Low back pain: management, rehabilitation and restoration of core functionality
xposted from my log:
I got a couple of PMs regarding low back issues and how to resolve them so I thought it would be a great idea to summarize my experience in getting over such problems, what I have learned and what are some basic facts that one must be aware of. Most of this content is probably directly or indirectly from McGill's research and books, my conversations with McGill and Cha59 and from seminars and presentations from the likes of Mike Robertson and Eric Cressey. Although, I have layed out 5 steps as well, they are not exactly the same steps as McGill's 5 but cover most of that material essentially. These are the steps I made in my mind after gathering all the information from the sources listed above.
In the hopes this does not get too ramble-y, a lot of the 'how to' information is left to external resources that I have mentioned above and my log can be referred for that in general. This will be more a summary of 'what to do' and my own experience of what I did.
If you suffer from any kind of low back symptoms, whether from an injury-incident or in general, this guide will be very useful for you.
First of all, one of the most potent mechanisms for disc/low back injury is a loaded spine either under end range of flexion or a movement of the spine into flexion while under some load. We will look at steps that will reduce the chances of this sort of injury happening and what to do if you are currently suffering from the after effects of such an injury.
I.
Central desensitization to pain
Winding down the sensitivity to pain is a very important first step to cure low back pain. This is something that I was repeatedly told by McGill. This involves raising the threshold for pain generation by avoiding tasks that trigger pain.
If you would like to read more about this there are studies out there on altered pain inhibitory systems in patients with low back pain leading to central sensitization of the CNS to pain. There are also studies showing vascularization of discs after injury which then causes discogenic pain and the pain pathways are made stronger with higher instances of triggers that generate pain. When chronic pain occurs in a structure or muscle of the body, cell signaling in the micro-environments around those structures can get altered leading to disruption in tissue repair and immunity to inflammation. This causes a cascading effect whereupon the tissue becomes resistant to repair and can even cause atrophy in affected muscles.
For those concerned with real world implications, the following is what you need to do to accomplish this 1st step.
II.
Building Core Stability
Congruent with step I. is step II. The goal of step II. is to create stability in the core so that when you are doing any movement, be it sitting or Bench Pressing, you are able to keep your spine as motionless as possible. Any exercise you do right now that triggers symptoms in your low back must be avoided as it shows an inability to maintain spinal stability while doing that exercise because of core dysfunction.
It is very hard to eliminate all your pain triggers in one go. This will be a process that takes some time. While work on step I. has begun, you can start the second step which involves creating stability for your spine.
Again, information can be found in LBD book but the following are the basic progressions to start with and some important tips for each:
Firstly, a basic understanding of core stiffness and how to generate it is important. This can be found in LBD as well as core programs of Mike Robertson and Eric Cressey. The core is the fixed point which allows all limb athleticism and mobility in any distal joint is a product of stability at the proximal joint closest to it.
The above exercises are done with a stiffened core while maintaining normal breathing patterns. If you can't breathe while doing these exercises, you might be stiffening the core too much at this juncture.
All of these exercises, their progressions, how many sets and reps to do is laid out both in Low Back Disorders and Ultimate Back. Any kind of screening that you need to do to advance in these exercises is also laid out in the those books. At this stage, I would also highly recommend the core programs that are available on Mike Robertson and Eric Cressey's respective websites. They helped me immensely.
It is important to understand that a knowledge of the structure of the core, cueing (need a good personal trainer for this) and mental imagery will go a long way in improving the effectiveness of these exercises. Filming yourself for form correction is the next best thing after personal trainers. I would recommend doing that plenty because you never realize yourself where your form breaks without such help.
How long of a course you need for these exercises depends on the current state of your 'hardware' and 'software'. Some might be able to leave these exercises in the dust within a month, some like me might have to do them for months.
It is important to always keep the load below the capacity threshold of your back so as to not hurt your back again. This means that capacity and load tolerance will build very slowly.
Beyond the 'hardware' which is the actual muscles, it is important to realize all movement in the body first starts with a thought and that is why the 'software' side of things is also important. Most of us are in pain or engaging in aberrant motor patterns because of an issue with the software aka how we create volitional movement and what patterns we end up using.
