We’ve all had it happen at some point in our lives. You move a weird way, you sneeze, you sleep in the wrong position, you bend over to pick something up or put on your sock and WHACK – you hurt your back!
No injury seems as debilitating as an injury to the back. It affects nearly everything you do: from walking, to sitting, to sleeping, everything. When you hurt your back, you’re just simply miserable. While there are a number of different causes to lower back pain (LBP), there are some evidence-based exercise methods that could make it a thing of the past. To understand what these methods are, you must expand what it means to train your “core.”
Prevalence Lower Back Pain
According to the World Health Organization an estimated 619 million people live with LBP, and it is the leading cause of disability worldwide. Recent data from the Centers for Disease Control and Prevention notes that 39% of American adults suffered from LBP in the last three months. It seems that regardless of the metric you look at, LBP is greatly affecting the lives of many people.
Causes & Types of Lower Back Pain
While it’s clear that LBP affects many people, what’s less clear is the cause. Determining the underlying cause(s) of an injury or pain is inherently complex. In fact, the biopsychosocial model of pain suggests that how we perceive pain is more than just biology and anatomy. Indeed, there are psychological, emotional, and social influences on how we perceive pain.
Getting into all of the nuances of the complexity of pain isn’t really necessary for this article. It’s just important to underscore that determining the precise cause of pain is challenging. To that end, don’t expect a clear cut answer as to what’s causing your LBP in this article, as that cause is elusive, at best. Even the American Association of Neurological Surgeons notes that causes of LBP are multifactorial, some common causes are list below, however this is not an exhaustive list:
- Sprains & Strains
- Traumatic Injury
- Fracture
- Herniated Disc
- Sciatica
- Lumbar Spinal Stenosis
- Osteoarthritis
- Scoliosis
Sprains, strains, traumatic injury, fracture all fall under what I consider acute injury. For all of these causes advanced and aggressive medical care is required. In this case you should consult with your physician first. Herniation, sciatica, stenosis, arthritis, and scoliosis are more chronic causes, manifesting themselves over a longer time horizon.
In the case of the chronic causes, symptoms may flare up that makes things feel more acute, but the underlying issue has been bubbling for some time. These chronic issues typically result in pain coming and going. While they do require treatment, and a qualified medical professional should be involved, in non-extreme cases care isn’t as aggressive or advanced.
It is the chronic pain, as well as just generalized (lower-level or subclinical) LBP that could respond well to training the real “core” muscles in a very systematic way. Before doing so, it’s important to check with a qualified medical provider to determine what’s appropriate. This is particularly true if you’re experiencing neurogenic pain, which is normally characterized by numbness, tingling, radiating pain localized to the lower back or radiating down the legs.
Redefining “Core” relative to Lower Back Pain
Somewhere along the way the exercise community confused a lot of people with how they talked about core. You might be one of those people, and I’m sorry if we confused you. On some level so-called “exercise professionals,” have attached training your core to simply your training rectus abdominus muscles (think the 6- or 8-pack muscles). I largely think this is borne out of the aesthetic desire to have a “ripped” midsection. Fitness and exercise professionals have done this alot, conflating exercise that should help us function better with exercise in an attempt to look “better” (“better” in quotes because I have no idea whose standard of better we’re trying to live up to).
For this discussion let’s disassociate the notion that we’re training our core to look better. Unless, of course, you consider not being hunched over in back pain all day to be not so good looking. If that’s the case, then the core we’re talking about might be just the thing to keep you upright and out of pain – that sounds pretty good looking to me!
As an exercise physiologist, when I think of core and what it does, I have a much more expanded point of view. In my mind, the core musculature is responsible for stabilizing the pelvis, spine, and shoulder blades in the right position. This right position allows us to maintain proper posture (while sitting, standing, lifting, walking and so on), it also puts our “core” muscles in the best positions to produce force. Finally it aids in putting all of our bones and other connective tissue in the best, least injurious, positions to accommodate force. The net effect of all of this can be greater functional capacity and strength, and hopefully reduced risk of injury as a result of LBP.
Now when you hear me say pelvic, spine, and shoulder blades it probably becomes clear pretty quick we’re talking about many, many muscles here (not just “6-pack abs”). Below is a list of the most critical muscles involved in posture (click on the links if you’d like to learn more about each muscle):
- Gluteus Maximus
- Gluteus Medius
- Hip Adductors
- Quadratus Lumborum
- Erector Spinae
- Internal Obliques
- Transversus Abdominis
- Multifidus
- Mid/Lower Trapezius
- Rhomboids
- Rotator Cuff
- Hip Flexors
- Hamstrings
- Pectoralis Major
You will notice muscles like the rectus abdominis and the external oblique are missing from the list above. Although developing those muscles (along with lower level of body fat in the midsection) might make your “core” look better, they won’t necessarily make it any more stable or any less prone to injury and LBP.
