"Low back pain is one of the most common complaints heard at doctor’s offices."
Believe it or not, it’s estimated that 80% of people will experience low back pain at some point in their lives. Actually, it’s probably pretty easy to believe, since most of us have experienced it ourselves. Low back pain is the number one cause of work-related injury and lost work days, and it’s estimated that 25% of people have experienced in the last three months alone. In today’s show, Dr. Keller Wortham, MD, explores low back pain and demonstrates some great exercises to bring relief.
- 00:51: Causes of Low Back Pain
- 02:31: Managing Low Back Pain
- 03:22: Muscles in the Lower Back
- 04:30: Six Exercises for Lower Back Pain
- 15:13: Stretch
Causes of Low Back Pain
Low back pain is one of the most common complaints heard at doctor’s offices. A variety of factors can contribute to low back pain. It can occur suddenly due to an accident, a fall, or lifting something heavy, or it can come on more slowly, perhaps due to regular wear and tear of the body, or arthritis, long periods of bad posture, a sedentary lifestyle, or overexertion due to infrequent exercise. It can also be caused by metabolic disorders, disc herniations, bone fractures… the list is really endless.
Most of the time, back pain is mechanical in nature, meaning it has to do with the hardware — the muscles, bones, tendons, and ligaments — and something is either injured or out of alignment in the musculoskeletal or mechanical system. This is because the back sustains a lot of stress from our lives. Whether we're walking, sitting, standing, or exercising, our lower body and upper body meet at the lumbar area, and a lot of that stress can translate to injury to the bones and muscles in that area.
Managing Low Back Pain
The first thing your doctor might do if you are complaining of low back pain is to make sure that there’s nothing dangerous going on, like a fracture from a fall, or some kind of nerve disorder causing numbness and weakness in the lower extremities. One of these could be a sign of a more urgent issue.
Most chronic back soreness, or for back pain caused by something mechanical like lifting something incorrectly or straining the back while working out, the doctor might provide recommendations to strengthen the muscles around the low back. Stronger muscles can better protect the nerves bones in that area, and help prevent future injuries.
Muscles in the Lower Back
Let's just kind of do a quick review of some of the muscles in the lower back. These include:
- The transverse abdominal muscles
- The quadratus lumborum
- The internal obliques (side muscles)
- The glutes (muscles in the bottom)
- The lumbar multifidus, which is the muscle that spans the length of the lumbar across several vertebrae and attaches to some of the sacrum.
- The pelvic floor muscles
This group of muscles is what we commonly refer to as our core muscles. And it's very important to keep them strong, so that we have good posture, so that we're protecting our lower spine, and to prevent herniated discs, fractures, and other injuries.
Six Exercises for Lower Back Pain
The following exercises can help strengthen the lower back muscles both to prevent future pain and relieve current pain in the low back.
- Start in a tabletop position with knees hip-width apart, and hands underneath your shoulders.
- Extend one leg backward, straight with the toe pointed or flexed
- Extend the other arm forward
- Hold for 2 - 3 seconds, then switch sides
- Do 10 reps on each side
If it’s too challenging to extend both the arm and leg at the same time, you can do just the leg and then just the arm. You want to maintain a straight line in your spine, not allow it to dip in the middle.
You're going to feel it in the low back, and it will help with cross body support as well, and strengthen some of the muscles of the shoulder upper leg, which can also be helpful for supporting your low back.
- Start lying on your back, with your feet resting on the ground. You want to put your heels to be about where your fingers can touch them, about hip-width apart.
- Engage your glutes, the backs of your legs and your core, to raise your hips off the ground, and hold that position for 10 to 15 seconds.
- Slowly release back down to the ground.
- Repeat for about 10 reps
If your fingers are touching your heels when you're lying down, this will ensure your knees are properly aligned. You don't want your feet too far out or too close to you because it could put more stress on your knees.
Joe vs. Superman
This exercise can really help strengthen your back.
- Start lying down in a prone position face down
- Use your hands as a pillow under your head
- Alternate raising one leg with the toe pointed
You want to feel like the motion is driven by the glutes and the upper leg. Again, you don’t want a banana shape in your spine, which can be hard on your back. Your leg doesn’t have to be too far off the ground — six inches could be enough, and it should point straight back.
