If you’re reading this, chances are you are already suffering. Maybe you strained it shoveling snow, or trying to hold your kid as they flip flop through ‘stiff as a board’ and ‘dead weight’ modes. Or maybe you just sneezed and ruined your life. It can happen at any time, and more often than not it turns into something chronic. My best advice for back injuries is – don’t get one!
Easier said than done. The thing is, that particular moment where you got up weird or just reached for something wasn’t actually the trigger. Unless you were in a high impact accident, most back injuries happen over time. Lack of stability, overloading, loading with bad posture or hyper-flexibility can all, slowly lead to wear and tear that at some point gives way at that final “trigger” moment, where you felt sever pain. So yes, prevention is best but often times our only clue that something bad is happening is pain. And if pain has started, then you are most probably already at a point where some damage has been happening for a while. Unless you are very health conscious and have had an awesome training program designed for you by someone who has done a full physical evaluation that focuses on injury prevention…this was bound to happen. Right now your saying “oh great, so I’m fuc*ed!”. Yep. See ya!
Just kidding. Here is my best advice on what to do right now. Get a proper diagnosis – this takes a few steps. A physiotherapist, chiropractor or Osteopath can’t actually diagnose you. They can tell you what the source of pain is. that’s the easy part. But telling you that your pain is located in your sacroiliac joint is not a full diagnoses but is still the first step. A scan, isn’t a full diagnosis either, but it is also necessary. Without getting in their and seeing if you have severe disc compression, disc bulge or vertebrae slippage, or whether you have sacroiliac joint dysfunction or tissue inflammation, you won’t actually know how to approach remedying the pain. Again, identifying the point of pain is not necessarily going to fix the problem in the long term. With a scan, you can then head back to a physio or osteo and try and figure out what the source of the problem actually is. If they are good and take a holistic approach they can then deduce where it might have all started – pronated feet, unstable knees, rotated pelvis, etc..
Okay, so you have a full diagnosis of where the pain is – if there is a structural, or tissue problem and if it is degenerative or not as well as a pretty good idea as to how it all started (often not in the back). What now? Surgery may be your best bet for pain relief but it won’t end there. You’re gonna have some homework. Forever.
Also manual therapists will never heal you. This isn’t my opinion its actually the opinions of both of the osteopaths I go to and I trust with my spine (life). What manual therapy can do is reduce pain and put your body in a place where you can then work on stability, mobility and strengthening so that you can prevent further degradation and pain.
Once this is all figured out, what exercises work best?
It depends on the source of the problem but you will probably need a 2 pronged approach. Exercises that stabilize and/or mobilize the area of pain and then exercises that focus more on fixing the true source of the problem. Unfortunately I can’t give you any magic exercises that will work for your specific lower back issue. But my approach to most injuries is stability first, then mobility.
First things first for stability work. You need to learn how to brace your core. This is paramount for performing exercises properly but also for surviving the day to day movements that may put strain on your back. For a quick breakdown on this go read my article on fixing diastasis recti. There are also 2 exercise examples for beginner stage stability work that are perfect for low back problems.
We use more than a dozen exercises, with various progressions to work on core stability. You want to try and find movements that activate more than one aspect of your core; your transversus abdominus, pelvic floor, major abdominals, low back muscles, priformis and glutes all need to be worked. You also want to do exercises in different positions, not just on the floor. Though there is a natural progression for all of the movements we use at the studio, I am going to jump ahead to 3 slightly more advanced exercises that I like.
In all honesty these 3 exercises all but eliminate my back pain, and when I am consistent with them, they allow me to move and train the way I normally do. Consistency is key. But remember I have spent years building stability beforehand, so these 3 may be too advanced or just may not work the same way for your injury.
– You will need a small resistance band that you can wrap around your legs, just above your knees for all 3 of these exercises. You can order some from amazon here –
1 – Pelvic raise and knee press – Lay on your back with your knees bent, feet hip width apart and heels fairly close to your butt. Draw in your abdomen slightly. Press your pelvis upwards as high as you can squeezing your glutes hard. At your topmost position press your knees out against the resistance band. Bring them back in and then return to starting position. Repeat. Start with 3 sets of 10 reps and work your way up 20 reps. Go to a higher resistance band once this gets easy.
2 – Standing fire hydrant – You can also do this on all fours. But this is an easier progression for when you’ve recently hurt your back.
Stand just beyond arms length of a wall, feet hip width apart. Draw in your abdomen slightly to create a brace that you will maintain for the entire set. Place your hands directly in front of your shoulders on the wall in front of you. You should be leaning forward on a slight angle, keeping your torso and head in line with your legs. Raise one knee off of the floor, bending it at about a 90 degree angle. The raised knee should be slightly ahead of the planted knee. Now bring the raised knee to the side and slightly behind you, pressing against the resistance band. As you do this your foot should, more or less, remain in the same position. It’s just the knee that is going outwards. Repeat 10x before switching sides. 3 sets. Make your way up to 3 sets of 15 before switching to a higher resistance.
3 – Quadruped glute raise – Start by kneeling. Create a strong abdominal brace. You need to maintain this brace for the entire set. Get on all fours, hands directly under your shoulders and knees directly under your hips. Keeping a 90 degree angle in your knee, press one foot upwards towards the ceiling, squeezing your glute. You want to try and maintain as stable as possible. This exercise, when done properly is way harder than it looks. You want to perform each repetition without shifting your weight when you lift your knee off the floor. You also want to avoid rotating your hips as you lift. This may limit your range of motion but for the time being that is just fine. Repeat for 10 reps then switch sides. 3 sets. Make your up to 3 sets of 20 then switch to a higher resistance.
Once a moderate amount of stability has been accomplished I like to start working on mobility. Mobility is not the same as flexibility. Stretching or increasing range of motion in the spine and hips is often times our reflex to relieve pain and ‘prevent injury’. But increasing range of motion without increasing control or strength is simply expanding the range of movement in which you can get hurt in. So we put together some movement patterns in which you can run through to gain further control in. As your mobility increases, your control of movement within your current range of motion. You can then extend that range gradually and let your body tell you if it is okay or not.
The patterns we use are too complex to describe in a blog post but you can find some good examples in this video. Start slow and listen to your body. After doing a mobility session take a day or two before doing it again to make sure it did not tweak anything.
As for the corrective exercises pertaining to the true cause of your injury, these will have to come from your osteo, physio or trainer. Every situation is different and it is well worth exploring different avenues to find the right combination. If your therapist or trainer does not do a full physical assessment before prescribing a program, walk away. Do not ask your doctor for exercise ideas, go seek a specialist. It will take a bit of trial and error but the right person will do so in a safe manner.
As a fellow sufferer of low back injury, I wish you the best of luck and can assure you that investing some time and money in getting a full diagnosis and proper individualized program will save you from a lifetime of pain. These injuries don’t go away without work. Sometimes they lay dormant until the next time it gets aggravated and each time it will be worse. So get out there and get your life….back.
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