Back pain 2: Kick low back pain to the curb

So let’s say you are in pain. What do you do?

Address the immediate, acute symptoms. Manage the pain with over the counter medication and anti-inflammatories (if you can tolerate them). If the pain is a result of a particular event (such as bending over to pick something up and feeling a sproing), ice it for the first 24 hours. After that point, you can use ice if you prefer, but I have found heat to be much better for relieving muscular spasm symptoms. Find positions that make you comfortable. Avoid activities that cause pain for the short term.

Keep the area moving as much as possible. As soon as you can walk around, do so. Keep moving frequently and regularly. Gentle walking is good, but you may also find swimming and yoga are tolerable. If you know any belly dancing, this is also a great treatment for LBP. Lying in bed is the worst thing for back pain, as it seems to exacerbate or prolong the symptoms.

Begin to do specific exercises as soon as you can. These exercises serve both a rehabilitative and preventive purpose. In general, these exercises fall into a few categories: spinal flexion exercises (rounding the back, such as curling into the fetal position), spinal extension exercises (arching the back), bridges, and quadrupeds. I demonstrate a few of these in Part 3. I highly recommend purchasing a copy of Robin McKenzie’s book Treat Your Own Back, which is cheap and available at the major online book stores, but if you want to spend a few extra bucks, invest in Stuart McGill’s book Ultimate Back Fitness and Performance. McGill is one of North America’s experts on back pain and spinal biomechanics. Many people find that these exercises, if performed at the onset of a LBP episode, can bring immediate relief or shorten the duration of the episode. Exercises should have the purpose of mobilizing the affected area, strengthening/stretching, and/or improving awareness of the low back/pelvic region. Research demonstrates that people with LBP appear to be less able to stabilize their pelvic region (for example, while sitting or standing), and that they have reduced endurance (note: not strength) of the spinal extensors, but whether this is a cause or effect of the original problem is not yet clear.

At work, if you spend a lot of time seated, change sitting position often. Get up and walk around for a few minutes as frequently as possible. Some LBP sufferers swear by sitting on a Swiss Ball.

One “home cure” recommended for DJS by Stuart McGill is to put on a lightly weighted, well fitting backpack (say 5-10 lbs) and go for a 15-20 min walk over uneven terrain. He’s found this to be a useful and free “cure” for students who show up at his university office with back pain from being hunched over studying for exams.

Be aware that you are most vulnerable to re-injury when fatigued, or for about half an hour after getting out of bed in the morning, or after getting up from sitting for a long time. During this period, take extra caution to keep a neutral spine and use proper lifting technique (more on this below). The most common injury moment occurs during household tasks for a couple of reasons.

First, people don’t pay as much attention to their lifting technique during household activities as they do in the gym. If you’ve read this site you should know how I feel about gym technique, and you are probably trying to be careful with your form in the gym. But you’re likely not paying as much attention to how you pick up groceries or rake leaves.

Second, household tasks involve a lot of stooping, lifting, and bending, frequently in awkward positions. So, you may be performing a perfect squat, but throw out your back when you bend over to put a dish in the dishwasher. A previous roommate of mine threw out her back for weeks after she coughed while bending over to open a low dresser drawer.

When lifting a weight of any kind, even a bag of groceries, hold your breath for a split second during the toughest part of the lift. Don’t hold it till you turn blue. Just hold it for a very brief moment during exertion. Imagine someone is going to punch you in the gut. This helps the torso musculature rigidify and stabilize the spine.

After your injury, start back to regular weight training slowly and carefully. Maybe you won’t be able to squat this week, but next week might be okay. Keep the weight moderate, stop before you are too fatigued, and check your ego at the door. Progress gradually, letting your body dictate the pace. You may find that more, shorter sets are better than fewer, longer sets. For instance, 8 sets x 3 reps might be better than 3 sets x 8 reps (using the same weight for the 3 rep sets as the 8 rep sets).

People with LBP can squat and deadlift and do any lift they like, as long as it does not cause pain. There are powerlifters with disk herniations who were able to return to squatting and deadlifting heavily with no ill effects. Different people will have different needs. Everyone has their own theories on what works. Some ideas may work for you. Some may not. Do what works best for your own situation. For some people, deadlifting is a great rehab exercise. For others, deadlifting is one activity that will need to be avoided. The only exercise that I consider a bit too high risk to attempt with LBP sufferers is the stiff-legged deadlift. That being said, some folks may find it an invaluable rehab exercise. So again, experiment (with care), be creative, and do what doesn’t cause pain. For folks who experience LBP from squats, Ironmind makes a hip belt that allows the lifter to attach the weight so that the load is distributed around the hip, rather than axially down the spine from the upper back (as in a regular squat).

Somewhat counterintuitively, standing exercises may be less painful than seated exercises. For example, a standing overhead press, because it allows the spine to move freely, may be less painful than a seated overhead press, where the spine is limited in its movement. In general terms, the freer the movement, the easier and less painful it often is. An unweighted squat may be pain-free, while a leg press on a machine may be quite problematic.

Combine your regular weight routine with rehab exercises. Do this as “preventive maintenance” for at least a month or two after the resolution of the pain, or forever if you like.

A weight belt may help with proprioception. Proprioception is the body’s awareness of what it’s doing and what’s going on. If a weight belt is worn by a lifter, the lifter can use the touch of the belt to help be aware of what the torso is doing, and to stabilize accordingly. Pushing against the belt during a lift also increases intra-abdominal pressure (IAP), which also assists in torso stabilization.

Drink lots of water. It helps keep the disks hydrated, happy and squishy. When disks get dehydrated, they lose their elasticity and begin to deflate.

If you are carrying a lot of weight around your midsection, consider throwing some of it overboard. This will reduce the load on the spine that is pulling it forward.

Keep a neutral spine as often as possible. Neutral spine isn’t really one particular position, but more like a dynamic state where the spine is allowed to find its natural and preferred position, depending on the requirements of the task. In general there should be a natural curve in the lumbar (lower back) region; however, if you are pressing overhead, you should tuck this curve slightly.

Squat to lift, always. Let the legs do the work. If possible, never move a load with the spine in flexion, i.e. rounded (unless it’s specifically a spinal flexion exercise, such as an abdominal crunch).