If you’re a physical therapist or medical professional and you’re reading this, you’re probably thinking, 1) “This guy is either insane or an egomaniac if he thinks he’s going to fix everybody’s low back pain.”, and, 2) “Let’s see if he can pull it off.”
A few caveats before we jump in here:
First, if you have pain in your groin or genitalia, can’t feel your legs, or have suddenly lost bowel or bladder control, stop reading and get the the emergency room now.
Second, “low back pain” is the term your doctor uses when he doesn’t actually know what’s going on in your back. It could be a disc bulge, it could be nerve root impingement, it could be a facet joint irritation, or a number of other things. Most docs aren’t trained to differentially diagnose the root cause of your low back pain. Why does that matter? Because if you don’t know the root cause of your pain, it’s possible you won’t get better. Not every back exercise works for everyone. If you follow the advice in this post and don’t get better, you need to see me or another physio in-person. It doesn’t mean you’re beyond repair, it just means you’re going to need some additional one-on-one help to figure this out. We do that here, so don’t hesitate to ask for help if you need it.
Getting back to the main point. Why do we care about pain? Because it’s epidemic. It costs our country over $500 billion per-year for treatment and the loss of productive work hours. It’s estimated that over 100 million people in the U.S annually suffer from chronic pain-that means 1 of every 3 people you know lives with daily physical pain. That’s sad.
Low back pain is particularly nasty. It can hurt to sit, stand, walk, lie down. It’s just hard to get comfortable when your low back is bothering you. You stretch it, it feels good, then 5 hours later it feels like you’re back at square one, or even worse than where you started. It feels better for a month or two, then you “tweak it” and you can’t move all weekend and the heating pad and ice pack become extra appendages on your body (if you’re still icing, do yourself a huge favor and read this). You’ve got braces, shoe inserts, special pillows, that lucky rabbit’s foot, a new Yoga outfit, and you still haven’t resolved your problem.
Let’s try to look at this from the 30,000-foot view for a minute. Do you think your low back exists in isolation? Is it just the angry part of your spine? Unlikely. Look at this diagram of your skeleton:
Your low back (lumbar spine) is composed of the five vertebrae that sit below your ribcage and above your tailbone.
Look above the low back, that’s the thoracic spine (the 12 vertebrae in the spine that have rib attachments). That a big-honkin’ mass of bones. Interestingly, it also houses and protects the part of your nervous system that signals to your brain “fight or flight” and “rest and digest”.
Look below your low back, paying particular attention to those balls that are sticking into the sides of your pelvis. Those would be your hip joints. They are beautifully designed to flex, extend, and rotate your thighs.
Have I thrown you yet? No? Try this on for size. Here’s a pic of the muscular system that overlies those bones:
And the nerves that weave in between those bones and muscles:
Hairy enough for you yet? How do we sort all of that mess out?
The answer is, we don’t. Your body is an integrated whole. Your low back doesn’t exist and operate outside of the capacity and function of your muscular system, nervous system, thoracic spine, pelvis, and hips.
This is what we call the “Upstream/Downstream” Model. If you’ve been hyper-focused on exercises for your “core” and your idea of “core” begins and ends in your low back, you’re missing huge swaths of your body that play a profound role in maintaining the health and integrity of your lumbar spine.
If you’re going to resolve your low back pain, those Upstream and Downstream areas need to be addressed. And so… so, so, so, so, I’ll show you another few tricks that I know! (sorry, way too many bedtime readings of the “Cat In The Hat” with my kids. But I digress).
Here’s what you clicked on the link for, the actual program to help you take a crack at fixing your back pain on your own:
The Healthy Back Program Part 1-Fix Your Crappy Posture!
Our first stop is at the Posture Checklist. If you spend 20 minutes per-day doing your “back routine” and the rest of the day in a wretched posture, you’re never going to gain traction and get on top of this problem. How you sit and stand during the rest of your day matters infinitely more than your super-secret squirrel core exercise routine.
Here’s the standing posture checklist:
- Feet are under the hips and pointed straight ahead (not out, you’re a human being, not a duck).
- Your butt is squeezed with 20% tension.
- Your rib cage rests directly over your pelvis. Try this, take a deep breath in and let your chest rise and stomach expand. Pause at the top of your inhale then exhale, letting your rib cage drop and your stomach relax. The force of your exhale should bring your rib cage down directly parallel with the level position of your pelvis you established by squeezing your butt. Keep that tension you created in your abdominals by exhaling at 20%
- Your shoulders should be gently rolled out, your palms should be resting on the side of your thighs and your thumbs pointed forward, not towards each other.
