Low back pain is one of the injuries/location of pain that I see most frequently in the clinic. Unfortunately, by the time most of these athletes make it to me, they have already been given poor information by other healthcare providers and then of course Dr. Google. 

The most common primary care medical advice for low back pain is to rest, do some gentle stretching, and then avoid any movements that hurt. These things are appropriate on day 1 of injuring your back but after that this protocol will make back issues linger longer than they need to. 

As for rehab- many physical therapists, chiropractors, and other rehab professionals may have the best intentions, but their treatments focusing solely on immediate reduction in pain often mean that rehab takes a less 'active approach' and relies heavily on passive modalities such as spinal manipulation, cupping, dry needling, soft tissue massage etc... Not than any of these things are bad- however, reduction of pain doesn't necessarily mean that we fixed the issue. It simply means you feel a little better in that moment. But then you also become reliant on these passive treatments to remain painfree. 

So what is the long term fix? 

We need to have a movement and exercise based rehab program. Use the passive treatments to reduce your pain, but then approach exercise/movement as the pathway to correcting the issue so your low back pain doesn't continue to become a liability. 

In this article, I want to share with you the 3 movement goals that I have when approaching low back rehab. 

Frequent and graded movement directly in the low back

This is probably the most important thing that should be done to not only decrease pain but to increase long term resiliency and capability. 

Initially, we focus on range of motion ie. getting the joints in the spine moving and grooving. We do this in a variety of positions and we want it done frequently throughout the day. The simplest way to target direct movement into the low back is by moving the pelvis. Variations of pelvic rocking are something that I send every low back client home with. They are also something that I use myself to maintain movement if I find myself feeling stiff or having to sit/be sedentary for prolonged periods of time. 

Over the course of rehab we then start to become a little more demanding by added resistance and/or load to all the different ranges of motion of the spine. We want to train flexion (bending forward), extending (arching the back), lateral flexion (sidebending), and rotation. This is achieved with weights, resistance bands, cable machines, medicine balls etc... This is the never ending portion of low back rehab. These are the things that I want you to continue doing as part of your long term workouts so that your back continues to stay strong, mobile, and injury free!

Improve movement efficiency at the hips

What do I mean by this?

Simply put, our hips are meant to be really strong, powerful, and mobile joints. It is more efficient for us to recruit movement and workload through the hips versus the spine. However, I find that with chronic low back pain almost the exact opposite movement pattern develops over time where people are unable to separate the hips from the low back and in turn end up using their low back to do movements that should have come from the hips. 

Mastering a strict hip hinge is usually where I start. A hinge does a few good things for us- it mobilizes the back side of the hip and lengthens and loads the glutes. Part of this training involves exploration into how much mobility your hips currently will allow you to hinge before your spine must kick in for the assist. We also want to be mindful of your muscular recruitment at the bottom of the hinge- do you use your glutes to come back upright or do you initiate the movement from extended your low back? These are all the things we want to work through as we train the hip hinge. 

Find a pillar stack position

Many will call this neutral spine. But basically this is your home base when you need to lift heavy or do an activity that requires bracing. This is not a posture that you need to be in at all times (remember our primary focus is frequent movement through the spine). We certainly don't need to remain neutral, rigid, and braced at all hours of the day, but we do need to ability to find that pillar stack position and brace effectively when it is needed. 

The pillar stacked position is where your ribcage and pelvis are in line- this makes it most efficient for your body to effectively brace your core and manage intra-abdominal pressure.  For bracing we want to ensure a 360 contraction that essentially 'hugs' your spine. Incorrect bracing would be simply sucking in the stomach or bearing down with just the upper abdominals. 

We practice finding pillar stacked position and bracing in a variety of positions- standing, laying, hands and knees etc.. and as soon as we master it in basic movements we start to layer the complexity. I also like to implement anatomical sling training here where we work several muscles groups together that naturally contract synergistically to provide stability through the trunk and pelvis.

If you are struggling with ongoing low back issues, I encourage you to sign-up for my Resilient Low Back Program where I give you a structured and progressive exercise plan based on the components discussed in this article. 

This is the same rehab blueprint that I have been using in the clinic to rehab military athletes with ongoing low back pain. 

There are no magic exercises or quick fixes, just a strategic and smart progression that will increase your mobility, strength, and movements patterns. 

For more information on the program click HERE

As always, feel free to send me an email at [email protected] if you have any questions. 

Yours in health, 

-Jamie 'Doc Mraz'