Lower back pain has seem to become an inevitable part of growing old. However, it does not have to be that way. If we look at some of the most prevalent causes of back pain and why many of the common solutions don’t deliver results, we can hope to prevent and, in the cases of preexisting back pain, manage the symptoms.
In this article I’m going to speak about my personal experience with lower back pain, more specifically a herniated disc. I will address what caused this injury and why it took so long for me to correct. I will also talk about the treatment methods that made it worse, made no difference and ultimately made it better.
When you hear back pain, most people think older individuals. So why is back pain so common, and why does it seem so hard to fix? In many cases back pain is due to a repetitive use problem. Doing something incorrectly over a long period of time leads to the pain. In some instances, it can be the “straw that broke the camel’s back,” but it only got to that point from years of incorrect movement. When the body moves as it is designed to, no additional stress is placed on joints, ligaments, and vertebrae. However, in the all to common case of incorrect movement, additional stress is placed on other parts of the body. Arguably the most important area of the body is the hips. Inability to hinge or rotate the hips leads to lumbar flexion (lower back rounding) and increased pressure on the discs between each vertebrae. The discs between the vertebrae in the spine act as shock absorbers and healthy discs allow pain free movement. However, when the discs are continually stressed and pressure is put on them, they begin to wear down. A majority of back pain issues can be attributed to disc issues…. bulging discs, herniated discs, etc. This is because the vertebrae lie so close to the nerves that run into your back and/or down into your legs and toes. A common complaint of someone with disc issues may be sciatic pain, numbness or tingling.
In the world of athletics and strength and conditioning, back pain can be a common injury. In heavy resistance or high impact sports, it may only take one time to cause an injury to the back. While it is hard to control an uncontrolled environment such as sport, the training should address the potential for these injuries and avoid unnecessarily putting an athlete in harms way. Young athletes typically are motivated by lifting heavy weights, with little attention is given to detail. Some can get away with it (for a while) and others cannot. Weight training should be a way of testing ideal movement against resistance. You should strive to either maintain the mechanics and increase the resistance or increase the mechanics and maintain the resistance. Proper lifting mechanics should never be compromised. By teaching and making correct movement patterns in the gym, it will carry over to everyday life and in sport as well. The gym should be viewed as a placed to learn how to move and train the muscle responsible for those movements.
As a prior back pain sufferer, I know the amount of pain and discomfort it can cause. My certain instance was due to lack of stability through my core (unable to breathe into my diaphragm to support my lower back) and inability to properly hinge through my hips. The lumbar flexion coupled with lack of support led to a posterior disc herniation. I had done the exercise I was performing (barbell rows) many times before that day, but in my case it was “the straw that broke the camel’s back”. I felt a sharp pain followed by my lower back getting extremely tight over the next 72 hours. This later led to constant nagging pain, extreme tightness, lack of mobility and inability to exercise or practice. Injuries to the lower back in most cases effect more than just the back itself. Your gait is changed, you compromise for a vulnerable area, and you begin to develop other issues as a result. In my case, I developed ankle pain, glute tightness, and over time slight loss of normal spinal curvature from being fixed in such a tight position constantly. I underwent many treatment methods but it wasn’t until roughly 2 years later that I noticed some substantial results.
Following my injury I did electrical stimulation treatments to relax the tight muscles, ice therapy, NSAIDs for inflammation, cortisol shots to help the pain, took time off from working out and playing sports…and none of it worked. Looking back, it’s no wonder none of it worked. Every one of those methods of treatment were addressing superficial issues. I then went on to foam rolling, lacrosse ball therapy, stretching, and yoga. Again little to no success. Although getting a bit closer to the root cause, these methods still looked to manage the symptoms. It wasn’t until I learned about correct movement of the human body and ideal stabilization and support that I was able to rid myself the pain and keep it away for good. Two key factors in my healing process were first, Becoming A Supple Leopard by Kelly Starrett and second, Dynamic Neuromuscular Stabilization (DNS). Becoming A Supple Leopard was my first exposure to how the body should move correctly. Specific rehab and mobility drills with instruction of how to perform, what to feel, and signs of doing it incorrectly really sped up my recovery process. I also incorporated superficial methods such as lacrosse ball and foam rolling, but noticed the tightness didn’t return like it use to because I had now begun to move correctly and had fewer symptoms as a results. Then, a couple years later, I was exposed to DNS. DNS got to the core of every issue and gave me a more detailed perspective on correctly breathing, stabilization and joint centration. The two combined proved to be a powerful rehab program, one that covered all aspects.
So what should you to avoid future back problems and to manage or fix current issues you may be having? Before beginning any strenuous program, whether it’s strength and conditioning or a rehabilitation program, you must first master the fundamentals and basics. This means start with learning how to breath into your diaphragm. Only when breathing is done correctly can you have ideal support throughout your body. Once breathing is sufficient, performing movements correctly is the next step. If you do something incorrectly, it will do more harm than good. If you do it correctly, the results and therapeutic benefits will occur. You may need to eliminate certain movements (such as a deadlift or barbell back squat) initially, but this should only take place when you are trying to eliminate the pain from the initial injury. You health and progress will be determined by the number of correct movements you can perform. This means you should be including rotation, anti-rotation, axial loading, supine, ipslilateral, contralateral, and any and every movement to develop efficient pain free movement in all planes. My personal favorite exercises (once I had gotten over the initial pain management period) are the modified McKenzie Press, anti-rotation cable pulley, modified back extensions, and any exercise that causes excess stress on the body without excessive axial loading (sled pushes, etc).
Low back specific exercise examples:
Anti-rotation cable pulley:
Mckenzie pushups (modified): Much of the relief will be found without unnecessary, potential harmful "pressing" to end ranges.
McGill Press:
