Self Care of Lower Back Pain: Part 4

Self Care of Lower Back Pain: Part 4

Part 4: Self Care of Lower Back Pain

The purpose of this article is to discuss some of the self-care practices that can prevent or address lower back pain. Lower back pain is not a general condition but has many specific potential sources that cannot all be addressed in this article. This article will discuss self-myofascial release

(foam rolling) for maintaining tissue health and Stuart McGill’s Big 3 exercises for building a strong, well-rounded core.

Self-myofascial release (SMR):

SMR is essentially the poor man’s massage. Massages are great for releasing knots and reducing creep. Creep is the low stretching of muscle beyond their normal length that can come from slouching. Mike Boyle explains creep as slowly pressing your fist through a plastic bag. If you don’t apply too much pressure, the bag will stretch and retain that stretched length. Slouching does the same thing for the lower back. The muscles and connective tissue of the lumbar spine are slowly stretched a lengthen and become denser. It was found that slouching as little as 20 minutes a day causes the ligaments of the lower back to lengthen (Boyle). The end result is lower quality muscles. SMR is especially important for the back side of your body because it reduces creep.

Importantly, SMR is perhaps the only area of strength and conditioning where “no pain, no gain” is actually true. For any SMR movement, roll out at a rate of about 1 inch per second and when you find a sensitive area hold that position while taking 3-5 deep breaths. The targeted muscle should be relaxed while rolling. If the muscle is flexed, transition to a softer tool.

Foam Roller Piriformis

The piriformis is an area I roll out daily. Put a foam roller, tennis ball, or lacrosse ball on the ground and sit down on it so pressure is applied against the butt cheek. You are looking for sensitive areas where the back pocket of your pants would be located. Check out the video below!

https://www.youtube.com/watch?v=sRNInSb4xg0

Other areas I like to focus on during SMR are my thoracic spine, levators, traps, quadriceps, and IT band. Below is a link to Prevail’s Self Myofascial Release YouTube playlist.

Self Myofascial Release Playlist

Stuart McGill’s Big 3

Stuart McGill is one of the leading lower back pain researchers. If you would like more information on lower back pain, his articles are very highly regarded in the strength and conditioning community (Here is a great summary article on his system). McGill’s Big 3 movements are core exercises that increase core stability without risking your spinal health. They aren’t the movements you’ll see in the latest YouTube video on getting 6 six-pack abs or a slimmer waist, but they have the potential to build a healthier, more resilient torso.

Curl to Neutral (curl up)

The curl to neutral is similar to a sit up except the lower back stays on the ground. The purpose of the movement is to train the abs without straining the lower back like sit ups.

Side Bridge

The core is never really a massive generator of force. For most functional movements, it just transfers force generated by the lower body to the upper body. Thus, the core should be trained to remain rigid against extension and rotation. The side plank trains the core to remain rigid when a lateral force is applied. During the movement, everything should be flexed especially the hips, core, and lat of the bottom arm. For this movement, it is important that the entire body remains straight (including the neck) and that the top shoulder stays back.

Quadruped Position (Bird Dog)

The quadruped position is an anti-extension and anti-rotation movement. The user has to keep themselves from letting their back arch and stay balanced as their leg moves.

There are many progressions for each of McGill’s Big 3 movements depending on factors including goals, training history, injuries, and mobility limitations. Check out Prevail’s Torso Training playlist for a run through the different variations!

Torso Training Playlist

Alright! That sums up this series on lower back pain. If you read all 4 parts I am very thankful you stuck with it. I hope this information has been informative and useful. I’ve got your back! Get it?

Reference:

Stuart McGill’s Big 3

Causes and Prevention of LBP From Poor Posture Part III:

Part III: Causes and prevention of LBP from poor posture

Screenshot 2017-08-22 11.48.53The purpose of this article is to discuss the causes and prevention of lower back pain that comes from poor sitting and standing posture. There are many ways LBP can develop from slouching and this article will focus on one source and attempt to provide an understanding of common motifs on how the body works. In Part II of this series, I talked a lot about the role of hip mobility restrictions in LBP and in this article I will focus on the role of the thoracic spine. Figure source

It would be helpful to read the previous parts of this series (especially Part I):

Part I: Introduction to the Anatomy and Physiology of Lower Back Pain

Part II: Causes and Prevention of Lower Back Pain in Athletes

The thoracic spine

The thoracic spine are the middle 12 vertebrae that mostly run along the rib cage. When Screenshot 2017-08-22 11.49.02we slouch, the thoracic spine bends forward, putting more stress on the lower back and pushing the neck and head forward. This can lead to LBP and headaches (Alexander). Figure source

Only so many bends before it breaks

The spine is a collection of versatile joints that can generate mobility and stiffness while withstanding high compression forces. Unfortunately, the stress placed on the spine means that it is vulnerable to fatigue, and later, pain. A large portion of the prevention of LBP is respecting the fatigue lifespan of the spine by reducing the number of flexions that put the spine in a vulnerable position (McGill). Patients who repeat the flexion events that aggravate their pain, such as sitting, set themselves up for worsening pain. Degeneration of the spine is completely normal, but good posture can be the difference between getting LBP now or later.

Joint by joint perspective revisited

The thoracic spine is especially relevant to the lower back because it is the joint directly above the lumbar spine. In Part II, we discussed the joint by joint perspective of training where the lower back primarily needs to provide stability while the hips and thoracic spine should provide mobility (Rusin). The hunched over position during sitting tightens the thoracic spine, which compromises our ability to maintain a good posture (Alexander).

