“Almost two out of three of us have pain in the lower back at some time in our lives” according to the NHS. Lower back pain can be very subjective and pain could be different from person to person, for example, extending your back might trigger pain whilst another persons pain comes from flexing. In worse case scenarios, pain can go through the glutes, down into the lower leg that could even reach the toes. This is called sciatica because the sciatic nerve is impinged somewhere in the spine.
On a scale from very active to very sedentary, lower back pain can be severe along the spectrum, regardless of how much activity you do as you could be putting too much strain on the spine and lower back (i.e heavy deadlifting) or putting too much stress on the hip flexors and lower back by sitting on the couch too much. Personally, I have had many issues with my lower back and at one point, I had to crawl onto my bed because I strained my back from lifting an empty suitcase (yes you read that right). I am very cautious of my lower back to this day even though I still lift heavy.
So what have I done in the past and still do to this day to aid my lower back pain*
*please note I am not a physical therapist, physiotherapist or doctor. Ask your doctor about severe back pain before you do these 5 tips that have aided myself
Fix Your Hips
Shakera famously sang ‘your hips don’t lie,’ and when it comes to back pain, they do not lie. Think of your pelvis as a pendulum, you want It to be balanced. If the pelvis tips forwards or backwards, it could increase the likely-hood of some sort of dysfunction if not treated. There are two main dysfunctions when it comes to the pelvis, anterior pelvic tilt and posterior pelvic tilt. Too make It easier for clients to understand, I say that anterior pelvic tilt is like Donald Duck as his ass shoots out whilst posterior pelvic tilt Is like Pink Panther as he has no ass! (see diagram below)
Anterior Pelvic Tilt vs Posterior Pelvic Test
Anterior pelvic tilt is caused by the shortening of the hip flexors, and the lengthening of the hip extensors. The front of the pelvis drops whilst the back of the pelvis rises. This leads to an increased curvature of the lower spine, and of the upper back. The changing shape of the spine, and the associated muscle imbalances, are often caused by prolonged periods of sitting. A lack of stretching or strengthening exercises also contributes to anterior pelvic tilt. So how do we prevent excessive anterior pelvic tilt? Strengthening our posterior chain and core whilst stretching out our hip flexors and even lower back. Try not to sit as much and always move every hour by doing some sort of stretching on your hip flexors such as a couch stretch.
Posterior pelvic tilt is a movement in which the front of the pelvis rises and the back of the pelvis drops, while the pelvis rotates upwards. The changing shape of the spine can cause discomfort in the hip and knees. Tightness in the abdominal muscles and/or tightness in the hamstrings may pull the pelvis into a posterior rotation. It takes a significant amount of tightness in the hamstrings or abdominals combined to produce this postural distortion alone. More often, posterior rotation is an adapted pattern that is reinforced by poor mechanics in sitting and standing. Mindfully fixing your posture will help but mostly stretching your abdominals and hamstrings while strengthening your hip flexors and glutes (Medias and Maximus).
Massage, Stretching and Yoga
The Chartered Society of Physiotherapists recommends massage therapy (MT) for the management of different pain-related conditions related to musculoskeletal disorders and studies have shown that massage therapy aids back pain relief. Massage therapists can aid ‘loosening’ of the tight muscles through different techniques (such as deep tissue, hot stones or even cupping) whilst physiotherapists can aid your rehab & rehab to aid you getting back to anything pain free. I am a big fan of massage and frequently use the massage therapist in the gym (https://www.instagram.com/dssportsmassagebiz/?hl=en) and, as he is training to become a physio, is an absolute bargain and I would not go anywhere else.
