Jul 18, 2022

I may have said in the past that the biggest mistake people make when treating lower back pain is using exercise. However I’m about to contradict myself. There is a time and a place for exercise in lower back rehabilitation and it’s all about creating a stronger biological scaffold to help support the spine during the rigours of everyday life.

Understanding pain triggers before introducing exercise

All manner of daily activities can cause stiffness and pain in the back. So our first step is to work out what it is that is triggering your pain from an everyday perspective? Can you sit at your desk and be pain free? Can you go to the shops and lift your shopping bags up pain free?  We need to work out how to manage the movements that are causing a problem.

Once we’ve got to the bottom of these we can start to understand how we build exercises that help rather than causing further issue. The aim is to reduce pain and build endurance. In the video tutorial above I share some images with you. These demonstrate that it’s not the actual exercising that strengthens your body, it’s what comes after. During exercise the body fatigues. When your workout ends, your body starts to recover and it comes back with the hope of being stronger. As your body comes back stronger you get what’s called super compensation. You then go through the cycle again – workout, recovery, super compensation to reach upper compensation. You’re getting a little stronger every time.   

Exercise in the right way at the right time

It’s not just a case of doing this once a week or once per day, you need to use exercise in the right way and do it at the right time. How much and when will depend on your pain triggers and how your body responds to the changing of its posture and your everyday habits. You might need to do one set of excises for a very short amount of reps to activate the muscles. Remember: the goal is not simply to get stronger it is learning how your body responds to training, manages its fatigue and then recovers, trying to get into the upper compensation phase so we can build further.

There are no hard and fast rules to the approach we take. We might use one exercise here, two here, etc. As long as the body is responding in the right way, we continue.  The key thing about the online consultation that I offer, is that I need to know how your body is going to respond during the initial stage of just understanding the pain triggers and then reducing them once we then start adding exercise. Only then can we add in progressions. That is honestly the biggest mistake people make. They do too much exercise too soon and too often. We need to manage that.

Let’s look at what a training  program could look like.

Which exercises should we choose?

The exercises that we are choosing need to involve some sort of movement. It’s not about doing heavy squats and heavy bench press or pull-ups. What we need is mobilisation. Yes, there needs to be a degree of challenge because we’re wanting to recover stronger. Early mobilisation and tissue loading has been shown to have positive effect, giving time and opportunity for tissues to heal.

Back to those pain triggers

By understanding pain triggers we can start to understand which tissue is creating the problem. Is it the disc? Is it the vertebra? Is it the nerve? Is it the muscle? Is the muscle causing the problem as a consequence of the pain coming from somewhere else? And if so where?

There is no one size fits all. There are certainly exercises that we will choose more than others and there are common threads to the exercises that are chosen but it is not just the case of saying here are your four exercises go and do it.

It is wise to initiate a loading program the moment the pain permits. But if you are constantly in pain there is no point in doing exercise programs, as that is probably going to make the problem worse. First we must get control of the pain of the pain triggers.

Incorporating bracing or stiffening

Bracing or stiffening of the intricate muscle network that supports the spine is one of the core skills we need to work on once we’re ready to get started. The muscles we’re referring to are the spinal erectors -  both deep and superficial - the abdominal wall, the lats and the thoracolumbar fascia, among others.

Bracing the abdominals can do the important job of reducing joint micro movements – something that’s important to bring to exercise if we want to minimise pain and injury from little jolts or missteps. We need to be aware, however, that too much bracing could cause a problem if your spine doesn’t like excessive compression.

Hip hinging

Hip hinging is another core skill that helps to activate the glute muscles. While back pain inhibits the gluteal muscles of the hip, it also tends to facilitate or tighten the psoas muscle. And it’s this psoas muscle that you find a lot of people trying to stretch out using big long lunges they’ve found on the internet. That may be useful, but only if you also activate the glutes alongside. You see, the tighter the psoas gets the more inactive the glutes become. So as we start tightening the glutes the psoas will calm down.

I explain more about this and the importance of stabilizing the pelvis in the tutorial above.

Building an exercise program for lower back pain

When it comes to building an exercise program for lower back pain, it needs to do a few things. We need to get control of the pain trigger and then understand the key concept of super compensation. Then we need to start looking at exercises that help us practise bracing the abdominals and hinging the hips to get the muscles working in the right way.

Once we do that we are in a much more effective position to start overcoming your lower back pain.

If you would like your own tailored lower back pain rehabilitation program, just click the link below go through to my how to overcome my lower back pain consultation and we can get you started on your road to your lower back pain rehab program.

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