Exercise for low back pain

I often feel like a broken record in my office. For the youths out there a broken record will skip, playing the same soundbite over and over. And over. And over. you get it!

Here are some of the movement and exercise tips that I seem to repeat often:

“The Founder” > Forward Fold.

Many of my patients would rather stretch than exercise. There’s no sweating involved, you can do it anywhere, in any outfit (mostly), and it’s easier. Somewhere in the zeitgeist long ago a forward fold was equated with easing low back pain. There is a small proportion of low back pain that might be improved with a forward fold. For the most part I think something like “the founder”, shown above, is far superior. This is an isometric exercise. This means that you are not actively moving, but your muscles are actively engaged during the activity. Where the forward fold can put pressure on the discs of the low back, the founder uses your own muscles and breath to actively decompress the spine. This not only helps make more space for the nerves being affected, it also reinforces an active core and spinal musculature which will keep things stable, strong, and less painful. FOUNDATION TRAINING

Hip hinge > lumbar bend

These are rules of thumb relating to low back pain and injuries. In general using a hip hinge to bend over and lift is a lot safer. When we hip hinge we use our much bigger and much stronger hip muscles like the glutes. When we lift from the lumbar spine with a rounded back we will use our tiny paraspinal muscles first and then recruit the big dogs. This is a variation of “lift with your legs, not with your back.” This matters with weight lifting and even when we bend over. We are essentially lifting our entire torso up off the ground every time we bend to pick something up.

A caveat: When we are healthy it can be a great practice to engage specific spinal segments in motion and exercise. This helps to promote range of motion and local strength. : Ido Portal is a prime example of these practices. He encourages people to exercise in awkward positions, i.e. do push ups from the back of the wrist, basically training all of our weak areas. That is something to work towards, but not a great place to start coming out of a low back attack.

Low Lunge > Figure 4

Pictured above we see a fairly jacked athlete doing my favorite “low back stretch”. The muscle sketched on is the psoas. It runs from the front of your lumbar spine through your groin to the middle and slight posterior of your upper leg. It’s weird. It’s also filet mignon and tenderloin in meat cut terminology. It gets pretty tight when we sit for too long and encourages some painful postures, one I call the “old man walk”

Trunk Strength > Arm/Leg strength

When it comes to weekend warriors getting back into an exercise program I see a lot of injuries that are the result of weak or disengaged trunk muscles. These muscles are big strong prime movers, think glutes, traps, lats. Also included are core muscles that do a great job of transferring forces during complex motion. This would be our core muscles and anything that connects to the spine. After a long period of being sedentary we can adapt to use arm and leg muscles independent of the prime movers and connectors. This is fine for grabbing a cup of coffee but when it comes to heavy lifting or complicated motion we might get ourselves into trouble. Any exercise can incorporate multiple groups of muscles, which is why I encourage people to work with a trainer or PT when starting a new program. They’re great at helping with proper form and engaging muscle groups you may not even know you have.