Secondly, I would highly suggest different forms of stretching. There are 3 main types of stretching that I like to do, dynamic stretching, static stretching & PNF stretching. When I am on my own, before I work out, I like to do a dynamic warm up in which I move my body and gradually lengthen the muscle to get it ready for activity. For example, leg swings, split squats and trying to touch my toes to stretch my hamstrings. Normally after a workout I don’t tend to stretch off (don’t do that) but throughout the day. if I feel ‘tight’ then I will do some static stretching such as pigeon pose. At one point, I stayed in a squat position for 30 minutes a day (Ido Portal) to aid my squat form. Thirdly, on a rare occasions I like to do PNF stretching but with a partner. My girlfriend will apply force to certain muscles and aid me into positions I would be able to do on my own, especially in my hamstrings. The idea of PNF refers to any of several post-isometric relaxation stretching techniques in which a muscle group is passively stretched, then contracts isometrically against resistance while in the stretched position, and then is passively stretched again through the resulting increased range of motion.
Thirdly, doing Yoga will aid your lower back pain in many ways. It can aid stretching and strengthening all in one. If you are new to yoga, start off very light and work your way into backbends etc. The goal of yoga poses isn’t about bending and forcing your body into certain positions—that could actually cause more back pain. Instead, yoga poses teach you proper alignment, such as how to maintain good posture. You may also become more flexible and be better able to maintain your balance. Do exercises such as cat-cow & hip thrusts that can help with your mobility and stability.
Volume, Intensity & Frequency Management
Volume: Intensity, frequency & sets put together that makes your programme. Volume is calculated by sets X reps X weight
Intensity: A proportional % of your one rep max but higher intensity does not always mean harder. For example, a set of 10 @ 73% should give you the same feeling as a set of 2 @ 92%.
Frequency: Generally how frequent you can perform a lift
The way I like to programme for myself and my clients is to do it the old classic way of decreasing volume and increasing intensity throughout the months of training cycles (shown below). From this perspective I don’t ‘burn the candle from both ends’ as increasing volume and intensity will make it very hard to recover from in my opinion. Not letting the body recover will eventually lead to injuries (i.e lower back pain) and mental problems such as burnout. Muscle strains and sprains happen all to frequently in the gym even if people have great form, but what could be the issue if technique is 99% yet they people are still get injured? There are a few reasons in my opinion,
1) your muscles are not recovered enough/and or not strong enough to take the load of a certain weight;
2) Repetitive movements that constantly put strain on the lower back (i.e too much frequency);
3) A reduction in trunk strength can lead to lumbar instability so exercises to activate the deep abdominal muscles including the superficial muscles, transversus abdominis muscle and the multifidus are important;
4) Miss-managment of volume & intensity see Juggernaut Training video on MEV & MRV (https://www.youtube.com/watch?v=v-hXTUvhALs)
So how can we aid management of volume, intensity & frequency? There are a few things that I would suggest, if you do not know about MEV or MRV, learn it. By knowing your maximal recoverable volume will increase the chances of you staying away from that number so you can consistently get stronger without paying a price. Secondly, programming yourself to mimic the graph in order to prevent injuries and often change your intensities (i.e do not always go for heavy tripes). Thirdly, recover properly and get stronger by eating, sleeping and staying mobile.
Technique is a way of carrying out a particular task, especially the execution, performance and skill of certain parameters. Technique is very important when it comes to lifting (and in everyday life). Probably Mark Riptoe’s book gives the best analysis of leverages and how to use them effectively when it comes to powerlifting. Alot of coaches will disagree with what I’m saying here, but without good technique, you are putting at risk of injury. When examining case reports, powerlifting appears to be a high risk sport. However, closer investigation reveals that in truth, powerlifting might not be very dangerous or risky for participants [Keogh, Hume & Pearson, 2006]. Efficiency to lifting is key in powerlifting due to shorter ranges of bar path to increase weight on the bar (why do you think so many people like myself try sumo) , using exorcist arch’s, and using low bar for squats while trying to keep the bar in a straight line or as vertical as possible. (see below). When you see videos of half assed quarter squats, cat back deadlifts and doing a mad 2 inch bench press, you’re going to hurt yourself and keep doing it over and over again, you’re going to hurt yourself. People will disagree with me and call me a SquatU fanboy (Adam), but there is truth in his posts, granted he goes a little OTT in certain things (Lifter A). Watch the boss tell you about his constant battle with injuries
In a study by Siewe et al., (2011) 43.3% of powerlifters complained of pain. I don’t think I’m far off and saying it could even be more in our gym BUT most of our lifters lift with really good form. As we constantly do the movement (3-5 times a week) and if we are not as efficient in that said movement, we are going to be putting a lot of pressure on our muscles, joints, tendons and everything else which could lead to injury. Speaking from my own experience, I have injured my lower back before in which I lifted a suitcase with nothing in it and could not move. I had to crawl to my bed. It was not pleasant. This was during a time I was trying to lift heavy and play football at the same time, I was burning the candle at both ends and my lower back shut down. Constant deadlifting, squatting and then playing on the 4G pitches just messed me up. I would not recommend lifting heavy and playing football (wait till your off-season to lift heavy).
