5 best strategies to manage low back pain.
Time to get rid of your back pain for good.
Low back pain (LBP) is common. Way too common. Treating it is difficult as there are often many factors contributing to your pain. The strategies I am going to share are meant to improve your situation. At worst, they should do nothing, meaning they will not make it worse.
All of the strategies will have multiple videos to help guide you through the process. These are strategies I have used with both clients and patients to not just manage but ultimately resolve their LBP.
I am going to go over each in more detail, but the 5 strategies are:
Supine deloading - you will also learn how to deload in sitting and standing
Core stabilization - you will learn about Core Stabilization. It’s not so much what you do but HOW you do it
Glute exercises - in general, when your glutes are strong there are fewer issues with your knees and low back
Hip mobility - when your hips are tight, there tends to be more movement through your low back to compensate
Hip hinge - you will learn how to properly hinge through your hips. Poor awareness and understanding of how to properly bend at the hips will routinely flare up your back
While I cannot guarantee these will resolve your LBP, I have had great success using these strategies to resolve LBP with my clients and patients.
The one commonality to those that did well? They did their homework!
If you do not follow the plan, it can’t work. This is true of any rehab plan, training program or nutrition strategy. You have to be willing to put the time in and change HOW YOU DO THINGS.
1. Lumbar spine deloading
Tightness in the low back is something most people have experienced. Why your back is tight varies a great deal. Often, tightness in your low back has nothing to do with the low back. The low back is more of the symptom than the problem.
A better solution to stretching your low back
In many cases, stretching your tight low back makes symptoms worse. Basically, the tightness is caused by muscle spasms due to instability (or too much unchecked movement) in your back, not actual tightness.
This perceived tightness causes you to stretch the back. Typical back stretches will stretch your muscles and calm the spasm. But, the same stretches can also stretch the ligaments that attach each vertebrae to one another in your spine.
Ligaments are meant to provide stability in the body. That is their job no matter what part of the body they are in. Once stretched, they provide less stability.
So now, you have removed the spasm that was there in an attempt to provide stability and made things more unstable and more likely to become irritated with basic movements, nevermind exercise.
Enter, the lumbar deload.
Deloading your spine gets you relief from certain types of back pain and it is a better way to "stretch" the back. It allows you to maintain a neutral spine position and can help you calm some of the spasms in your low back.
Deloading can help manage some acute LBP that has nerve-related symptoms. However, if you have acute back pain, go get checked out by a qualified clinician instead of using the internet.
Remember, these should make you feel better, not worse. If you feel pain while trying it, STOP immediately. Work on being deliberate. Slow and controlled works best for this technique.
Supine deload
Seated deload
Standing deload
2. Core stabilization
Core stabilization (CS) really starts to get to the root of the actual problem for MOST types of back pain. This won't fix all back pain but about 99% of you can benefit from these strategies. Even if the pain has a different origin, most people can benefit from improved lumbar spine positional awareness and ab strength/endurance.
The devil is in the details when it comes to doing these movements properly. They are simple but not easy.
You have to focus on your setup and pay attention to what you are 'feeling' while doing the movements. If you are laying on the floor, flailing around while you think about other things, you are wasting your time and your back will not be any better off.
If however, you focus on being DELIBERATE with your movements then there are huge benefits you can gain from these movements.
Without going off on a tangent, most back pain has some component of instability. Basically, the vertebrae in the low back move too much. They need STABILITY, not more stretching and MOBILITY.
Your abdominals primary job in the body is to stabilize the low back. Let that be your main focus when performing these movements.
Your setup for each movement will be the same. Arch your back away from the floor as far as you can go. Flatten the back all the way to the floor. As you do each, pay attention to how your back responds to each extreme.
Most people tend to feel better when their low back is flatter. When you stand for prolonged periods of time, when your abs are weak or when you fatigue during many exercises, the back arches more. Sometimes just standing too long with poor awareness can irritate your back.
Where was I? Oh right. Arch your back up as far as you can go. Flatten your back all the way to the floor. Let your back arch a little bit from the floor. It is not an exact point and will take time for you to find your best position.
Once your position is set, brace the abs. Think about someone coming up to punch you in the stomach and you are bracing for impact. Let this be your focus as you perform the stabilization movements, not the actual leg and arm movement. The abs should hold this position while you perform the arm or leg movements. Like I said, simple, just not easy.
Initially, keep your sets brief. Only perform 2-5 reps per side. You need to manage fatigue and improve motor control. This is best done with intense focus and brief, but more frequent, sets. Think 10 sets of 3 instead of 3 sets of 10.
You will get the same amount of volume but your quality of the reps will be different when you only perform sets of 3 reps. This is a great strategy, in general, when you are dealing with pain or coming back from an injury.
This video is longer and goes into more detail.
The videos below are brief and just show each of the core stabilization movements. These are best used as a quick review after you have watched the longer video.
Brace and march
Brace w/ alternating flye
Brace w/ arms overhead
3. Glute exercises
Your glutes (butt muscles) are big muscles. They need to be strong. In most cases of LBP, they are incredibly weak. This weakness, coupled with other issues that we will discuss later, feed into back pain by leading to compensatory movements and relying on the wrong muscles to do work the glutes should be doing.
