EXERCISE AND LOW BACK PAIN: REHAB AND CONDITIONING

written by: Nem​
Low back pain is one of the most common health complaints. As much as four out of five adults will experience significant low back pain at some point in their lifetime. There are many causes of low back pain, however, the most likely cause of low back pain is muscle or ligament strain and a general lack of movement.

Before we start talking about ways you can fix your low back pain, it's important to make sure you are not suffering from something more serious that needs an immediate medical attention. Kinesiology is an effective treatment for most low back issues, but we first need to make sure you don't have any "red flags" present. 

If you recently injured your back and are currently experiencing any of the following symptoms, please consult your physician right away:

• ​incontinence;
• fever, chills, night sweats;
• unexplained weight loss;
• intense pain even when lying down;
• severse pain going down your leg;
• you recently had a major trauma from falling or you were involved in a car crash.

If you are not experiencing any of the previously mentioned symptoms, it's likely that you are dealing with a minor ligament strain. When ligaments get strained or overstretched they cause pain and unlike muscles, they take longer much longer to heal.

Ligament strain most commonly occurs due to:

• Poor biomechanics - faulty movement and/or poor exercise technique;
• Inactivity - spending too much time in positions that put excessive pressure on low back ligaments and joints;
• Poor low back fitness.​

​POOR LOW BACK FITNESS
When we move, muscles contract to produce movement, but they are also crucial to maintain joint stability and adequate form to prevent joint damage. 

When muscles get fatigued or they cannot produce enough tension to maintain good form, ligaments take over and as a result ligaments get overstretched which then causes pain. 

Since core and low back muscles work in tandem to keep low back healthy and strong, it become clear that we need to emphasize these muscles to stay fit to protect ligaments.

However, this doesn't mean that we should only train core and low back. It's important to train body as a whole to prevent imbalances, but our focus should be on the core and low back since this muscles have a direct influence on low back health. 

Low back and core muscles work together to stabilize the spine and allow proper movement. In fact, low back muscles are classified as core muscles because of their close relationship with other core muscles.

Many people think of core as a six pack or this one specific muscle they need to strengthen when actually core consist of all muscles that run the entire length of your torso.

​We have core muscles on the front, back and side of the torso working together to stabilize the spine, shoulder girdle and pelvis. This provides a stables base of support for your arms and legs to produce powerful pressing, throwing, jumping and pulling movements. ​

​POOR BIOMECHANICS
Having strong muscles is only a part of an equation to keeping low back strong and pain-free. Even the strongest people get injured. Knowing how to use our muscles is just as important. 

As kinesiologists, we teach our clients how to perfect foundational movement patterns like squat, hinge, push, pull, carry and lunge. From here, we add different variations of these movements which furtner expands our clients' movement repertoire.

This means when they encounter some variation of these movements during their normal daily activities, they will know exactly how to move to protect their low back and avoid re-injuring ligaments. 

​INACTIVTY
Sedentary behaviour and inactivity is one of the most significant predictors of low back pain. In other words, individuals who sit a lot and don't move much, are more likely to experience some type of low back pain compared to physcially active individuals.

How much physical activity is enough? Try to accumulate at least
150 minutes of moderate- to vigorous-intensity aerobic physical activity per
week, in bouts of 10 minutes or more. Aerobic activities include walking, cycling, running, swimming and dancing for example. 

If you can meet these recommended physcial activity targets, remember that some activity is better than none. Do as much as you can at the moment and slowly build over time. 

Nem's workshop at Amsterdam Brewery on a topic of low back strengthening and injury prevention. 
​

HOW TO IMPROVE LOW BACK AND CORE STRENGTH

​To build a strong and functional core, you want to include a variety of exercises that challenge the core muscles in different ways. Include movements such as trunk bending (e.g. crunches), holds (e.g. front plank, side plank) and rotations. 

Depending on your current fitness levels and pain intensity, you might need to start with core exercises performed lying down and focus on proper motor control and activation first before moving to more advanced core variations. You’ll need to learn what the neutral position really is and what it feels like to have this neutral spine position. Performing a variety of exercise lying down like dead bugs, McGill crunch and learning how to “draw in” will teach you just that.  

From here you’ll move to different plank variations like a front plank and side plank. Once these exercises become easy, you’ll move to more advanced plank variations where you’ll learn to properly brace your core and keep proper spinal alignment while moving arms and/or legs. For example, try holding a front plank position and then lifting opposite leg and arm at the same time. Do you tilt to one side? Are you able to keep balance and keep whole body relatively straight?

At this stage we can start to include standing and half kneeling positions that involve resisting external resistance. An example of this exercise is pallof press where you obliques and other core muscles resist trunk rotation. 

And finally the last stage of core conditioning include dynamic exercises performed at varying speeds and using external objects like medicine balls and dumbbells. Some examples include standing cable rotations and half kneeling medicine ball throws. 

SAMPLE LOW BACK STRENGTHENING PROGRAM TO PREVENT INJURIES

​If you are not sure where to start, we are providing you with a five exercise sample core routine that you can try right away. This routine will challenge your core musculature from different angles and planes of movement for a complete training effect. The recommended number of sets and repetitions are just an example and you’ll want to adjust these parameters based on your current fitness levels and pain intensity. Slight ache in low back is fine as long as there is no sharp pain present. On a pain level scale from 1-10 with 10 being the most excruciating pain you every experienced, we want to stay withing 1-5 zone. 

You can perform this sample routine 2-4x/week that consist of the following five exercises:

1. DEAD BUG EXERCISE (2-3 sets, 8-15 repetitions/side)

2. FRONT PLANK (2-3 sets, 10 sec hold, 3-8 repetitions)

3. SIDE PLANK ​(2-3 sets, 10 sec hold, 3-8 repetitions)

4. LEG LIFTS ​(2-3 sets, 8-15 repetitions/side)

5. CABLE ROTATIONS ​(2-3 sets, 8-15 repetitions/side)

OTHER WAYS TO KEEP YOUR LOW BACK HEALTHY

In addition to exercise and getting core muscles stronger, there are other things you can do to ensure low back health:
- Weight management - excess weight will put more pressure on the spine and increase likelihood of experiencing some type of low back disorder.
-Proper nutrition - aside from weight management, healthy nutrition will provide you with all the nutrients your body needs to function at its best and support recovery.
-Stress management - stress has been linked to heightened pain response. In other words, reducing stress levels alone can reduce pain intensity. This has to due with the fact that pain is affected by many other things aside from tissue damage.
​- Sleep - our bodies heal when we sleep. Ensuring you are getting 7-9 hours of high quality sleep every night will help tremednously in getting rid of low back pain and improving core fitness. 

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​TO KINESIOLOGY CAN HELP YOU WITH LOW BACK PAIN

If you are looking to accelerate the rehab process or you want to consult professional to ensure you are doing everything right for your body, we can help!

We'll do in-depth kinesiology assessment to figure out where the problem lies and develop an effective low back rehab plan that takes into account your own unique anatomy, physiology, preferences and lifestyle.

Here are some of the ways we can help you:
- In-person kinesiology and personal training
- Online kinesiology and personal training services
- Our full service offering
- Get in touch with us and let us know how we can help
- ​Subscribe to our email list to get our latest updates

Other articles you might be interested in:
- Who are kinesiologists in Toronto and Ontario
- Difference between a kinesiologist and physiotherapist in Ontario