shift over that foot’s toes and the suspended leg should be as straight as possible.

Back Squat- The back squat is an important exercise that should be taken advantage of in your leg routine. It is also a great glute/hamstring workout if done correctly. It is a very functional movement that should be mastered for its use not only in the gym but in our daily lives as well.It is important to keep a wide chest with your shoulders back. Your head should be up and look forward, and your back should be straight. Keeping the feet shoulder width or wider apart, with your knees tracking over your heels.

Lateral Leg Raises- Building up strength in the medial glutes, often neglected muscles, is important in reversing an anterior pelvic tilt along with externally rotated legs. Hip abduction exercises are an effective way in targeting those muscles. Hip abduction is the motion of pressing the legs outward and laterally. Hip abduction is to press outward, while hip adduction is to press inward. Lay straight and on your side, without bending at the waist. Laterally raise your leg straight up to the ceiling. Keep both legs aligned through the whole movement. This helps from breaking form and the hip going into either flexion or extension.