If you try to engage someone or even yourself in some basic hand gestures that involve flexion, extension and lateral movement of the joints of your fingers, you will realize one of your hands has a difficult time with the correct movements. This is partly because of right or left handedness but we are talking about very basic movements of joints, and not something complex like writing, so the disparity between the effectiveness of those simple movements can be attributed to a lack of motor control. This motor control you will see can be enhanced and grooved with regular practice.
How well you are able to do this, dictates how long you will take with these basic core exercises. Andy Murray and Tiger Woods for instance were back playing top level sports within a year of back surgery for nerve impingement issues. They were highly dedicated and probably had a team of top level trainers, but more importantly, their minds were already well-trained in fine motor-control.
Important note on torsional stability and generation: Torsional control of the core is the last axis of back rehab and stability generation. There are many screens to check for your current torsional stability and when and where to begin with torsional stability is laid out in the McGill books as well as those core programs.
Some information pertaining to the above steps can be found here and here
III.
Gluteal Amnesia and Mobility
It is very important to have strong glutes as they are the big primary muscle that can support your upper body and reduce the strain put on the smaller muscles of the spine.
IV.
Push & Pull Patterns
Learning to enage your lats will start happening when you do things like Plank Rolls and Walk Outs but these are essentially pushing and pulling movements.
More info can be gained from reading Ultimate Back and I am not very well qualified to lay out any steps involved in learning the correct push and pull patterns but everything I have written up to this point is the prerequisite in learning the optimal pushing and pulling patterns because a stiff and strong core is needed to these movements well.
Learning these patterns will also make you better appreciate the nuances of big lifts like the Bench Press, Dead Lift and Squat.
There are progressions for these patterns depending on where you are at with them. I have reached Bench Press when it comes to pushing but for pulling I am still trying to develop lat involvement to a higher degree by doing pull up and chin up prehab work.
V.
Speed and Strength
Again, all speed, athletic performance and strength gaining is tied to a properly functioning core. Depending on your ultimate goals, you may choose variations to your training regimen to include stuff for speed for instance. This will again involve things like core impulse generation and control. There are again various exercises you can find on this by reading Ultimate Back.
A word on some conventional clinical wisdom prevalent in those treating low back disorders
McKenzie Stretches
I regularly engage in McKenzie I-II & III. The goal for me however is just a relaxation of the back muscles after a day's worth of work and not the conventional wisdom why people do it - to seep the disc material back into the disc. That happens at a rate so slow, that you'd literally have to sit in McKenzie for days. I also do these because my lumbar spine could use a bit more lordosis. A proper way to do them can be found here.[/QUOTE]
Flexibility (esp of hamstrings)
Not important. I have pretty poor hamstring flexibility but I have learned now that in itself does not cause any harm to my back. What is important however is to not have any asymmetries in both strength and mobility. If you have one leg stronger than the other, it's a good idea to make up the other leg's lack of strength using unilateral work. A good measure for strength imbalances (other than actually seeing if there is a difference through exercise) is to check how balanced each side is. If, for instance, you find it easier to do Hip Airplanes on one side than the other, there is probably some balance as well as strength asymmetry between the sides.
A lot of clinical wisdom focuses on hamstring flexibility and makes you do leg raises that are determental for back health. You should only raise a leg the amount till which it causes no movement in the lumbar spine. Stiffening the core can further increase the range at which this eventually happens.
Mobility is the better phrase to use than flexibility and the most important joint where you need it (when it comes to low back pain) is the hips.
Chiro and Manual Therapy
McGill did not study these but wrote that he did not find why they wouldn't be useful to some people if done correctly. I am not exactly sure what the right sort of therapy is for the back since I have never experienced it myself.
Traction Therapy
It works pretty well and can be helpful to many esp. those suffering from compression intolerance.
Walking
Another underrated therapy for low back troubles. A walk, especially on rough up and down terrain with a low hanging backpack containing a 10kg dumbbell is excellent for anyone with flexion intolerance.
In general when walking one must keep their arms swinging. This reduces the load on the spine and engages the big lats
Hot and Cold Packs
Never done hot packs but ice packs can be useful for reducing both localized and radiating pain through numbing of the area as well as changes in nerve conductivity through temperature change
Cortisone Injection
I have no experience or knowledge about these but obviously long term pain killer use is not optimal for back rehab
TENS and UltraSonic
Used mostly for reducing inflammation and nerve stimulation. I have received tons of these but never really felt any better or worse.
