The following are the current thoughts (at least in my camp) on preserving your low back or reducing the chances of your low back pain getting worse. I call the post “What not to do” but there are definitely some things that you want to do in here as well.
Low back pain is the leading reason besides the common cold, and I think head aches, why people miss work. It’s also just a pain in the ass. It comes, it goes, it’s bad one day, it’s okay the next. There are tons of reasons for low back pain. That is why this post is just a list of recommendations of what you can do, and shouldn’t do, regardless of your activity level, if you want to keep a healthy back. Most of this info is taken from Stuart McGill’s book Low Back Disorders (if you are having back pain I HIGHLY suggest you man up and purchase this book. That pointless back brace you bought probably cost like 4x’s as much).
Try to touch your toes in the morning – While we sleep our discs fill with water while they are unweighted leaving our spines expanded in the AM. This expansion leaves our spines vulnerable during flexion movements because they make the vertebrae more susceptible to shear forces. Simply put, if you try to touch your toes in the morning you increase the likelihood of a herniated disc significantly! Wait 2-3 hours so your spines can stabilize (lose their water) and then feel free to move as you wish (keeping in mind to avoid end range flexion and extension).
Lumbar rotation – The lumbar spine is designed to rotate 13 degrees. 13 degrees! This is like the short (hour) hand on a clock going from 12:00 to 12:30! It’s nothing. Clearly the lumbar spine is not designed to rotate. So forget about your Russian Twist exercises, or lumbar rotations (which I am guilty of prescribing in my first 3 months as a PT, but did a little reading and decided to forget about them).
Crunches, Roman chair, or superman exercises: Just don’t ever do these… period. I appreciate the business if you do! I don’t even want to show you video of them and put the ideas in your head.
Wear a back brace: So I’m not a huge fan of braces of any sort as a solution, ie motion control shoes and ankle braces, because they actually let your muscles send a message to the brain saying “Don’t worry brain, there’s someone down here helping me. I’m good to take some time off.” Over time, as these muscles atrophy, you actually get weaker! You go to pick up your kid who just scored the winning soccer goal in his U-12 travelling game and BAM! you topple to the ground in astounding back pain because your vertebrae are sitting in a pile like a demolished building now that L2-S1 have literally exploded in your back. All because of a back brace. Your body has the best braces you can imagine; they’re called muscles.
Stretch like an idiot: I love this stretch. Look at that sweet lumbar posture during the stretch. This guy recommends holding it for about a minute. Or this one. I love destroying people’s knees! I think the people at expertvillage need to change their name to idiotvillage.
Walk like there’s a stick up your ass: Just because you’re hurt, doesn’t mean you have to walk like it! McGill actually suggests walking fast, and notes that slow walking actually exacerbates pain. Also, that stooped over position is just making your paraspinals lengthen, in turn weakening them. This goes for the interspinous ligaments as well.
Sit with frequently changing posture – Mike, did you say that right, changing posture? That’s right, change postures frequently to prevent constant loads on certain aspects of the spine. The postures that you chose should still be “good” postures with the lumbar spine supported. Don’t sit more than 50 minutes at a time
Maintain your level of fitness: Obviously if your back is in serious pain you should take some time off, go see your PT, and decrease your pain first, but then you need to stay active, or somewhat active. Walk (discussed above) and keep your extremity muscles strong. Okay, maybe deep squats and heavy deadlifts are out of the picture for a little while. but there is plenty you can still do. Keep your core strong too!
Do core strengthening: With all the rules in mind from above, it is extremely important to stay strong in your core. All the rules above apply, but this means that you can do plenty of standing (chops and lifts), half-kneeling (same), and supine (curls ups, bridges on the ball) exercises to improve your core stability and hopefully improve the motor control of your musculoskeletal system.
See your PT: I read some study a couple months ago that regardless of the reason, back surgery is usually only 50% or less successful at reducing pre-surgical pain levels. I think that it is worth pursuing non-surgical options with those stats.
Learn to breathe: This may be the most important! If you are always holding your breathe, you are essentially wearing a back brace (see above) on the inside. Your lungs are doing all the work while the muscles are checked out. While doing exercises (except HEAVY Olympic lifts), for any body part, if you cannot take a deep breathe during your reps, it is too hard.
