Lower back pain.
We all struggle with it at some point.
Whether it’s from our sedentary jobs, previous injuries or from training most of us have had lower back issues. These injuries or issues can sometimes leave us out of the game for extended periods of time and a decent physio or physical therapist is hard to find. It can be a frustrating journey especially when we don’t have a system to help the recovery process from lower back pain and other debilitating issues.
Not only does lower back pain force us out of training or enjoying our favourite sports and activities it can also cost us financially, mentally and emotionally. The flow on effect of injuries can last well after the injury has disappeared. As first priority we should be using a system that:
a. gets us back to activity as soon as possible
b. can be done with minimal equipment or coaching
In order to achieve that we need to start with some basic knowledge and actions on to ensure we don’t make the problem worse. Firstly, pain. We all have different thresholds for pain but knowing when something is not right is usually a guessing game. So how do we work around this?
Tests, screens and assessments.
Just like my 10 Step Self Screen you need a basic screen you can do yourself in order to know whether or not you should be heading off to the specialist or physio. If the lower back pain is that bad, skip the screen and go straight for a scan and second opinion and the rule of thumb here is, if in doubt, refer out. This should be anyones decision tree when training, especially coaches.
Secondly is understanding the probable cause which should guide treatment or management of the condition. Here’s a few common causes of injuries and where you should head once you know what your cause is:
- Previous injury – The leading predictor for injury is previous injury. Head straight to a specialist for physio, rule out any further damage and begin your rehab with assistance. For experienced individuals you may have the knowledge and training to manage your condition, the rule here is that if you keep getting injured you’re clearly doing something wrong, find someone to coach or help you through the problem
- Exercise/Movement related – You were in the gym and something happened in a particular movement but you have been training consistently for a while. If serious lower back pain is present, refer out. If not, conduct a screen and assess movement competency. Fix whatever presents and only return to previous exercise intensity or weight once issue has been addressed.
- Sedentary lifestyle – Usually issues present here from going too hard too soon. Remembering the rule for referring out and once you are able to screen, assess, deal with the issues present and reduce volume/intensity/complexity and gradually increase over time.
Once we have conducted our screen or received a second opinion it’s time to start our rehab. Time to recovery is different for everyone so ensure you pay due diligence to your rehab, test and assess regularly and refer out if you hit a roadblock.
A simple approach to keep your rehab moving you can use is mobilise, stabilise and integrate. It’s what we use here in the Unlock Your Movement series that usually hits most markers to getting back to activity. So how do we use it for lower back pain? Let’s take a look.
Mobilise – Firstly, check and reset your breathing pattern. Quite often its a poor ability to use diaphragmatic breathing to brace which leads to lower back injuries, crocodile breathing is a great addition here. Be sure to use soft tissue or trigger point therapy to address tightness in any muscles. Look at muscles that are effected or effect the flexion pattern in order to try and reestablish range of movement, QL (Lower back), Glutes, Psoas (hip flexors) are a good starting point. Thirdly, look at mobility stretches the work on flexion (if you can comfortably manage this), hip extension and rotation focus on being able to breathe through range and not forcing into pain.
Stabilise – For this element we look at trunk stability, glute activation and hip extension. We start from the floor and work to standing by adding stability exercises that challenge not only symmetrical stance but single and split stances. Starting with simple deadbug drills on the floor and moving to bird dogs in quadruped help give a person the perception of safety on the ground which allows range to be reestablished. We can then take it to half and tall kneeling with exercises such as the chop and lift.
Integrate – Once we have restored range, stability and confidence (this is more important thank you think) we can integrate the movement back into our training. Utilising symmetrical, split and single leg stances reinforce the mobility and stability work we have just done. In terms of lower back pain, focus on movements that encourage a static spine before dynamic movements e.g. split squats are great as you can maintain an upright position, then move to squats and the hip hinge movements as there is more likelihood or flexion in these movements. Start with no load and with assistance if needed (TRX is a great option) and progress from there. And obviously, grinding or slow strength movements (squats, deadlifts) before ballistics (kettlebell swings).
Here’s the in depth version lower back reset for those wanting to really gain an understanding of the process.
- If in doubt, refer out.