- Close your jaw and pin your tongue to the roof of your mouth. This will stabilize your head and neck. The middle of your ears should be over the middle of your shoulders. You may need a family member or friend to take a picture of you from the side to see if you’re in this position.
If you’re not in these positions, can’t get in these positions, or it doesn’t feel comfortable to hold your body in these positions, Houston, we have a problem. An inability to maintain a neutral spine position decreases strength in the extremities and loads the spine with force it was not designed to handle consistently.
As for sitting, though it’s not ideal, here’s what it shoulder looks like:
- Same orientation of the pelvis and rib cage (parallel to each other).
- Head is in the same position relative to the shoulders.
- If you’re typing or writing, your shoulders stay in line with your ears, and all you need to do to start writing or typing is bend your elbows and flip your hands over. As soon as your shoulders start creeping forward, your head follows. For every inch forward from neutral your head sits, you add 10 pounds of vertical pressure down through your cervical spine. Funny how your neck hurts at the end of the day, isn’t it, desk athletes?
- You can’t squeeze your butt when you’re sitting on it, but you can align your knees and feet with your hips or get them slightly wider than hip width to try to add some stability to your pelvis.
We have to get you in good posture first if you have back pain that is either persistent or recurrent and you haven’t been able to resolve it permanently with exercise. Again, your daily posture is way more important to your body and nervous system than your 20 minutes of daily back exercises. For our visual learners, we made a video a while back going through that whole Standing Posture Checklist.
The Healthy Back Program Part 2-Mobilize
Getting back to the idea of taking care of the Upstream and Downstream issues, let’s tackle the areas, joints, and tissues that create the most dysfunction in the low back.
Let’s go over a few rules for self mobilization:
- If you’re mobilizing and something is going numb, burning, or tingling, STOP!
- You should always try to maintain good position, don’t sacrifice good posture for the sake of tackling a mobility issue.
- Stay at it until you create some change for the better-if it’s getting worse, you’re going at it too hard. If you haven’t noticed a change yet, keep at it. We recommend a minimum of 2 minutes per area, 5 minutes maximum, depending on how stiff you are.
- If it feels sketchy, it’s sketchy. You don’t get a medal for torturing yourself. The goal is to actually feel better when you’re done.
Spend some time with each of the following mobilizations and retest how you feel after you’ve completed them.
- The Gut Smash: It’s an experience almost too rich for words. Best explained here on our YouTube channel.
- The Low Back Smash: Grab a lacrosse ball, tennis ball, or something similar and lie on your back with your lower legs resting on a chair or couch. Roll your legs and hips to the left and put the ball under your back away from the middle of your spine. Keeping your abs engaged, slowly roll your legs and hips back to your right, adding your body weight into the ball. If you can’t take a full breath in and out, you’ve got too much weight on the ball. Continue rocking your legs and hips right and left until you can comfortably take a full breath in and out with your full weight over the ball. Repeat on the other side.
- Thoracic Spine Extension and Rotation Smash: A favorite of the golfers and throwing athletes I work with. Grab a foam roll, PVC pipe, barbell, whatever’s handy, and lie over the roll with it positioned perpendicularly to your spine., starting in your lower rib cage (not in your low back). Keep your abs engaged, squeeze your butt and lift your hips and start moving the roll up your back by pulling with your legs. You can keep your hands and arms crossed around your shoulders or lace your fingers together and put your hands behind your neck (if you’ve got neck issues). Stop on any spot that’s stiff, tight, or sore, drop your hips to the floor, do a mini-crunch forward as you take a breath in, then exhale, let your upper back extend over the foam roll, and try not to freak out. Repeat this back-and-forth, min-crunch-to-arch pattern until it starts to feel better. When it starts feeling better, stop arching and flexing and start rolling your upper body side to side to catch any rib stiffness you may have acquired from years of sitting at your computer trying to hide the fact you were evaluating your fantasy football line-up instead of actually getting some work done. Continue rolling side to side until you can breath and rotate side to side at the same time.
Let me make one thing absolutely clear: pain is not normal. The normal resting state of the human body is pain-free. If you don’t have back pain but your posture is off, it’s only a matter of when, not if, your back will start hurting. If you don’t have back pain but these mobilizations hurt, congratulations! You’ve pre-empted the back pain that was surely headed your way.
Posture and mobility are two-thirds of the equation. A quality strength training program is essential to keep you strong around your spine. We’ll discuss what that looks like in a future post.
If you have back pain and you’re not getting better treating it on your own (or ignoring it and hoping it will go away-how’s that working out for you, by the way?) go get some help. We’d love to help you. If that’s not possible, don’t give up. Fight for yourself and get the help you need.