- Most low back pain is a result of an overreliance on the low back musculature to perform activities of daily living
- Beware of the diagnosis trap
- The biggest problem of prolonged sitting is abdominal atrophy
- Low Back muscle endurance is a better predictor of low back pain than low back muscle strength
- Decompression in any area of the body requires compression somewhere else
- Decrease stress on the low back muscles by maximizing hip mobility and strength
- The number one postural recommendation for low back pain is to unlock the knees and find your heels
- Low back pain can be driven from non-mechanical causes, one of the most common is poor gut function
- When lifting heavy objects limit spinal motion as much as possible. When living and moving you want to access all of your spinal motion.
- Manipulation which induces motion into the lumbar spine can be helpful, however, that is secondary to reorienting the spine and decreasing the neurological reliance of the low back stabilizers
Most low back pain is a result of an over reliance on the low back musculature to perform activities of daily living
What do I mean by activities of daily living. A lot of low back pain does not occur at the gym, it often happens to people who are just going through their daily activities. Someone could overuse their back just breathing if they don’t know how to utilize their diaphragm, they will overuse their back when walking if they can’t find their heels, they will overuse their back muscles when reaching into a cabinet if they don’t know how to separate their shoulder from their spine.
Overreliance on the low back muscles can occur very easily because it is not that difficult (neurologically speaking) to turn on the muscles of the low back. If you want to produce force quickly, the easiest way to accomplish this task is to hyperextend your low back. If I want to lift something, I need to produce a force into the ground, the easiest way to do this is through low back extension. If I want to hit a golf ball far, I will extend my low back right before impact to induce a systemic stiffness and project force into the ball. There is nothing wrong with these movement strategies. However, if you do not teach your body to spread out force to the other areas of your body, the muscles of the low back will eventually fail.
Hyperextension of the low back is easy neurologically speaking; therefore, you need to work at the opposite to keep the nervous system in balance.
Beware of the Diagnosis Trap
Very often in rehab medicine there is an overreliance on the diagnosis. With low back pain, patients will often get hung up on whether it is a sacroiliac injury, a disc problem, piriformis syndrome, etc. the list goes on and on. There is value in receiving a diagnosis, however, patients and clinicians must avoid the trap of being overly reliant on the diagnosis to guide treatment. Patients and clinicians must remember that a diagnosis is just a name, but it often does little to provide information of the dysfunctional process underlying it. In addition, you never truly know the diagnosis until treatment is attempted.
There are many reasons to be wary of the diagnosis but especially when it relates to low back and pelvic pain. The low back and pelvis are so directly linked that it would be almost impossible to have low back pain without a pelvic issue and vice versa. If there is too much focus on the diagnosis very often there will be an over reliance on addressing one area of the body without integrating other areas.
The most skilled low back practitioners rely on diagnoses of flexion intolerant, extension intolerant, or left AIC pattern. These are examples of dysfunctional patterns of movement rather than a focus on an individual area.
The Biggest Problem of Prolonged Sitting is Abdominal Atrophy
There is no shortage of material that discusses the harms of prolonged sitting. In my opinion, general lack of movement is the biggest health risk to our society, even more than our poor diets. Most online articles that discuss the harms of sitting focus on how the hip flexors will get short and tight. This is somewhat true; however, I think the biggest problem of prolonged sitting is the abdominal atrophy that occurs (in addition to gluteal atrophy).
The main role of the abdominals is to act as muscle of respiration. On exhalation the abdomen should contract driving the diaphragm towards the head and expelling the air out of the lungs. On inhalation the abdomen needs to act in opposition to the diaphragm, creating a cylinder for the diaphragm to pressurize.
Prolonged sitting tends to turn off the primary function of the abdomen. Poor function of the abdominal muscles will result in tight hip flexors and an overreliance on the low back muscles for erect posture. The previous topic mentions the need to be able to spread force throughout the body, if the abdominals do not work it is very difficult to spread out force and spare the low back.
Low Back Muscle Endurance, not Low Back Strength, is the best Predictor of low Back Pain
This is straight from Dr. Stuart McGill’s research. Therefore, it is not the muscle-bound gym rat, who will never get low back pain, in fact quite the opposite is true. This concept is a continuation of the first two principles. If you over rely on the low back muscles, then they will eventually fatigue and lead to low back pain.
Some of the best ways to improve low back endurance, are through side planks, bird dogs, kettlebell swings, and simply walking or jogging.
Decompression in any area of the body requires compression somewhere else
Spinal decompression machines have become very popular in recent years. It makes sense, a lot of people have this sensation of tightness and pressure in their low back, therefore a simple solution would be to pull the low back apart to relieve that stress.
However, this thought process is incorrect. The human body is not really a rigid object, it is actual a fluid container that is capable of shape change. We all possess the superpower ability of shape shifting to some extent. For example, when we lift something heavy it’s not really our muscles acting like this lever and pulley system. The object is elevated because our muscles, nervous system, and connective tissue turning our ball of mush into an incompressible fluid.
Therefore, when you view the body as a fluid container, then you would understand that if any area of your body feels the need to be decompressed than you need to understand that another area of your body needs to be compressed.
In this ever-changing world there is one thing that we can all count on. It has existed before we were here and it will last long after we are gone, this constant never-ending force is GRAVITY.
Therefore, it is a crazy assumption that just because someone can open their spine in a horizontal position with a machine, that they would be able to maintain that decompressed state when they stand up.
This cannot be reiterated enough but to decompress the spine you need to learn how to create compression in other areas of the body.
Decrease stress placed on the low back muscles by maximizing hip mobility and strength
The hips are engineered amazingly well to absorb and produce a tremendous amount of force. The more someone can utilize their hip mobility, then the more they will spare the low back. The low back joints are not intended to rotate; however, the hips are meant to rotate.
Unfortunately, the inability to utilize the hips and the tightness of the low back musculature can be a chicken and egg argument, or even worse a positive feedback loop where each both undesired states will feed off each other.
In general, from a clinical standpoint, it is best to first concentrate on unlocking the low back and then focus on utilizing the entire hip complex.
The number one postural recommendation for low back pain is to unlock the knees and find your heels
In general, you do not want to think about your posture 24/7, you will drive yourself crazy and it’s not worth the brain energy. However, the easiest recommendation for people is to focus on unlocking their knees. If you were place your hands on your low back muscles, you should feel an increase in muscle tone as your knees go from being unlocked to locked. Unlocking the knees is a very simple low back sparing strategy that many people will benefit from. The next time you are in a crowd that is standing, just observe how many people have their knees locked out (it will be a staggeringly high percentage).
The next recommendation goes along with unlocking the knees and that is to find your heels. This means try to shift your body weight from your toes back to your heels. This is first accomplished by unlocking the knees, then if you can almost push your body back and feel your weight center over your heels. If done properly the low back muscles should instantly relax.
Low back pain can be driven from non-mechanical causes, one of the most common is poor gut function
This phenomenon occurs more often than people realize and again this can be a chicken and egg argument. The best way to understand this link between gut function and low back health is to picture what occurs when you are very bloated. A bloated individual has basically turned off their abdominal muscles otherwise they wouldn’t bloat in the first place. We have already covered what happens when the abdominal muscles do not function properly.
In addition, if there is a poor gut function, that will drive poor immune function, which will create inflammation. Excessive inflammation can be a cause of significant pain anywhere in the body but especially in the low back where that area is often over stressed.
When lifting heavy objects limit spinal motion as much as possible. When living and moving you want to utilize all of your spinal motion.
The spine is designed to be mobile, that is why there are so many joints. There are 24 spinal vertebrae, if this area was intended to not have motion, then there wouldn’t be so many spinal segments. However, when lifting heavy objects such as in a squat or deadlift, we want to minimize the amount of spinal motion and maximize the movement around the hips. Before performing these lifts, we want to activate the bracing structure around the spine, in addition to sniffing in some air that pressurizes the abdominal cavity that helps to insure very limited spinal motion.
However, we do not want to move like robots with no spinal motion. Therefore, when not under load, it is best to explore the spinal motion available to us. Spinal waves are a great way to improve your overall spinal motion but more importantly, improve the neurological awareness of our spine. Most people have very little awareness on how to move their spine in specific patterns, by increasing this overall awareness and control, injuries should be reduced.
Manipulation which induces motion into the lumbar spine can be helpful, however, that is secondary to reorienting the spine and decreasing the neurological reliance of the low back stabilizers
Chiropractic manipulation of the low back can be helpful in reducing or preventing low back pain. However, from my experience manipulation should be performed after the pelvis and low back have been repositioned and the neurological reliance on the low back muscles has been reduced.
This is a pet peeve of mine with regards to my profession. Manipulation does not realign or put things back “in”, what manipulation does is induced motion into joints. Putting motion into joints can be extremely helpful in breaking the neurological pattern of tight low back musculature, however, understanding why the low back muscles and joints got tight in the first place is addressing more of the root cause of the problem.