Bend only at the knees suggestion
This is popular suggestion for those with back troubles. "Don't bend forwards"
Although the spine should be spared flexion, a proper technique for 'bending' forward aka the hip hinge is much more suitable than forever stopping that motion. It would probably lead to trouble over the long run due to further switching off of the gluteal muscles.
Don't ever lift heavy objects
True but I have already laid out the path you'd need to safely lift heavy and get stronger. There is a progression of movements you can learn about in the Ultimate Back that can be used to achieve a level of fitness of the back where this would be a good idea.
I got a couple of PMs regarding low back issues and how to resolve them so I thought it would be a great idea to summarize my experience in getting over such problems, what I have learned and what are some basic facts that one must be aware of. Most of this content is probably directly or indirectly from McGill's research and books, my conversations with McGill and Cha59 and from seminars and presentations from the likes of Mike Robertson and Eric Cressey. Although, I have layed out 5 steps as well, they are not exactly the same steps as McGill's 5 but cover most of that material essentially. These are the steps I made in my mind after gathering all the information from the sources listed above.
In the hopes this does not get too ramble-y, a lot of the 'how to' information is left to external resources that I have mentioned above and my log can be referred for that in general. This will be more a summary of 'what to do' and my own experience of what I did.
If you suffer from any kind of low back symptoms, whether from an injury-incident or in general, this guide will be very useful for you.
First of all, one of the most potent mechanisms for disc/low back injury is a loaded spine either under end range of flexion or a movement of the spine into flexion while under some load. We will look at steps that will reduce the chances of this sort of injury happening and what to do if you are currently suffering from the after effects of such an injury.
I.
Central desensitization to pain
Winding down the sensitivity to pain is a very important first step to cure low back pain. This is something that I was repeatedly told by McGill. This involves raising the threshold for pain generation by avoiding tasks that trigger pain.
If you would like to read more about this there are studies out there on altered pain inhibitory systems in patients with low back pain leading to central sensitization of the CNS to pain. There are also studies showing vascularization of discs after injury which then causes discogenic pain and the pain pathways are made stronger with higher instances of triggers that generate pain. When chronic pain occurs in a structure or muscle of the body, cell signaling in the micro-environments around those structures can get altered leading to disruption in tissue repair and immunity to inflammation. This causes a cascading effect whereupon the tissue becomes resistant to repair and can even cause atrophy in affected muscles.
For those concerned with real world implications, the following is what you need to do to accomplish this 1st step.
- Evaluate your movement patterns and stop or reduce all aberrant motor patterns that cause pain either directly or indirectly by sapping the capacity of your low back and causing pain later on.
- This involves changing the way you get up and down into chairs. Spreading the floor with wider stance while sitting and in the act of getting up, reduces the chances of spinal flexion. How you move in and out of cars, close and open doors, get in and out of bed are examples of movements where this correction is needed.
- Mainly though, you need to become aware of movements and postures in which you are leaving the optimal alignment of your back (rib cage and pelvis in direct alignment) and reduce / take countermeasures to resolve them. This step is also called grooving correct motor patterns.
- Most of this information comes directly from Low Back Disorders by Stuart McGill. I recommend reading that from start to finish to get an even more in depth knowledge of these fundamentals.
II.
Building Core Stability
Congruent with step I. is step II. The goal of step II. is to create stability in the core so that when you are doing any movement, be it sitting or Bench Pressing, you are able to keep your spine as motionless as possible. Any exercise you do right now that triggers symptoms in your low back must be avoided as it shows an inability to maintain spinal stability while doing that exercise because of core dysfunction.
It is very hard to eliminate all your pain triggers in one go. This will be a process that takes some time. While work on step I. has begun, you can start the second step which involves creating stability for your spine.
Again, information can be found in LBD book but the following are the basic progressions to start with and some important tips for each:
Firstly, a basic understanding of core stiffness and how to generate it is important. This can be found in LBD as well as core programs of Mike Robertson and Eric Cressey. The core is the fixed point which allows all limb athleticism and mobility in any distal joint is a product of stability at the proximal joint closest to it.
- Curl Ups The important thing to remember in curl ups is to not lift your head too high or lead with the chin. A subtle movement is all that is required to engage the core if you are doing it correctly.