Improving thoracic spine mobility

The press up is a valuable corrective movement that moves the user in back extension. The press up keeps the user away from flexion and counteracts the poor posture most of us assume when sitting. The bend in the spine should be distributed throughout the spine (the lower back does not articulate that much in this plane). The glutes should be relaxed. If practical, doing work while in the press up position (supported by elbows) can be helpful!

VIDEO: https://www.youtube.com/watch?v=G2CsgK9BNaI

Furthermore, stretching the thoracic spine through multiple planes of motion is also beneficial. A lying spinal rotation stretch can help the thoracic spine improve its mobility. For the spinal rotation it is important to remember the emphasis is on the thoracic spine. The lumbar spine only has a rotational range of motion of 13 degrees and most people have decent lumbar mobility. The shoulder should be placed on the ground before the hips are rotated and the emphasis is on the twisting in the chest.

Video: https://www.youtube.com/watch?v=Jplj_fe11sI

Misconception Correction: Some stretches are bad for LBP

A pillar of the prevention of future LBP is removing the movement that causes pain. For most people this movement is flexion. Oddly, some LBP patients stretch their spine by curling up and pulling their knees into their chest. This reduces their pain because it activates stretch receptors in the lower back muscles, but sets the patient up for worse future pain. The stretch is a flexion event that will trigger the pain mechanism they suffer from. Beware of stretches that are quick fixes to pain.

Tune in next time for a discussion on the self-care of LBP! It will be a more practical article with a healthy array of foam rolling and corrective exercises.

Part II: Fundamentals of Lower Back Pain in Athletes

Part II: Fundamentals of Lower Back Pain in Athletes

This article is on the causes and prevention of lower back pain (LBP) in athletes. LBP can result from several different kinds of causes that cannot all be addressed in a single article. My goal for this article is to provide a foundational understanding of the motifs that can contribute to LBP.

See Part I here

Prevention is the most important component of keeping your back pain-free. The best predictor of a new injury is a previous injury. One of the founders of chiropractics, B.J. Palmer, said: “The preservation of health is easier than the cure of the disease” (Palmer). For this reason, time invested in prevention will yield more benefit than time spent on rehabilitating an injury that could have been avoided.

Back pain may not be rooted in back issues. When looking at the primary needs of our joints beginning at the ankles and ascending to the shoulders they alternate between needing mobility and stability work (see table).

Joint Primary Training Needs
Ankle mobility
Knee stability
Hip mobility
Lumbar Spine stability
T-Spine mobility
Shoulder stability
(Boyle, 2007)

The alternating pattern comes from observations that joints like the ankle have a tendency to become stiff and need additional mobility work, while joints like the shoulder have a tendency to move sloppily and need stability work (Cook). Most people have good mobility in their lower back but are poor at maintaining its stability.

The significance of the alternating pattern is that a deficit in the primary needs of the joints immediately above and below lumbar back forces the spine to compromise its ability to stabilize (Boyle, 2007). A lack of hip mobility is a common cause of LBP because it forces the lumbar spine to compensate by providing mobility. The lower back cannot provide maximal mobility and stability in the same moment.

When these errant patterns are repeated and become habits, it becomes more difficult to engage the hips without also losing a neutral spine position. A joint by joint view of training suggests that the early signs of LBP may reflect inactive hips and preventative work may be best focused on joints above and below the lower back.

The Cook Lift is a good test of whether an athlete activates their lower back when they engage their hips. Here is a video of the Cook Lift demonstrated by Prevail Chief Operations Officer Peter Blumert!

A good progression for the Cook Lift is a set of 8, then 10, then 12 reps.

The cause of back pain results from cumulative trauma rather than a singular event.

LBP originates from thousands of flexions of the lumbar spine which causes disc herniation at a microscopic level through nucleation and delamination (Tampier et al., 2007; McGill, 2010). These preceding events occur without giving athletes an indication a future injury is looming. An important idea is that the lumbar spine only has so many bends before it breaks (McGill, 2014). Use them wisely for essential everyday activities instead of sit-ups that place a large load on intervertebral disks (Reynolds, 2009). Simply substituting the curl-up for the sit-up takes a lot of the stress out of the back.

Movement quality and endurance are the keys to preventing LBP.

Between strength, endurance, mobility, and movement patterns, the quality of the movement patterns appears to be the most significant difference between patients with lower back injuries and asymptomatic controls (McGill, 2014). Patients with LBP lift more with their back causing unnecessary lumbar flexions. A common flawed movement pattern involves “gluteal amnesia” where athletes present with tight hips, hamstrings, and hip flexors and do not activate their glute complex to the necessary degree (McGill, 2007). These patients often do not improve with typical therapy methods because general back pain programs do not focus on developing the hips. Furthermore, the endurance of the lower back is more critical than its strength because the technique is more likely to breakdown after several, light movements compared to a few heavier ones (McGill, 2007).

Misconception correction:

Balance is not stability. YouTube and gyms everywhere have a population of lifters that rely on the Bosu ball (half ball) and fitness ball for their workouts. Their core argument (get it?) is that the instability of the ball provides more stability training than traditional lifts. Squatting, pressing, and rowing on the Bosu ball improves balance but does not improve spine stability (McGill, 2014). Instead, spinal stability is improved by practicing stiffening the core to allow the force to be transferred through it more effectively. Practice abdominal bracing during your big lifts to improve your core stability.

Our next article will discuss lower back pain developed from sitting and standing.

Further Reading:

A Joint-by-Joint Approach to Training

Designing Back Exercise: from Rehabilitation to Enhancing Performance

Lower Back Disorders, 2nd Edition

Prevail Conditioning