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Lower back pain is the single leading cause of disability worldwide, with about one-half of all working Americans admitting to having back pain symptoms each year. These numbers are astounding. So the question is not if you get lower back, it's more like when you get lower back pain -- what should you do about it? Most of the time we aren’t sure why what caused our lower back pain to start in the first place, much less what to do to make improvements. The following are things you SHOULDN’T do to help get you back on the right track. Lower back pain can be like an old scab -- if you continue to do things don’t allow it the opportunity to heal, it wont! Fail to acknowledge that its there Don't settle because your old, fat, out of shape, tried therapy, or someone said you had a herniated disc. Don't let it become a part of your identity. Having pain is not normal, and sometimes we struggle to recognize this. If you experience lower back pain or extreme tightness after your workouts, something's not right. It's always better to take action now before it turns into a more frustrating, more painful issue that can lead to unnecessary costly injections and procedures down the road. If you have pain, even minor pain, take action to eliminate it.  Continue doing things that aren’t helping I actually had a patient once who severely injured her back performing an overhead squat. She saw a chiropractor, was was told she will need to do prone press ups the rest of her life. Seriously? This isn’t a hit on chiropractors because I see it happening all the time in the physical therapy profession too. After 2 weeks of simple treatment specific to her injury, she was back to working out without issues. If you’ve been told something like this, or if you’ve been doing the same lower back routines day in and day out without long term relief, it might be time for a change. When it comes to the lower back, “rehab” or “conditioning” exercises should not be painful, and typically it don’t take long before patients start experiencing significant relief (if you select the right ones). If you’ve been doing the same movements or exercises for weeks or months, it's time to consider some different avenues.  Sit or rest for long periods First rule of thumb → after a lower back flare up or aggravation, that last thing you want to do is sit on the coach, binge on Netflix (unless it's Game of Thrones) and try to wait it out. If it’s really bothering us, sometimes we don’t want to move at all, however if we avoid movement, we allow the problem to fester. It may be uncomfortable to get started, but exercise has been proven to be beneficial for nearly all low back pain cases. The best action is to find a simple form of exercise that feels okay. Examples might include going for a walk, spending time on the stationary bike, or doing some light rowing. When we move around, important healing hormones are released which circulate throughout the body, and nutrient rich blood flow is directed to the healing areas. It also causing increased muscle activation, thus providing more stability to aggravated area.  Do things that are painful While this may seem like common knowledge, when our back tightens or flares up, often we continue to engage movements or positions that aggravate the area. It's almost like picking a scab. If we continue to aggravate it, it simply will be slow to recover. If a particular lift or movement (i.e. deadlift, burpee) continues to cause pain, it’s time to take a break from it. Pain is a signal that something isn’t right. Either sub the exercise out or modify it so its pain free. Just as its important to consider activities in the gym, is to consider painful activities outside of the gym. Sitting for extended periods, sleeping on your stomach, driving for long periods, lifting heavy objects with poor form, and twisting awkwardly are all common activities that tend to increase your pain. Be smart and listen to your body.  Lift with poor body mechanics Speaking of lifting, If your going through a period of lower back pain or tightness, it's important to recognize if you’re putting unnecessary stress on your back… whether from poor body mechanics when picking something up from the floor or poor technique when weight lifting. Allowing your weight to shift towards your toes when performing these activities puts increased strain on your back. Recognizing this simple concept can significantly reduce lower back pain and pressure. It's also important not to bend at your back throughout the day. If you need to pick something up, make sure to keep it close to the body and use your legs, even go down to one knee if you have continued pain.  Don’t seek help from a back pain expert (physical therapist) when you know you need it
If you’ve had an acute flare-up or experienced pain for more than a week or two, stop wasting time and see a doctor of physical therapy. Lower back pain is the most common thing we treat. Do you need a referral from an MD? No. Do you need imaging (x-ray or MRI) before treatment? No. Research studies have shown that 60%+ of people WITHOUT lower back pain have imaging studies that show bulges or degenerative changes. While it is noble to try to manage the pain yourself, the earlier you start treatment, the better your chances are of making a smooth recovery and quickly returning to normal activities, and keeping it at bay for good. If you’re a CrossFit athlete, check out my FREE ebook on the most common reasons CrossFit athletes suffer from lower back pain, and what to do about it. Just click the link below! Thanks for reading, Dr. Andrew