- Side Planks These will hit the obliques in the core and create stability in that plane. It is important to realize and fix any compensatory movements that you might be making while doing these. It is very easy to rotate the torso while in a side plank position and thus negating the effect of this exercise while grooving bad motor patterns.
- Bird Dogs These work the posterior elements of the core esp. the lumbar portion of the erectors but mainly all of them. Bird Dogs is also a very basic movement to start learning the dissociation of lumbar motion from hip motion.
The above exercises are done with a stiffened core while maintaining normal breathing patterns. If you can't breathe while doing these exercises, you might be stiffening the core too much at this juncture.
All of these exercises, their progressions, how many sets and reps to do is laid out both in Low Back Disorders and Ultimate Back. Any kind of screening that you need to do to advance in these exercises is also laid out in the those books. At this stage, I would also highly recommend the core programs that are available on Mike Robertson and Eric Cressey's respective websites. They helped me immensely.
It is important to understand that a knowledge of the structure of the core, cueing (need a good personal trainer for this) and mental imagery will go a long way in improving the effectiveness of these exercises. Filming yourself for form correction is the next best thing after personal trainers. I would recommend doing that plenty because you never realize yourself where your form breaks without such help.
How long of a course you need for these exercises depends on the current state of your 'hardware' and 'software'. Some might be able to leave these exercises in the dust within a month, some like me might have to do them for months.
It is important to always keep the load below the capacity threshold of your back so as to not hurt your back again. This means that capacity and load tolerance will build very slowly.
Beyond the 'hardware' which is the actual muscles, it is important to realize all movement in the body first starts with a thought and that is why the 'software' side of things is also important. Most of us are in pain or engaging in aberrant motor patterns because of an issue with the software aka how we create volitional movement and what patterns we end up using.
If you try to engage someone or even yourself in some basic hand gestures that involve flexion, extension and lateral movement of the joints of your fingers, you will realize one of your hands has a difficult time with the correct movements. This is partly because of right or left handedness but we are talking about very basic movements of joints, and not something complex like writing, so the disparity between the effectiveness of those simple movements can be attributed to a lack of motor control. This motor control you will see can be enhanced and grooved with regular practice.
How well you are able to do this, dictates how long you will take with these basic core exercises. Andy Murray and Tiger Woods for instance were back playing top level sports within a year of back surgery for nerve impingement issues. They were highly dedicated and probably had a team of top level trainers, but more importantly, their minds were already well-trained in fine motor-control.
Important note on torsional stability and generation: Torsional control of the core is the last axis of back rehab and stability generation. There are many screens to check for your current torsional stability and when and where to begin with torsional stability is laid out in the McGill books as well as those core programs.
Some information pertaining to the above steps can be found here and here
III.
Gluteal Amnesia and Mobility
It is very important to have strong glutes as they are the big primary muscle that can support your upper body and reduce the strain put on the smaller muscles of the spine.
- Stretching - Static stretching should be avoided as it only 'feels' good in the short run due to the stimulation of the stretch reflexes of the muscles.
- Dynamic stretching and mobility for the gluteal complex is very important. I personally find quad stretches the most effective for me. These can be found under 'psoas' stretches on the internet but it's highly important that the entire quad region including hip flexors and all the way down to the knees is stretched. However, this stretching should not be thought of as the end game.
The aim of this dynamic stretching like walking lunges etc. or even a static hold (not all of them are counter productive) is not to stretch out the muscle, but rather to integrate the muscle into daily motor patterns correctly without compromising the spine
EX - Try getting into the starting position of a supine dead bug. If you keep a hand under the small of your back, many people will experience a movement of their lumbar spine towards the floor when they raise their feet off the ground or engage in the actual movement. This does not mean a 'short hip flexor' that needs to be stretched as in elongated. It means that the hip flexor is not strong or stable enough to keep the spine rigid when you flex the hip. Translate this into a squat and you realize why people buttwink or get injured when squatting. So both a stretch as well as a dynamic integration of the psoas in the hip flexion and extension movements is needed.
Of course, a stiffened will make the movement in your spine much less likely therefore the proper integration of the hip complex works only if your core is strong
- Mobility in the glutes can be trained through various movements like Hip Airplanes and single leg glute work.
- The most basic glute progressions for strength and eliminating 'gluetal amnesia' are Glute Bridges and Clams. These must however be performed while keeping the core extremely tight.
