This is not medical advice. If you’ve recently had an accident, go see a doctor.
The Problem
80% of people will experience low back pain at some time in their lives. Unfortunately, traditional medicine leaves people addicted to painkillers, or some undergo multiple back surgeries when more conservative measures would have resolved the problem.
Solving back pain can be difficult, but it’s certainly possible without injections, addictive pain medications, or surgical operations.
When I was 21 years old a doctor diagnosed me with degenerative disc disease. He said I’d never run, jump, or lift weights for the rest of my life and this was based on a 30-second view of an X-ray [seen below].
Using a picture to diagnose a back injury is a flawed method because it’s estimated about 37% of 20-year-olds all the way up to 96% of 80-year-olds have disc degeneration in their spines without any pain symptoms at all!
Ultimately, just because a scan picks up an “abnormality” does not necessarily mean that it is the root cause of pain. When a radiologist sees a bulging disc on an MRI scan, they have no way of knowing whether it’s due to a recent event or is a 20-year-old scar that has healed over time and no longer causes pain, even if it’s still visible on an MRI.
In order to identify and diagnose the cause of back pain, we need to examine which specific movements, loads, and postures trigger pain. Only after uncovering causes of pain can we turn to imaging if we want to identify specific tissues that are likely driving symptoms.
The Cause
Your individual cause of pain is unique.
Your back pain may be caused by a structural issue (bulging disc) or a functional issue (gluteal amnesia), but often it’s a combination of both.
Although there are many different structural causes for back pain, there are really only 4 primary functional causes: Flexion intolerance, Extension intolerance, Extension with rotation intolerance, and Load intolerance.
The first step to overcoming your back pain is to identify the functional causes of your pain. Back Mechanic by Dr. Stuart Mcgill provides tests to identify the functional causes and self-diagnose your pain.
Once you have a better understanding of what causes your pain, you can actively avoid triggering your pain, and you’re halfway to success!
Posture
The first and simplest improvement to your back pain is to spend more time in positions that make you feel good and less time in those that tighten you up.
If your back pain worsens after sitting, don’t sit so much. Stand or perform a half-kneeling stretch at your desk.
Flexion intolerant - spend more time lying on your stomach and make sure your chair has plenty of lumbar support, or avoid sitting!
Extension intolerant - sit back in your chair so you don’t overextend your spine.
Extension with rotation intolerant - stand and sit evenly - don’t shift your weight to one side and don’t cross your legs.
Load intolerant - learn how to brace properly and improve core stiffness.
Poor posture moves stress from muscles to ligaments and this can cause degeneration and pain. It’s critical that you address your daily posture if that’s a cause for your pain.
Muscle imbalance
When our hips are tight and stiff, it causes us to use the lower back for purposes not intended.
Synergistic dominance - inhibition of the glutes may lead to dominance of the hamstrings during hip extension ie. you use your hamstrings instead of your glutes.
Altered reciprocal inhibition - overly tight hip flexors (from sitting for 40 hours a week) inhibits your glutes and your body is more likely to compensate by using other muscles.
To help with common muscle imbalance, we want to increase hip flexor flexibility, strengthen the glutes, and improve glute coordination so that we use them when we should.
Core Stability
If you try to deadlift and your spine rounds during the movement, or if doing core exercises hurts your back, you probably lack core stability.
Learning how to brace and adding rigidity to your spine will allow you to move at the hips, not at your back.
A primary key to building core stability is learning how to engage your lats.
Low back pain solution
The two most effective stretches I’ve found for back pain are the couch stretch and hanging from a bar. The couch stretch will loosen your hip flexor muscles and hanging will stretch your spine and every muscle in your upper body.
To strengthen your core I’d start with the Mcgill Big-3 or any other exercises that help train core stability.
To awaken your glutes and build coordination, practice banded glute bridges and hold at the top to discover if your glutes are active or if you feel your hamstrings and lower back muscles working hard.
Learning to master the hip hinge by starting with the shortstop squat will teach you how to move at the hips, not at your lower back.
Example Low Back Pain Workout
What you need is unique. Here’s a workout template, but it might not be right for you. If you feel any pain, consult your doctor or find a fitness coach to help you improve technique.
A - Cat camel exercise 1x8
B - Foam roll upper back & hips
C - Couch stretch
D - Hang from a bar
1A - Hollow body hold
1B - Side Plank
1C - Bird Dog
2A - Glute bridge
2B - Superman extensions
2C - Oblique side bends
3A - Dumbbell lunge
3B - Single arm row
3C - Single arm db press
Stubborn Pain
Inflammation can cause back pain to persist, so patience is necessary. The number one priority is to avoid triggering your pain by learning the causes of your unique pain. Once you’ve started training the right way your back pain takes some time to heal. Be patient and continue practicing your stretches and strengthening exercises.
When we accept a diagnosis, we accept powerlessness. The more you take ownership for your sickness, the more powerful you become. Take 100% responsibility for everything in your life. Here’s a great book if you’d like to read more on this topic: The Biology of Belief by Dr. Bruce Lipton.
If you want to work with me to overcome your chronic pain, schedule a fitness consultation here.
Hope this helps! - Tom
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