All in all, use your leverages properly and constantly strive for better technique! No half ranges of motion either!
GET OFF YOUR ARSE
While it might be expected that LBP and sedentary office work are highly related, the literature offers only little evidence. On the one hand, recent studies report that seated working periods of longer than 7 h per day significantly increase the risk of LBP (Subramanian and Arun, 2017). Even though associations between sitting duration and LBP seem to be controversial, other aspects of sitting behaviour might have critical links to LBP among office workers. Here, Womersley and May (2006) reported that individuals with pain sat uninterrupted for longer periods and showed a more flexed and relaxed sitting posture than pain-free individuals, suggesting that individual sitting habits may be related to LBP, even if the causal links are unclear. Moreover, Claus et al. (2009) proposed that any sustained sitting posture could result in fatigue, discomfort and pain, suggesting that a “good” posture could still be detrimental if it persists uninterrupted for extended periods (Coenen et al., 2017). As a result, postural variability as well as regular small movements are plausibly beneficial for the prevention of LBP (Davis and Kotowski, 2014; Vergara and Page, 2002; Pynt et al., 2001; Srinivasan and Mathiassen, 2012; Aarås et al., 2000).
These studies suggests that sitting can or cannot be a main factor of causing lower back pain. Sitting in a position for a long time can make muscles tight or even weaker. However, in my opinion by moving every hour and stretching (such as a couch stretch or movement by going on a walk or doing split squats) would be the most ideal to prevent lower back pain. As studies have shown, sitting that cause lower back pain is inconclusive but what seems to be a trend is sitting for longer periods of time can be detrimental. SO GET OFF YOUR ARSE every hour and move about!
So when I done my lower back in, I planned how to aid my back pain through various therapists such as Moveu, Squat U & Chad Wesley Smith with my own spin on things. After about a month or so I was back to lifting and sort of back to normal. Obviously resting and taking a step back from the weights helped but I knew I had to keep moving and strengthen up my trunk in order to start lifting heavy again. My programme worked for me and not going to lie, it hurt to start with and couldn’t get much range of motion without pain so go to your tolerance and build up your range of motion.
My programme looked liked this and I did it 4-5x a week (All bodyweight) but will need a foam roller for warm up
Joe De Franco Limber 11
McGill Big 3 (https://squatuniversity.com/2018/06/21/the-mcgill-big-3-for-core-stability/)
Bulgarian Split Squats 4×8-12 (https://www.youtube.com/watch?v=w4OUtEO27UM)
Hip Thrusts 4×8-12 (https://www.youtube.com/watch?v=SEdqd1n0cvg)
Around The Clock Lunges (https://www.youtube.com/watch?v=HAfEGsJqJjA) I know its Elliot Hulse BUT this is when he wasn’t mad and give out good content
Emphasising Hip Hinging Box Squats (as low as I can go without pain) 4×8-12 (https://www.youtube.com/watch?v=Hk65AxtXJD4). The box can be your couch, aim to get lower and lower each day
10 Mins of YOGA which I just pulled off YouTube and i’m sure you could do the same
There you guys have it, a nice programme for lower back pain that shouldn’t take you long to do. Start moving properly and exercise more. If you do get a lower back injury, try walk as well to keep the blood pumping. Remember, you want to increase flexibility, stability and movement in the spine without pain. Some exercises might be hard to do, use somebody to aid your stability if needed but, in the long run, your lower back pain should ease and you can start living life without the worries of pain.