Disclaimer: I’m not a doctor and that if you think you’ve got something going on with your back, you should seek medical/professional help (doctors, physical therapists, etc).

Background

According to NOSS (Neurosurgery, Orthopaedics & Spine Specialists), lower back pain one of the most common ailments in adults in 187

farmer-carry

The Farmer Carry

countries! Given the prevelance of this ailment, there are hundreds of treatment options including; surgery, chiropractic care, pain management, pharmacological intervention or exercise. Since I’m not qualified to speak to the other issues, I’ll give you some of the best tried and true fitness solutions that I use with my fitness training clients to help alleviate lower back pain symptoms within my scope of practice.

Common Causes

I believe that many of the ’causes’ are not events (i.e. shoveling snow) but a chronic problem with acute flare-ups. Just because you are pain-free doesn’t mean that you don’t have a problem. Many of the common causes is chronic muscle dysfunction which then leads to greater pathology like a bulged disc for example. The prime muscles that are usually not working at all or incorrectly are the core muscles (rectus abs, obliques, multifidus, erector spinae, etc) and the glutes (gluteus maximus, gluteus minimus & gluteus medius).

Why Exercise/Movement

  • Just moving-doing everyday activities helps more than bed rest when you’ve got lower back pain (1).
  • Exercise (back extensions) has been found to be slightly better at improving back pain than not doing exercises. Although this research review acknowledges that there are limitations in the measures, subjects and the designs of the studies in trying to compare them all equally (2).

    back-extension

    The back extension hold

  • Those with lower back pain have been found to have greater and quicker fatigue in their lower back muscles and gluteus maximus than healthy controls (3).
  • Research has shown that your ability to hold a back extension for 90 secs helps reduce your risk for injury (4).

All of the following points are related to the lower back musculature and their strength. But let’s not forget about the overall ability to stabilize the spine-not just take it out of flexion and into extension.

How to Fix the Problem

According to Dr. Stu McGill(5) (arguably the world’s foremost expert & researcher on the low back) there are 5 fitness solutions to building a bulletproof back. While the 5th step is more geared for performance, I’ll just focus on the first four steps since this will give the best framework to get out of pain and out of dysfunction.

Remove the Cause of Pain

This is a simple step, but often over-looked. If doing a particular movement hurts when you do it-STOP DOING IT!

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Work on Spinal Stability

This isn’t the crazy stabilization exercises that have somehow gotten a free pass with the golden words of ‘functional’. No, this is not doing crazy exercises while on a Bosu or stability ball. What Dr. McGill means here is spinal bracing, not to be confused with ‘hollowing’. Think of bracing as ‘tightening the corset’. You want to maximize the tension through your trunk and hips (not just isolating your abs) for the particular needs of the movement while still being able to breath. In this phase your goal should be to emphasis the QUALITY of movement and position over the QUANTITY of the time. You should also strive to keep the spine in the strongest yet most tolerable position during your training.

McGill recommends starting with isometrics (like a plank) and hold it for 10 seconds or less. As you slowly build up tolerance and capacity you can increase the reps, not the time. When done correctly, this will be challenging. The problem we see is when you hang out for a long time in a plank, for example, that your form dramatically falls apart the longer you hold it.

Increase endurance

Pallof-press

Pallof Press

After perfected your form and increased the reps, now you can start extending the duration of the isometric. You can also increase the intensity of the exercise. Remember that this is activity/exercise specific. Just because you’ve been able to work on your bird-dogs, doesn’t mean you can jump right to endurance in the plank.

Build strength

This is just another progression from the previous step. An easy way to think about this is increasing the intensity. This could be increasing the weight of a farmer carry, or increasing the weight/tension of a Pallof press. Once again, one of the key tenets is to minimize the movement of the spinal joints (i.e. excessive flexing).

Exercises to Try

Rather than say try all of these, I’d recommend starting with the first exercise and continue based on your tolerance and ability to maintain PERFECT form and execution.

  1. Bracing on back (knees bent)
  2. Bird dog
  3. Plank/side plank
  4. Back extension
  5. Pallof press or Farmer carry

Summary

  • Brace the spine by tightening all the core muscles including hips
  • Build up your reps not your duration of isometrics in the beginning
  • Work on exercises that spare the joints of the back like doing isometrics such as planks and farmer carries

References

1. http://www.nejm.org/doi/full/10.1056/NEJM199502093320602

2. Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD000335. DOI: 10.1002/14651858.CD000335.pub2.

3. Kankaanpää, Markku et al. Back and hip extensor fatigability in chronic low back pain patients and controls. Archives of Physical Medicine and Rehabilitation, Vol 79, Issue 4, 412-417

4.Kankaanpää, Markku et al. The Efficacy of Active Rehabilitation in Chronic Low Back Pain. Spine Journal, Vol 24, Issue 10, 1034-1042

5. http://www.backfitpro.com/pdf/selecting_back_exercises.pdf

6. http://www.backfitpro.com/pdf/Enhancing_back_performance_with_super_stiffness.pdf