If you want more of a challenge, then you can extend your hands forward and do a karate chopping motion. Then raise both your arms and legs at the same time, again, again not too far up. Tuck your chin so that it looks like you’re flying (hence the Superman in the title). Again, hold for about three seconds and then release back down.
You will feel a major engagement of the muscles along your spine (your paraspinal muscles), your glutes, and a lot of those other muscles that we mentioned in the beginning. This helps protect the lumbar and vertebrae against all the stress that they have to endure to keep us up and walking.
This is a really good core abdominal building exercise. It’s easier to execute on your elbows, instead of in a full push-up position, which involves a lot more upper body strength.
- From your hands and knees, lower yourself down with your elbows on the floor
- Extend your legs out behind you. Maintain a straight line from your crown to your heels, without letting your spine collapse in the middle
- Keep your core and glutes engages, so that you feel support along the entire body
- Hold for 30 to 60 seconds. If you can’t do it for that long, work your way up to that.
You your elbows under your shoulders, and you can either place your hands parallel to each other, or if that’s difficult, clasp them together. And either way, you want to try to hold plank for 30 to 60 seconds. I have a little competition with myself. You should feel this across the low back and also on the front side in your abs.
When you're done, it’s nice to do what they call child's pose in yoga, to stretch out your back. Start on your knees, and then lower your hips to your heels and place your forehead on the ground, then extend your arms out in front of you. You should feel a nice stretch in your low back.
We've done a lot to engage the muscles in the front and the back, but we also need to engage the side muscles, and the obliques. Side planks, a variation on the previous exercise, can help with that.
- Start on your side, with your elbow right under your shoulder on the mat, your hand perpendicular to give your some support.
- Extend your legs out, with one foot on top of the other, and raise your pelvis up
- Hold this position for 30 seconds if you can
- Release and switch sides
Again, make sure that you keep your hips raised and don’t let them sink down. The side plank will really help with the transverse abdominals and the internal obliques.
This is another cross body exercise, that’s great for the abdominal muscles, as well as the hips and and upper arm muscles.
- Lie down with your back firm against the ground.
- Scoop your tailbone up so your low back is flush with the ground. You don’t want to be able to two hands underneath your back.
- Raise your legs, keeping the knees bent so the shins are parallel to the ceiling.
- Raise your arms above your head
- Lower one arm back over your head, and the opposite leg down
- Hold for about 3 seconds, then bring them back up, and switch sides
By keeping your legs up and perpendicular and by keeping that arm up even when you're lowering one side, you're still engaging some of the other support muscles, so you'll get really good exercise of the abdominal muscles, as well as the low back on the posterior side.
Those are six exercises that you can do at home without any equipment. You can do them on the carpet if you don't have a mat. Do them every day, or at least several times per week, and you will start to strengthen those core muscles. Those muscles are really important for stabilizing the spine and helping protect the discs and ligaments, and all the other tendons which will help keep your lumbar spine safe.
Sometimes, lower back pain can have to do a tightness, so you want to make sure that you're also stretching. We talked about child's pose which is a good stretch for the lower back. But sometimes it can have to do with tension in the hip flexors. For this, you can do a runner's lunge by stepping forward with one leg and lowering all the way down, keeping the other leg extended out behind you and lowering that knee to the ground.
Stretching out those hip flexors can help correct a misalignment of the pelvis due to tightness there.
There are also lots of different ways to do a hamstring stretch. If you've got a band or a belt even, you can put it around your heel, lie down, and just use that to pull your leg up to stretch out your hamstring.
You might get to a point where you have to bend your knee a little bit, and then try to extend, resisting against that belt. You want to go a little bit past what's comfortable, allowing your leg to bend, and then pushing up. Don’t keep the knee locked, or pull so hard that you tear something. Allow it to bend, and use your own muscle strength to stretch against the resistance that you've put there. That's a safe way to stretch your hamstrings.
The hips and hamstrings are muscles that really pull on the pelvis and attach to the low back, so stretching these is very beneficial to increase flexibility and strengthen core muscles to help support your lower back and prevent low back pain.