The alarm goes off, you roll over to turn it off as you take a glimpse at the time, 6 AM.
Sigh, it’s okay, time to eat before heading to the gym. As you gingerly roll out of bed, you go to stand only to feel stiffer than usual. You make your way to the kitchen and are met with an immediate uncomfortable sensation. You continue to move but this sharp debilitating pain starts running throughout your back and radiating down your leg. As the sensation increases, you are frozen by the pain.
Tell me if this sounds familiar:
You sneeze and throw out your back
Bend over to tie your shoes, throw your back out
Rotate to place an object on the floor from a seated position and are met with back pain.
What all these innocuous scenarios have in common is that they’re not the reasons why your back hurts. They were the last straw, a coincidence because no one would argue that sneezing or tying your shoes are mechanisms for low back pain. There is no such thing as non-specific back pain, only reasons that have yet to snuffed out.
Relax…You’ll be Okay
Many individuals come into my office with some sort of “generic” back pain or self diagnosed sciatica. Their pain is real and they don’t care so much about what it is (at least not in the moment) and are more interested in if we can get rid of the issue.
After tissue exploration and manual therapy, we stand up to perform some exercises to help improve the tissue’s capacity. I’m quick to let them know its not as bad they think and that together we can solve this. Not surprising, most individuals I’ve worked on will remark that they feel immediate relief.
I’m not some magician, but I do let clients know that bending over, sneezing or standing up wasn’t the reason for their pain. Instead it was one of the following reason(s).
Your spine moves when your hips should
By now, most know that if you’re always putting yourself into bad spots, it’s not if but when will you get into trouble. Your body is no different.
The topic of posture is at the current forefront of social media with polarizing views that you have to be a certain way for perfect posture or that posture doesn’t matter. The truth is always somewhere in the middle. If you’ve read my work on Instagram you’ve heard me say this but it begs to be said again:
“The best posture for you is one that is always changing.”
Your movement capacity is the same. Say you have a job that requires you to bend over and move 15 lb sandbags. If you only needed to move 10 bags, you could essentially move them however you felt like and be fine. But if you needed to do that for 8 hours each day, 6 days a week; you’re probably going to want to move in a biomechanically sound manner.
Learning how to hinge, disassociate hip from lumbar movement and rotate well go a long ways in improving load bearing and avoiding an overuse pattern.
Related to movement from the hips and not the lower back would be the ability to contract into hip extension without compensation. Lying on the floor offers a great deal of stability and lets you see what each side is capable of doing.
If one can’t get good hip extension while lying down, there stands a solid chance there is excess motion elsewhere when upright.
Your Spine Doesn’t Segment Well
Can you Cat-Cow? Many have performed this ubiquitous yoga movement, but few have used it to asses their capacity to move their spine.
Common for individuals with lower back pain is an inability to move segmentally move their lumbar spine without overly hinging through their mid backs. When this is the case, a hinge point develops and this is the site of stress. The back is a bridge, so the load should be evenly distributed versus being placed just in one section of the vertebral column.
Your Hips Don’t Move Well
Single leg stability: You should be able to drop down to about an equal depth on both sides. This is an easy way to assess whether one hip moves better than the other. Things to note would be how smooth each side feels and if the foot/knee collapses during the squat.
The RNT split squat is a great way to help shore up the strength and subsequently their stability on that side as well. The band helps pull your knee into compensation, so you have to use your muscles to maintain proper tension and alignment during the exercise.
90-90 Hip Transitions: These are a fantastic way to mobilize and loosen up the hips before activity. I also like them to discern if there’s a control issue somewhere along the chain. You go from transitions to a lunge and squat pattern during them as well here.
You Have a Structural Problem
Spinal Compression Test
Take a seat and sit up tall
•Get into a good “posture” with your arms by your side (slight arch in your back)
•Grab the chair with your hands and pull up to compress your spine.
•Did you have pain in your back now that it we added a bit of compression in the rounded position?
•If so, it would mean that even when your spine is in a good biomechnical position, it doesn’t tolerate compressive forces well.
•Same as above but let your back round out
•Did this recreate your pain?
•If so, it would indicate that your pain is triggered by lifting out neutral, flexion intolerance.
What to do if these tests come back positive?
•Try not to slouch too much when standing or sitting
•When bending down to grab things, learn to hinge properly or kneel down in addition to improving core strength
•Lie stomach down a few times a day.
When standing, try to vary positions. When seated, sit back into your chair.
Work on improving mechanics during movement and core strength as well.
Ultimately should you have an issue, be sure to visit a professional to help rule out any serious problems. The advice shared here should help the majority of individuals get on the right track, but you always want to be sure to not be overlooking a larger problem.