If you’ve come into my office with chronic or ongoing lower back pain before, I probably mentioned that corrective exercise is likely necessary for a full recovery. Chances are you’re wondering exactly why you need corrective exercise, what an corrective exercise program for lower back pain should look like, and why your current exercise or physical therapy program might not be working. In today’s post I will cover all of these questions so you can have a clear understanding of what causes back pain and how to get rid of it, for good!
Many of my clients who come to see me for back pain have already been to numerous other healthcare professionals. They’ve been to a physical therapist who said their glutes are too weak, a chiropractor who told them their pelvis is misaligned, and an acupuncturist who told them their muscles are too tight. After receiving so many diagnoses, these clients often feel confused about what the problem is and how they can systematically treat the issue. If this is you, I understand what you’re going through and I’m here to make back pain easier to understand. Let’s take a step back from all these diagnoses and put back pain into two categories: (1) movement problems (i.e. software problems) and (2) hardware problems.
The most common reason for chronic lower back pain is ongoing movement problems. Specifically, the inability to stabilize the spine and move correctly through the hips and pelvis.
Contrary to common belief, the lumbar spine (lower back) is not designed for much motion. They don’t like to twist, bend forward, or ab crunch. That’s why there are 35 muscles that connect onto the spine that are designed to primarily resist motion.
Next door to the lumbar spine, we have the hips. The hips are large, mobile joints that are designed for movement. They are designed for movement forward and backward, side to side, and rotate so that our lower backs DO NOT need to produce these movements to any large degree.
What happens to back pain patients is that they forget how to stabilize their spine and move through their hips. Over time, this results in jamming and irritation of joints, slipped disks, nerve entrapments (in soft tissue and/or in bone), and more. Essentially, as movement problems compound, eventually the hardware of the spine begins to fail.
Note: even if your hardware is starting to fail from many years of faulty movement, learning to move better is almost always a more effective method than surgery.
Also note: If you’ve been told “your pelvis is misaligned, your muscles are too tight, etc” these issues can be attributed to faulty movement patterning and a lack of stability in certain movements and planes of motion. Once we address these issues, “tightness” will dissipate.
Some of us are born unlucky. We may have severely limited hip mobility in one leg, one leg substantially shorter than the other, or other hardware issues or diseases that contribute to back pain. Others of us have used our bodies in ways that have led to “abnormal” bone structures (like stenosis), worn out joints, herniated disks, bone spurs, and more.
These hardware issues may merit surgery at some point. The important thing to keep in mind is that just because there’s a hardware issue doesn’t necessarily mean surgery is the best path. A well-planned corrective exercise program can often yield better results than surgery. Surgery should be a very last resort.
“Wise athletes always build extensive spine stability prior to progressions into building hip power” – Dr Stuart McGill, Ultimate Back fitness And Performance (pg 81)
The first part of any strength program should be building core strength in more stable environments, mainly on the ground. The advantage of working on the ground is that exercises can be made easy and allow the patient to identify and treat his or her movement weaknesses.
These exercises (mentioned above) collectively train all 35 muscles that surround the spine including, but not limited too, the obliques (internal and external), transverse abdomens, multifid, quadratus lumborum, psoas, latissimus dorsi, and erector spine. None of these muscles are more important than any other. Competency in using all of these muscles to create spinal stiffness is essential for a happy, pain- free back.
Swipe through to see what some of these exercises look like (updated and improved the the Ultimate Sandbag). Note: there are literally hundreds of exercises in these categories. To find out which ones are right for your body, you need to be evaluated.
There are seven primary human movement patterns: hinging, squatting, pushing, pulling, lunging, gait, and rotation. The inability to stabilize the spine during any of these movement patterns can result in back pain – especially those movement patterns involving the legs!
Many people with chronic back pain will be limited in their abilities to perform even the most basic versions of some of these primary human movements, and will generally have to begin with squatting, kneeling, and half kneeling exercises before moving into other patterns.
NOTE: These exact exercises may or may not be suitable for you. The trick is systematically find the exercises that are right for your body. Nothing should feel too difficult or create pain.
Many of my clients at Pain Solutions are people who have gone to physical therapy for extensive periods of time (over 3 months) and are either (1) not getting any better or (2) getting worse. This leads many of these patients to conclude that rehab or corrective exercise cannot get them the results they want to achieve; however, nothing could be further from the truth.
While there are great physical therapists around the world, 99% of the time that my clients aren’t getting the results they want in physical therapy it’s because their therapist is using outdated techniques that will not yield great results.
Here’s a short list of signs that your physical therapy program is outdated:
1. You Only Use Bands. While bands can certainly be useful tools, they aren’t the only tools you should be using to get the best results possible. Weights like The Ultimate Sandbag and kettlebells not only provide more load, but teach us how to move better through external feedback.
2. You Never Practice Squatting Or Hip Hinging. I’ve seen many knee and back pain clients working with physical therapists who never have them practice primary movements like hip hinging or squatting, or even tell them that “squats will make you worse.” Nonsense. If you ever want to get out of back pain you need to learn how to use your feet, core, and hips to stabilize your body against gravity. Hip hinging is especially a game-changer for many patients with back pain, and it’s what the best in the industry all recommend.
3. You Spend Lots Of Time Isolating Muscles With Exercises. In life, our muscles don’t work in isolation. The muscles in your hips, for example, have to work with the muscles of your core feet, and even your upper body to produce efficient, pain-free movement. That’s why in order to teach you how to move better, we need to teach your muscles how to work together. If your PT has you spending lots of time doing clamshells, leg abductions, or traditional hip bridges, your time and effort is not being well spent. Don’t take it from me though. Pick up a copy of Ultimate Back Fitness And Performance.
4. Your PT Has Never Had To Try Lunging, Or Isn’t Working You Toward Lunging. If you’re reading this article, there’s probably at least a 50% chance you can’t lunge very well. If you can’t lunge, that’s a major movement problem that needs to be addressed. If you’re PT hasn’t assessed your ability to lunge or isn’t working with you in a half kneeling position, you’re missing out BIG TIME.
5. Your PT Has You Try Difficult Exercises And Tells You It’s OK To Have Pain Afterwards. Pain is a sign from your body that something went wrong. If you have pain after exercise, it means that either the exercise was poorly designed, or that the exercise was too difficult for your current capacity. At Pain Solutions, if an exercise is triggering pain, we don’t ignore it, but look for ways to make the exercise stop causing pain, or even switch to a different exercise altogether. If your PT tells you it’s ok to have pain, it’s a sign that they don’t have the tools to help and it’s time to find help elsewhere.
So now you’re probably wondering – how long should I have to follow a corrective exercise program to see results? As you can imagine, the answer is “it varies,” but generally you should notice substantial overall, on average, improvement after 3 months of following a program, which includes in person corrective exercise and at home training. If you’ve been following a program for 3 or more months and aren’t seeing substantial results, please schedule your first drop with me. You deserve to get out of pain and have at your disposal the best tools and programing to help you achieve that goal.
Wondering what corrective exercise and training looks like at Pain Solutions? Watch the video down below.
Pain Solutions Massage Therapy & Personal Training
Phone: 415.518.2125
Email: ben.beeler2014@gmail.com
Hours:
Monday: Closed
Tuesday: 8:30am-10am, 1pm-7pm
Wednesday: 8:30am-10am, 1pm-7pm
Thursday: 8:30am-10am, 1pm-7pm
Friday: 8:30am-10am, 1pm-6:30pm
Saturday: Closed
Sunday: 2pm-6:30pm
