lower back pain



One of the most common issues I see as a trainer is lower back pain/tightness. Some of the pain can easily be assessed and corrected like when someone tells me they deadlifted the day before and now their lower back is tight. In this instance, I focus on helping that person with their deadlift form and it usually goes away.


Some other times though, it's a little bit more complicated because a client will walk into the gym and say "I don't know what I did, my lower back just hurts". In these cases, in which there is no way to pin point exactly what causes it, I do the only thing that I can to help which is making sure that the spine is aligned properly. The easiest way to know whether this is happening or not is by:


- Making sure the lower ribs are aligned with the pelvic floor-


If we can achieve this, we know that the spine is aligned properly and there should not be excessive compression anywhere, including the lower back.


Before we go any further, it's important to note that I am not a doctor and do not diagnose pain. The above strategy is a pretty broad one and if that does not improve the client's pain, I refer them to a doctor.


Let's take a look at the image below from DNS to get a visual understanding.

(https://capitalchirodsm.com/introduction-diaphragmatic-breathing/)



In the upper left picture (A) we can see our natural spinal curves. We want to have an appropriate amount of lower back curving in (lordosis) and upper back rounding out (kyphosis). You can also see in the picture the thoracic diaphragm and pelvic floor (the two green domes) facing each other.


When people come to me with random lower back pain, I know that they are coming in with some sort of variation of the upper right picture (B). The two diaphragms aren't aligned properly and we can see the increased lower back curvature. This increased curvature puts more stress on the lumber spine and affects the following muscles:

- spinal erectors

- hamstrings

- glutes

- obliques

- transverse abs

- hip flexors


Note: we can also have the opposite problem, a spine that is too flat. This will also affect these muscles and misalign the diaphragm and pelvic floor.





Spinal erectors


These are your muscles on either side of your spine and are typically the ones that get really tight. If you run your hand beside your lower back and feel like there are two iron cables beside your spine, odds are those muscles are a little tight.



Tight spinal erectors increase lordosis, so we need these muscles to chill out.












Hamstrings


These tend to be in a constant state of elongation (they are always longer than they should be). They help to pull the pelvis into a posterior pelvic tilt, which helps to restore a normal lordosis.


Since they are in a lengthened state, they cannot do that properly, so we need to make these muscles work harder.










Glutes

An increase in lower back arching (lordosis) tend to make glutes long and weak. This causes your hip extension to become weaker, which makes your lower back work more. Engaging the glutes is not my initial focus with lower back pain but comes into play later. We will discuss glutes in a later post.








Obliques and transverse abs


These help to pull the front of the pelvis into a posterior tilt (like the hamstrings) and are also in a lengthened state, which prevents them from doing that properly. The goal is to make these muscles work more.


They also pull the ribs down as you exhale, so paying attention to your breath as you do exercises will help you a lot to feel them.


This muscle here is the transverse, with the oblique being a bit smaller behind it.








Hip flexors

They pull the pelvis into an anterior tilt (like the erectors) and are also tight. Just like the erectors, we need to make these muscles relax.













Quick recap on what I focus on:

- relax the erectors and hip flexors

- get the hamstrings and obliques and transverse the work more.


I prefer to get my clients to work on strengthening the weaker muscles first. This will also make the tight muscles relax so I find it more efficient than starting with hip flexor stretches or lower back stretches.


The order of importance (for me) is this:


  1. Get people to feel their obliques. This can easily be done with this move:



Important cues:

- Inhale through the nose

- Exhale as much air as you can. The more you exhale, the more you will feel the obliques

- Gently pull your elbow towards your knees as you exhale

- Do 2 sets of 5-8 breaths per side

- Gently tuck your back pockets towards the back of your knees throughout the movement


Then we can progress to this type of movement, which helps focusing on both obliques at the same time:


Important cues:

- Gently push your elbows into the ground when you inhale

- Exhale as long as you can. You should feel both oblique work as you do so

- Gently pull your elbows towards your knees as you exhale

- Do 2 sets of 5-8 breaths


2. Feeling your obliques AND your hamstrings at the same time


The next level is to add some hamstrings to the mix. We can start with a very easy move like the 90-90 breathing drill below:



Important cues:

- Gently squeeze the ball

- Pull the wall down with your feet

- Reach for the ceiling with your hands as you inhale

- Exhale for at least 5 seconds

- Do 2 sets of 6 breaths


Once we can successfully feel both our obliques and our hamstrings, we can move to something a little bit more challenging like the single leg bridge on foam roller:



Important cues

- Reach for the ceiling with your hands as you inhale

- Push your foot down into the roller as you exhale

- Exhale for at least 5 seconds

- Do 2 sets of 6 breaths per leg


3. If they CANNOT feel any hamstrings during these exercises, we can look at loosening the hip flexors by either doing the couch stretch or some hip flexion pails/rails.


If this sounds a bit confusing, feel free to book a free fitness consult with me to go over this material in person.


Once we have our obliques and hamstrings feeling good, we reassess the pain. There are two options here:

- Lower back feels better: great! We move on to our regular workouts and focus on keeping our obliques and hamstrings engaged.

- Lower back hasn't improved: We do a workout that does not aggravate the pain and I tell them to go get checked by either a physio, physical therapist or doctor.


The importance of proper breathing

Your diaphragm is your biggest respiratory muscle and has a TON of implications on your posture and potential pain issues. Learning how to use it properly can help resolve some pain issues.


If you don't know already, here is your diaphragm:



Notice how the right diaphragm is a bit more rounded at the top and has longer attachments down the spine compared to the left side. We won't talk about that just yet but it's good to start noticing this.


When we inhale, our diaphragm contracts and goes down. This creates a vacuum in our chest cavity that allows air to flow into our lungs. When we inhale properly, the diaphragm will stay parallel with the pelvis as our ribcage expands forwards, backwards and sideways. When we inhale IMPROPERLY, the air still has to go into your lungs somehow, so your ribcage will expand more in one direction, creating unwanted pressure in places like your lower back or your neck.


Check out the video below for a visual explanation.



Here's the posterior rib cage drill:



Lower back pain can be caused by a lot of different things. Without a proper medical diagnostic, the best we can do is the make sure that we have a proper alignment of our spine. Your diaphragm, obliques and hamstrings are the three muscle main muscle group that we can go after in order to do that. Proper breathing mechanics is also a simple yet often overlooked detail that can help us relieving pain and that starts with learning how to breath with your diaphragm.


If you would like to get a more individualized assessment on this subject, book a free fitness assessment with me right here.


Happy training,


Clem












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