Low back pain is very common problem that millions around the world face on a daily basis. A wrong movement, an effort when straightening up, an inappropriate posture to carry an object or a small child… and there you have a sharp pain in the lower back. It is both a public health problem with a major economic and social impact, and an occupational health problem.
This is a simple guide for the layperson to avoid lower back pain. If you’re an experienced trainee, or are looking to build a high-performance back, then this post isn’t relevant to you.
But if you’re tired of the aches and pains in the lower back, then this post serves as a simple guide to getting some relief.
It is a program, and hence must be implemented by yourself. It also isn’t a quick-fix, and requires that you maintain the attributes needed for a healthy back. But rest assured, it’s structured and time efficient, and the rewards will be yours to keep for a long time.
Starting Off
Low back pain is the pain in the area of the lumbar vertebrae. It is the most common form of back pain and most often not serious. More than 80% of people will experience low back pain at some point in their lives and the prevalence of low back pain continues to increase.
Most back pain is caused by conditions of the spine and joints, as well as the muscles, ligaments and nerve roots that surround it or the discs between the vertebrae. Often, it is not possible to identify a single specific cause. Any painful condition of the spine can cause stiffening (spasm) of the muscles surrounding the spine. This spasm can make existing pain worse. Stress can aggravate low back pain, but the triggering mechanism is not clear.
There are plenty of particular causes for lower back pain, and hence there is no exact solution. The best approach would be the sledgehammer approach: attempt to solve every possible problem.
Fortunately, this is easily done. You want to do 3 things:
(1) loosen up muscles that are too tight
(2) activate and strengthen supporting muscles
(3) Grease proper movement patterns
Loosen Up What is Tight
The best approach will be a combination of myofascia release therapy (message) and stretching. There are many muscles that could affect the low back, so we will target them all.
The order that we’re going to do go through is to release, stretch, then mobilize.
Release therapy is basically message. The aim is to get rid of what we call “trigger points” – knotted, painful regions of muscle fascia.
The basic principle is to use an implement to roll around the region in question until you find a trigger point, as evidenced by a sharp pain. Then press into the point for a couple of seconds, then roll around it for about 30 seconds to a minute (and not more). For details on this type of therapy, Mike Robertson has a great, free PDF covering techniques. If you have the time, then I’d encourage implementing every single exercise in that PDF 3 times a week for a month, then reducing it to 2 times a week for a month, and then to 1 time a week after that (which is what I do).
However, with lower back issues, the region which is most likely to be the cause is the piriformis and gluteus medius. To target this area, follow the procedures in this video.
Onto programming. Every day:
1. Do myofascia release therapy as above. At least at the piriformis like the linked video, and more if you like (from the PDF)
2. Do some lower body stretches listed here. Hold each stretch for 20 – 60 seconds. Your benchmark should be that the stretched muscle releases some tension from the original stretched position.
(Optional – try this only after at least 1-2 months on the above protocol) Advanced Hip Flexor stretching and hip mobility drills.
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Activate and Strengthen Supporting Muscles
Strengthening the core muscles is helpful for the proper functioning of our hands, legs and back. Core muscles are essential to every movement we make. We are going to activate and strengthen various groups of muscles. In particular, we want to target the core and the glutes.
First, the core. Stuart McGill has shown the relationship between core endurance and core stability, which reduces the likelihood of back pain by providing a “protective support” for the low back during daily activities.
We’re first going to target 2 main exercises: the front plank, and the side plank.
After that, we’re going to include some birddogs and glute bridges.
As you progress along, add in some SI joint rehab exercises ala Lyle McDonald like this and this.
Onto the implementation. To start off, a good daily routine would be:
1. side plank – 10 seconds hold on each side, 3 sets (30 seconds total each side)
2. front plank – 10 seconds hold, 3 sets
3. birddogs – 10 reps for each leg, 3 sets
4. Lyle McDonald’s SI Stabilisation exercises according to his template
It should be done in the order presented, and it should be done after the stretching and release therapy.
Start initially with just the side plank and front plank, and then work your way up to a single 60 second hold for each. Then you can start to add the other 2 exercises as you see fit (if your back is already thanking you after just the planks, then leave it be).
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Grease Proper Movement Patterns
The goal here is to move in a way that takes excessive load off the lower back.
The only one key movement pattern here is what we like to call the hip hinge. This is mentioned in this instructional video.
This does not have to be done with any weight at all, and the goal is to be able to engage the posterior chain (muscles on the back of the body) while doing everyday things like sitting down on a chair and lifting something off the ground. The video is a great illustration of what you want to achieve.
Progression should be done haphazardly. ie: whenever you feel like it, practice sitting down with the hip hinge motion onto a ‘box’ (the side of your bed for instance), and then stand back up using the cues of the video.
Some cues for learning the movement, thinking about pushing ‘hips back’.
One good drill is the “sit back” drill.
Another, less critical component is learning to squat deep with good posture. This drill is great for killing many birds with one stone.
It forces you into the bottom position of a squat, which demands great hamstring flexibility, thoracic (mid back) flexibility, hip mobility, and glute activation. It’s great since you can simply hold the bottom position to loosen up, and do a couple of reps (say 10 reps) of this exercise to quickly ensure that you’ve maintained the adequate flexibility and mobility to enforce lower back health. ie: a time-efficient way to maintain your mobility.
Conclusion
In sum, hit each of the points (1), (2), and (3) with the protocol mentioned daily for about 2-4 weeks, then reduce to 3 times a week for another 4 weeks, by which proper movement patterns should be established and maintenance can be done with the exact same routine 1-2 time a week (preferably twice a week).
For the regular person simply looking to move better and avoid back pain, this is about all you need.