I hope that these recommendations come in handy the next time you are in pain, but also remember that if you take them into consideration, there is plenty of research to show that you may be reducing your risk of this debilitating condition.
I’m so unbelievably happy to know there are practitioners out there who are finally negating the “superman” exercise!!!! Thank you !!
It’s hard to argue with research.. something like 7000+ Newtons of force on the spine during each rep. Also if you look at the exercise it just looks like it can’t be doing anything productive. I hope others are reading the same stuff as us. Thanks for your comment Kevyn.
I tried doing superman the other day (not much, just trying it out) and must say two hours after my exercises my ass hurt and had the usual nerve pain down my legs, which lasted two days. I do have a herniated disk L5. So that rules that exercise out.
Doesn’t sound like that exercise is a good fit for you! I’d definitely recommend seeing your local PT for some help in getting a good program together! Thanks for reading!
Great stuff Mike, surprisingly, not everyone in the chiropractic realm is familiar with McGill’s stuff. People need this!
Pingback: Back Pain: What (not) to do | Mike Scott, DPT | Best Back Doctors - Back Pain Relief·
Pingback: Back Pain: What (not) to do | Mike Scott, DPT | Low Back Pain Relief·
The Body was blessed with joints that have large degrees of motion and small degrees. As health care providers we should prescribe exercises and stretches based on what the patient needs . The stiff patient put on a stability program, the hyper mobile put on mobility program?? Its not our place to tell patients never to do something based on 1 small scale study. Tell a baseball batter not to rotate and a gymnast not to flex and extend?? Strengthen all Motions no matter how small, regain all motion unless contraindicated. It works
First off, congrats on the new clinics and thanks for giving the post a read. I totally agree with you that we were given joints (especially vertebrae) for a reason; to move. I also agree that we should prescribe exercises based on what people need. I am not basing my “suggestions” on only one small scale study, or just McGill’s findings, and I am not telling everyone not to ever do something except for crunches/supermans/russian twists. It is my belief that there are better and safer ways to train those muscles and get the results you want. I would never stop my baseball players and golfers from rotating, because they are trained to do this. It’s well known that most of their rotation comes from their hips and thoracic spines which have plenty of available rotation. Their lumbar spines have the ability to stabilize during these movements. The definition of stability that I believe in is the “ability to control the body in the presence of movement”. I’m not saying to have a stiff patient sit there and not move, and just make their spines rigid. And I definitely did not say put the hypermobile patient on a mobility program, adn I agree it should never be done. Quite the contrary, I am saying we need to teach these people to move with control. Slamming into extension, and rotation blindly won’t get anyone better. The lumbar spine should flex ~50 degrees and I feel that’s fine as long as it is controlled and there is not any apparent “hinging” going on (once again I don’t think it should be done in the AM). ~15-20 degrees of extension is also okay with me too. Rotation is so miniscule I just feel that we should be able to control it with using the obliques instead of forcing it and risking high velocity/high force impact at the facets.
Hope all is well back in Wellesley!
Mike Best of luck in Cal.
I just defended the need for all PTs to strengthen all patients through full ROM with a trainer. Unless their is a medical contraindication.
Our Anatomy ,Physiology,Kineseology and Ther Ex Books are our Doctrine. Be careful if Mcgill says don’t Flex, and Boyle says don’t Rotate.
Give the patient/ athlete what they need. All extremes of motion are most stressful. Thats why they need to be addressed.
Best of Luck Carl
Thanks again Carl! It is definitely crucial for pts to be able to control all motions. I think that in this age when everyone is a personal trainer, the “fad” exercises that people want to do should be examined closely by the people who are in control of people’s care or training and do what is best for the patient or client. I think that strengthening all motions can also mean being able to control ALL motions through their appropriate ranges, but what I have noticed is that people can have trouble with controlling the end ranges of certain motions resulting in flare ups of their backs. All motions are parts of every day activities, but loading them up to train them is different than teaching control of the motions. I don’t want to tell someone to do crunches, or supermans if they can possibly end up in pain. I think we all want to get people up off the table and floor and getting them kneeling, half-kneeling, split stance, single leg, etc if we can to get them back to “functional” positions for their sports (I know it’s a Boyle “term”), but functional exercises existed before he did.
Pingback: What to do and not to do…That is the Question - Pacific Chiropractic Clinic. Work injury, neck and back pain, headaches. Lynnwood, Edmonds·