When your glutes are strong and are trained appropriately, you will tend to has less knee pain and LBP. The glutes are big, strong muscles and they need to be worked hard. Get your mind out of the gutter.
If you have chronic LBP typically, the glutes that are weak and don't seem to work like they are supposed to. It's some sort of ass dysfunction #assdysfunction.
Bridge better to have less back pain
A simple, but very telling test, is to perform a bridge. When you bridge, do you feel a lot of pulling (sometimes cramping) in the hamstrings? Do you feel pulling and pain in their knees? Do you feel low back pain as soon as you come off the ground?
With proper coaching, and limiting the range of motion at first, you can learn how to bridge the right way without pain.
When your body has a dysfunctional movement at a joint, it is dysfunctional every time it moves. More complex movements will make this more apparent, but it is there even with simpler movements.
When you bridge, you move from a position where your hips are flexed to a position where they are extended. This movement, as far as the hip is concerned, is the same during a bridge as it is when doing a squat, deadlift, or lunge.
Master the bridge with no pain and it helps you transition to the other movements.
Let’s punch your glutes in the mouth
Make sure before you try any of these exercises that you become proficient in the core stabilization movements. YOU MUST BE ABLE TO STABILIZE THE BACK WHILE DOING ALL EXERCISES.
This is kind of a big deal which is why it's in all caps. You should not feel anything in your low back while performing any of the exercises below. Absolutely nothing. If you do, you are doing them wrong. Sorry, this is just the reality of the situation.
Focus on bracing before you move. and maintaining the brace while you move. This idea is not easy but it is necessary to get you out of pain.
If you can perform these with the core stabilization, you on your way to managing your LBP.
4. Hip mobility
When your hips move so does your low back. The two are intrinsically linked. When you arch your back or flatten it against the floor, this is done by rotating the hips and pelvis.
So, when your hips can't or don't move, your low back is often asked to move more to take up what the hips are not doing. This adds additional stress to your low back that is already hypersensitive. This is not a good situation.
There are a lot of muscles passing on all sides of your hip and they can be tight for different reasons.
A common mistake is stretching one part of the body at the expense of another. This is dumb. It doesn't mean you're dumb. You might be, but many times smart people do dumb things without realizing it.
You may try to stretch the hip flexor but just stretch and irritate the anterior capsule of the hip. Or maybe you try to stretch the hamstrings and end up stretching your sciatic nerve instead.
Neither one of the situations is beneficial to you but both are incredibly common mistakes made when trying to stretch the hip flexors or hamstrings. Don’t worry. I am going to show you how to do both, properly.
You need to focus on maintaining a neutral spine position while you stretch. Otherwise, that stretch to improve hip mobility is now irritating your low back. If you can find a way that it makes sense to irritate the back (which is already irritated) to stretch the hip, please share it with me. I love learning new things.
Remember that all stretching should be mild to moderate in intensity. You should be able to breathe, relax or talk while stretching. If your stretch is too intense, your body can reflexively contract muscles you are trying to stretch. And for the record, stretching contracting muscles doesn’t work very well.
5. Hip hinge
The hip hinge takes the previous lessons and ties everything together. It's like the rug in the Big Lebowski. It really tied the room together.
Why are you still dealing with back pain, man?
The hip hinge is pivoting at your hip joint to move. Sounds pretty easy. This movement, combined with the other lessons, can take months to perfect and make pain-free. Know this and don't expect chronic LBP to resolve over the weekend.
You first need to be able to locate and stabilize a neutral low back position. Working on your butt (exercises) will allow you to use the glutes to create and control the movement while your low back, hamstrings, and quads remain less active.
Your improved hip mobility will allow this motion to happen at the hip joint, not the low back. Each lesson was built upon the previous lesson. You just got Miyagied.
If you are too young to get the reference, basically Mr. Miyagi gets Daniel to do a bunch of chores around his house. Daniel gets pissed because he wanted to learn karate. But after sprucing up Miyagi’s crib, Danielson now was a karate master. He was patient zero for getting Miyagied.
Again, these movements must be performed without any increased pain. If your pain spikes, it means you lost position or are performing some part of the movement incorrectly.
Start with partial range of motion movements. If these are pain-free, move a little more. DO NOT forget the earlier lessons when performing the hip hinge, especially the BRACING.
Back pain sucks. Depending on which studies you look at, somewhere around 90% of people will suffer at least 1 debilitating episode of LBP. That means it is more than just a little tightness.
If you follow these strategies, you too can get out of pain.
For those of you reading this that do not have pain. DO NOT wait until you hurt to incorporate these strategies. They will not prevent you from being strong and fit. These strategies often enhance lifts as you are better able to create total-body tension when lifting. They will also help you stay out of pain.
Do not go it alone
If this seems overwhelming and feels like it is something you cannot tackle on your own, don’t.
If you are tired of being in pain, let’s discuss a customized plan that gets you out of pain and back to living life to the fullest.
You need a customize plan to address not just your back, but you as a person.
You need a plan that is actionable and fits into your life.
You need someone to check your technique to make sure you are doing the exercise properly.
You need someone who has helped hundreds of clients/patients resolve their LBP.