As a fitness professional, I often encounter clients who have either suffered from or are suffering from low back pain.
Low-back pain is one of the most common musculoskeletal disorders that plagues the population and is said to be the second most common complaint doctors hear from patients. When it comes to low back pain, whether it is acute or chronic, or a result of a strain, sprain or disc degeneration, it can be extremely debilitating and can limit one’s ability to function in daily life.
What Causes Back Pain
Many people mistakenly believe that lower-back pain is caused by a problem with their lower back. This is understandable given that movements of daily life, sports and most weight-bearing exercise modalities require the spine to move forward, backward, side to side and in rotation
However, movements of the spine require other parts of the body to work as well. The human body is designed to move, and efficient movement involves numerous muscles and joints working together simultaneously. When one part of the body moves, it can influence motion at all other parts of the body.
Injuries related to the loss of joint mobility are preventable through 3 concurrent exercises: Strength, Stability and Flexibility Movements.
It is widely believed that stretching the back and increasing the range of motion is beneficial and reduces back problems—however, the scientific evidence shows that, on average, those who have more range of motion in their backs have a greater risk of future troubles.
In short, low-back pain cannot be resolved simply through a stretching program or muscle strengthening alone. Strength has little association with low-back health. In fact, many people hurt their backs in an attempt to increase strength. Many years ago while training, I acquired a slip-disk through a 110-kg dead-lift. Some reasons were a lack of flexibility and stability in my body's overall kinetic chain.
There is no question that excessive loading can lead to back injury, but instability at low loads is also possible and problematic. For example, it is possible to damage the passive tissues of the back while bending down and picking up a pencil, or sneezing, if sufficient stability is not maintained.
A sedentary lifestyle contributes greatly to low-back pain.
Sitting down all day and lack of movement creates muscular imbalances in our bodies. Muscular imbalances cause overcompensation of other small muscles that are not meant for a major movement. i.e. bending and lifting an object.
Muscular Imbalances:
Tight hip flexors and lack of hip mobility
Tight calves which result in pain of knee and lumbar area.
Tight Quadratus Lumborum (an-overused small core muscle inserted into C-5 lumbar)
Weak glutes (large buttock muscles) due to prolong sitting and lack of movement.
Lack of ankle mobility
Weak back muscles (rounded backs/shoulders commonly seen in many sedentary individuals)
Weak scapular muscles (shoulder blade area)
Weak or tight core muscles
Tight cervical (neck) muscles (too much time on smart phones and computers)
Enhancing Low-back Health through Stabilization Exercise
For my clients, I'll address their low-back pains through 3 concurrent ways as mentioned above: Strength, Stability and Flexibility Movements.
A Daily Routine for Enhancing Low-back Health
The following exercises have been chosen to spare the spine, enhance the muscle challenge and enhance the motor control system to ensure that spine stability is maintained in all other activities. Having stated this, they are only examples of well-designed exercises and may not be for everyone—the initial challenge may or may not be appropriate for every individual nor will the graded progression be the same for all clients. These are simply examples to challenge the muscles of the torso.
Strength & Stability:
1. Cat-Camel
The routine should begin with the cat-camel motion exercise (spine flexion-extension cycles) to reduce spine viscosity and “floss” the nerve roots as they outlet at each lumbar level. Note that the cat-camel is intended as a motion exercise—not a stretch—so the emphasis is on motion rather than “pushing” at the end ranges of flexion and extension. Five to eight cycles have shown to be sufficient to reduce most viscous-frictional stresses.
2. Curl-Up
The cat-camel motion exercise is followed by abdominal exercises, in this case the curl-up. The hands or a rolled towel are placed under the lumbar spine to preserve a neutral spine posture. Do not flatten the back to the floor. Flattening the back flexes the lumbar spine, violates the neutral spine principle and increases the loads on the disc and ligaments. One knee is flexed but the other leg is straight to lock the pelvis-lumbar spine and minimize the loss of a neutral lumbar posture. Alternate the bent leg (right to left) midway through the repetitions.
3. Bird-Dog
The extensor program consists of leg extensions and the “birddog.” The key is building endurance with increased repetitions rather than extending “hold time.”
Flexibility Exercises
Flexibility exercises are immediately followed after strength and stability exercises.
1. Child's Pose
The pose gently stretches the hips, thighs and ankles too. Child’s Pose provides a counter-stretch for backward bending postures, such as camel pose. Stay anywhere from 30 seconds to a few minutes. Note: Beginners can also use Child's Pose to get a taste of a deep forward bend, where the torso rests on the thighs. Stay in the pose from 1 to 3 minutes.
2. Quadratus Lumborum Stretch (QL Stretch)
Begin on your back with your feet on the floor and knees toward the ceiling, with the arms extended out to the sides of the body, palms facing up. Cross the right leg over the left leg and slowly lower both legs to the right, holding this position for 30 seconds. Keeping the legs crossed, slowly move the legs to the center and then lower the legs to the left. Again, hold this position for 30 seconds.
3. Kneeling Hip Flexor Stretch
Begin in a single-leg kneeling position with the right foot in front and kneeling on the left knee. Maintain a neutral spine and contract the left glute to stretch the left hip flexor. If you’re able, deepen this stretch by gradually shifting the hips forward.
Identifying the training objectives is paramount. The emphasis here is on enhancing spine health—training for performance is another topic.
A Bowl of Rice Fitness Programs are specifically designed to give a step-by-step process for helping clients overcome muscle and joint pain. Our carefully guided exercise program provides postural assessment, anatomy, corrective exercise and life-long skills and knowledge necessary to help clients become pain free.
As a Certified Exercise Professional by American Council of Exercise (ACE), Gerald Tay uses science-back knowledge and his past experiences as an overweight individual to help beginner clients achieve life-long health benefits through his carefully crafted fitness programs.
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