I’ve also listed the muscles in a specific order. The list starts with muscles that should be strengthened and ends with muscles that need to be stretched. I’ll explain more below on why we’re talking both in terms of strengthening and stretching, but the transition point in the list is the rotator cuff. The external rotator cuff (Infraspinatus and Teres Minor) muscles need to be strengthened and the internal rotator cuff muscles (Supraspinatus and Subscapularis) need to be stretched to assist in shoulder blade stability and posture.
Since I’ve mentioned posture quite a bit, we need to discuss what proper posture is, review why it’s important, and talk about how modern daily life wreaks havoc on good posture.
Role of Posture in Lower Back Pain
Proper posture (see picture) allows for primarily three important things with regard to LBP:
- Muscles, bones, and connective tissue being in positions to tolerate the mechanical forces put on the body during life.
- Optimal positioning for lifting and moving objects.
- Minimal stress on weak links in the chain. Said another way, you could consider these areas of the body that can’t tolerate load and stress quite as well.
All the muscles I listed above are associated with achieving and maintaining proper posture. One of the hallmarks of proper posture is that the body is in extension. Legs are extended, back is extended, head and neck are extended. When this happens, many of the muscles in that list above are contracting at a low level to keep us in that position.
You don’t have to be a biomechanist to realize we don’t expend a lot of time in extension. In fact, most of our time is spent in flexion (see picture). We’re in this position at our desks, in our cars, at home. It’s safe to say more of our time during the day is spent in flexed posture than extended posture. When that happens these muscles get progressively weak:
- Gluteus Maximus
- Gluteus Medius
- Hip Adductors
- Quadratus Lumborum
- Erector Spinae
- Internal Obliques
- Transversus Abdominis
- Multifidus
- Mid/Lower Trapezius
- Rhomboids
- External Rotator Cuff
These muscles get progressively tight:
- Internal Rotator Cuff
- Hip Flexors
- Hamstrings
- Pectoralis Major
What’s interesting is that weakness contributes to tightness and tightness contributes to weakness due to a physiological principle called reciprocal inhibition. Although this might sound complicated, I think I can make it understandable with a simple example.
If you were going to drink your coffee, you’d contract your biceps and the anterior (front part of your) shoulder to bring the cup to your mouth. In order to produce that movement in a smooth, fluid, fashion you’d want the muscles that oppose those actions (the triceps and the posterior shoulder to relax). Low and behold that’s exactly what happens and produce fluid movement to get that all important jolt of caffeine into your body. Essentially, the nerve signal that tells muscles on one side of the joint to contract, tells the muscles on the other side of the joint to relax. Great for fluid movement, bad for posture.
As we sit our hamstrings, hip flexors, pectorals and internal rotator cuff muscles shorten and tighten, causing all the muscles that oppose them (the extensor muscles) to weaken. Tightness drives more weakness, and more weakness drives more tightness. It’s a vicious cycle that takes out of healthy extension posture and into less healthy flexion posture.
Five Ways to Train Your Core to Reduce Lower Back Pain
Enough the anatomy lesson, time to give you five exercises to train our core muscles and reduce LBP.
Exercise 1: Proper Seated & Standing Posture
You might not think of proper posture as an exercise per se, but given how rarely most of us maintain proper posture (i.e., extension), you’ll find pretty quickly that these postural muscles are quite deconditioned. Trying to spend as much time during your day in proper posture is the first, and most effective, way to train your core.
Exercise 2: Planks
Whether modified (on your knees) or standard, planks when done right strengthen many of the deep core muscles that keep the pelvis and spine stabilized. Be sure to pull your bellybutton into your spine when doing the plank as this activates important core muscles for stability.
Exercise 3: Superman’s
This movement is the superhero of extension exercises. When lifting into the superman position nearly all the extensor muscles on the back side of your body activate (literally from head to toe). Be sure to squeeze your butt cheeks together and pinch your shoulder blades as you’re extending upwards.
Exercise 4: Hip Flexor Stretch
These muscles are chronically tight, since we’re sitting all day long in hip flexion. Using an active isolated hip flexor stretch is the best way to go. Improving flexibility in the hip flexor muscles will align the pelvis better and put the glutes in a better position to contract.
Exercise 5: Wall Pec Stretch
We can’t ignore the upper body. What happens to the upper part of the spine, affects the lower back. Tight shoulders and pecs round and weaken the upper back, which then rounds and weakens the lower back, increasing the risk of LBP.
Putting It All Together – “Core” Strengthening for Lower Back Pain
Here’s a simple workout incorporating all of those exercises above (except for proper seated and standing posture, that is an all the time thing). Do this workout 1-3 times per week:
You don’t have to suffer from LBP anymore. You can take control of your lower back health, just by expanding your definition of core, focusing on proper posture, and doing the exercises recommended above. At Applied Fitness Solutions, we’re here to help you on your journey to better health. Reach out today to chat with one of nationally certified fitness coaches – we’re here for you!