Mobility also encompasses balance training. A better balance in the lower body can be trained through safe progressions mentioned in Ultimate Back and the amount of work you need into this depends on your training goals.
- This point could be a full step in itself. The integration of the hip and hamstring function back into the core function is very important. I personally have not reached this stage yet, but there are many exercises that can be done to accomplish this. Hip Hinging, Single and both leg overhead pull. Pull throughs, Hip Airplanes etc.
It is important to make sure your core stability is at a stage that these movements will not be risky for your back.
In terms of the lumbar region, it should have very little mobility in it. Sure, some range of flexion and extension is needed by everyone, but the rotation aspect of the mobility of the torso should be accomplished by learning to rotate using the thoracic spine and hips. Remember: rib-cage and pelvis alignment should nearly never break and this can only be achieved by keeping the lumbar spine as motionless as possible.
This process can also be thought of as a 'full body' spinal stability aka your ability to stabilize your spine at a moment's notice upon the demand of any activity or postural requirement.
Up to step iii I feel is important to prevent back injuries and rehab from current ones. Step iv and v are about further injury proofing yourself and developing functional and pure strength.
IV.
Push & Pull Patterns
Learning to enage your lats will start happening when you do things like Plank Rolls and Walk Outs but these are essentially pushing and pulling movements.
More info can be gained from reading Ultimate Back and I am not very well qualified to lay out any steps involved in learning the correct push and pull patterns but everything I have written up to this point is the prerequisite in learning the optimal pushing and pulling patterns because a stiff and strong core is needed to these movements well.
Learning these patterns will also make you better appreciate the nuances of big lifts like the Bench Press, Dead Lift and Squat.
There are progressions for these patterns depending on where you are at with them. I have reached Bench Press when it comes to pushing but for pulling I am still trying to develop lat involvement to a higher degree by doing pull up and chin up prehab work.
V.
Speed and Strength
Again, all speed, athletic performance and strength gaining is tied to a properly functioning core. Depending on your ultimate goals, you may choose variations to your training regimen to include stuff for speed for instance. This will again involve things like core impulse generation and control. There are again various exercises you can find on this by reading Ultimate Back.
A word on some conventional clinical wisdom prevalent in those treating low back disorders
McKenzie Stretches
I regularly engage in McKenzie I-II & III. The goal for me however is just a relaxation of the back muscles after a day's worth of work and not the conventional wisdom why people do it - to seep the disc material back into the disc. That happens at a rate so slow, that you'd literally have to sit in McKenzie for days. I also do these because my lumbar spine could use a bit more lordosis. A proper way to do them can be found here.[/QUOTE]
Flexibility (esp of hamstrings)
Not important. I have pretty poor hamstring flexibility but I have learned now that in itself does not cause any harm to my back. What is important however is to not have any asymmetries in both strength and mobility. If you have one leg stronger than the other, it's a good idea to make up the other leg's lack of strength using unilateral work. A good measure for strength imbalances (other than actually seeing if there is a difference through exercise) is to check how balanced each side is. If, for instance, you find it easier to do Hip Airplanes on one side than the other, there is probably some balance as well as strength asymmetry between the sides.
A lot of clinical wisdom focuses on hamstring flexibility and makes you do leg raises that are determental for back health. You should only raise a leg the amount till which it causes no movement in the lumbar spine. Stiffening the core can further increase the range at which this eventually happens.
Mobility is the better phrase to use than flexibility and the most important joint where you need it (when it comes to low back pain) is the hips.
Chiro and Manual Therapy
McGill did not study these but wrote that he did not find why they wouldn't be useful to some people if done correctly. I am not exactly sure what the right sort of therapy is for the back since I have never experienced it myself.
Traction Therapy
It works pretty well and can be helpful to many esp. those suffering from compression intolerance.
Walking
Another underrated therapy for low back troubles. A walk, especially on rough up and down terrain with a low hanging backpack containing a 10kg dumbbell is excellent for anyone with flexion intolerance.
In general when walking one must keep their arms swinging. This reduces the load on the spine and engages the big lats
Hot and Cold Packs
Never done hot packs but ice packs can be useful for reducing both localized and radiating pain through numbing of the area as well as changes in nerve conductivity through temperature change
Cortisone Injection
I have no experience or knowledge about these but obviously long term pain killer use is not optimal for back rehab
TENS and UltraSonic
Used mostly for reducing inflammation and nerve stimulation. I have received tons of these but never really felt any better or worse.