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This is one of the most common questions I get so I thought it would be good to expand on it today. It's the all to common story -- you’re mid wod, doing great, then all the sudden your back gets tighter… and tighter... and tighter… and so tight to the point where you’re forced to grab a weight belt or take extra long rest breaks. Your lower back muscles eventually get so tight you quit the workout in fear that you might do some long term damage. Now your on the sidelines frustrated and wondering why. Well, you’re essentially overloading the muscles of the lower back leading to the excessive “pump” feeling. This can happen from a number of causes, but here are the reasons why: You have tight hip and a stiff thoracic spine (mid/upper back) Our daily habits OUTSIDE of the gym play a tremendous role in your ability to workout safely. If we develop stiffness in the areas above and below the lumbar spine - the thoracic spine and hips - our bodies will cause the lower back to work harder to pick up the slack. And we all know happens when we overwork our lower back. If you sit all day, whether at work, while driving, or binge watching NetFlix, chances are you have tight hips, specifically the hip flexors (known as the iliopsoas). This muscle has a direct attachment to all the lumbar spine vertebrae and is one of the top contributors of lower back pain and tightness. It is absolutely essential that you spend extra attention here. Add both the world's greatest stretch (video below) and kettlebell psoas release (video below) to your warm-up routine. Also spend extra time warming up as a whole - being warm and loose increases the your bodies ability to circulate blood and fluid, which will help to mitigate the pump feel and decrease the chance it will fire up.
You use your back when you shouldn’t If you’re dealing with lower back tightness, chances are your failing to hip hinge. Meaning in instances where you should be using your hips and legs to complete tasks, you’re using your back. This can range anywhere from picking up heavy plates and loading the bar to rounding during a deadlift or dumbbell power snatch. Speaking of the dumbbell snatch - how many times have you “blown up” your back with high reps of this exercise?? You are likely not thinking about your legs enough and bending at the back with every rep. Take your time (as fast as you can of course haha), and use your legs more. Bend at the hips and try not to round at the back.  You lack weight shift control while lifting This one is HUGE. How often do you pay attention to how your weight is distributed within your feet? When performing an exercise, every time you shift towards your toes you increase pressure and demand on the lower back. This can happen with any exercise but especially when the weight (or your weight; ie running) is in front of your center of mass. This commonly occurs with front squats, cleans, overhead squats, deadlifts, dumbbell snatches, barbell thrusters, wall balls, kettlebell swings, and burpees. I bet these are some of the most common movements that tighten up your back, right? Pay attention to how your weight is distributed in your feet! Ideally your weight should be evenly distributed between your heel, the ball of your foot, and just behind the pinky toe OR shifted more towards the heel only depending on the movement (ex: deadlift). Being conscious of this tip alone will make a huge difference.  You lack core strength and control
Essentially you’re allowing too much spinal motion during your CrossFit movements -- both extension backwards and flexion forwards. A great example of when this occurs is when pushing weight overhead. If your shoulders are tight, you’ll likely extend at the lower back to get the weight fully overhead. Not good. Another example is the power clean -- when the load starts to get heavy, an athlete will often extend forcefully at the lower back, and even worse, catch the load in the extended (over arched) position. Here's where athletes go wrong. They are often told by Dr. Google or another healthcare practitioner to strengthen the lower back with movements like supermans, reverse hypers, or bird dogs. What you should be doing is training stability of the anterior core. And i’m not talking the 6 pack exercises like crunches, russian MB twists, or sit ups. I’m referring to “anti-motion” exercises like the plank, pallof press, or ball slam. These exercises will give you the stability you need to prevent the overworking tightness on the posterior side. Add them into your routine. It sucks when your lower back starts to tighten because it can often ruin a workout. Paying attention to these key 4 concepts will make a huge difference when implemented regularly. What doesn’t work includes inversion tables, hot packs, e-stim, gravity boots, hamstring stretching, foam rolling, or other passive modalities. If you want a long term fix, take action. Lower back pain is the number 1 area we treat at The Charlotte Athlete and we would be glad to help. If you’re in the Charlotte area and are interested in working with a unique professional that can help you improve your lower back health long term, we need to talk. Being proactive and staying on top of your health will help you avoid serious health problems down the road. Submit a contact request by clicking the button below and we’ll get you set up with one of our Doctors for a free 15-minute phone consult. Thanks for reading, Dr. Andrew |
This is where we share our expert opinion on hot topics in physical therapy, injury prevention, sports performance, strength and conditioning, nutrition, and sometimes other random thoughts. Enjoy.
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