Bend only at the knees suggestion
This is popular suggestion for those with back troubles. "Don't bend forwards"
Although the spine should be spared flexion, a proper technique for 'bending' forward aka the hip hinge is much more suitable than forever stopping that motion. It would probably lead to trouble over the long run due to further switching off of the gluteal muscles.
Don't ever lift heavy objects
True but I have already laid out the path you'd need to safely lift heavy and get stronger. There is a progression of movements you can learn about in the Ultimate Back that can be used to achieve a level of fitness of the back where this would be a good idea.
There will be a lot of typos and similar mistakes in the text as I have only read it once and there's one in the title as well lol but I hope there is useful info in here to help those seeking resolution for back troubles
Fantastic.
This should probably be in the stickies.
This should probably be in the stickies.
A+ thread
Equal "push and pull" functions probably solve/prevent majority of peoples issues.
Great summation, this should obv be stickied.
Personally I found LBD really tough to read with all the terminology a foreing speaker has to learn and never finished it while UBF&P was a lot more accessible. I think cha recommended to read LBD 1st and it sure does cover about everything but just pointing out for some I think it's better to start with the more accessible material because LBD can feel overwhelming.
Personally I found LBD really tough to read with all the terminology a foreing speaker has to learn and never finished it while UBF&P was a lot more accessible. I think cha recommended to read LBD 1st and it sure does cover about everything but just pointing out for some I think it's better to start with the more accessible material because LBD can feel overwhelming.
This is very good.
I would like to add a bit to it. Everyone is different but I've had back issues most of my life and I've tried most of the things you mentioned. Some have helped significantly. Mostly the mobility and core work. But the one thing that made the most improvement was ART and rolling. I found that the root of the problem with me was my hips. Rolling and using a ball (I use a lacrosse ball) has helped tremendously. Loosening up the piriformis was especially significant.
For most of my life I've had at least 2 bad back episodes per year. These were ohcrapIcan'tevenrolloverinbed episodes. Since I started on my mobility/core/rolling regimen (over 2 years) I have had exactly zero bad episodes. It does act up occasionally but no crippling pain and much shorter recovery times. I don't think people with bad backs are ever completely free of back pain but it is very manageable.
I would like to add a bit to it. Everyone is different but I've had back issues most of my life and I've tried most of the things you mentioned. Some have helped significantly. Mostly the mobility and core work. But the one thing that made the most improvement was ART and rolling. I found that the root of the problem with me was my hips. Rolling and using a ball (I use a lacrosse ball) has helped tremendously. Loosening up the piriformis was especially significant.
For most of my life I've had at least 2 bad back episodes per year. These were ohcrapIcan'tevenrolloverinbed episodes. Since I started on my mobility/core/rolling regimen (over 2 years) I have had exactly zero bad episodes. It does act up occasionally but no crippling pain and much shorter recovery times. I don't think people with bad backs are ever completely free of back pain but it is very manageable.
thanks guys!
Yea, I definitely forgot to mention ART. Probably because I myself have had no experience of it but it is definitely something I miss in my rehab. A good quality therapy like that definitely helps! I hope to get some ART sometime in the fall this year.
One of the investment with the biggest ROI so far for me has been a lacrosse ball. It's just great to use for rolling especially the glutes. If someone actually takes the time to do rolling and I mean actually spend some time doing it and not just a 5 min quick dash just to run through the motions (I did that for a long time), it is very helpful. Someone who will just do it to check it off the list of things like warm ups for example, will just feed themselves a fall sense of security because they'd only be getting immediate stretch reflex relief and not any long term benefit.
Another good benefit of rolling comes in helping with step I.
I found it hardest to accomplish that step. There are still too often times where I am just degrading the quality of my back by just sitting and even though I know it's bad for my back, the environment you find yourself in makes it very hard to not sit or engage in old and in grained motor patterns. You have to do something with your time outside of back rehab, and the tendency is to fall back to defaults.
So what I do is that I tend to do the rolling and mobility work when I am watching tv etc. . Even while one or two tabling poker, you can easily be on a yoga mat doing some sort of rolling.
It accomplishes many goals all at once:
This is very good.
I would like to add a bit to it. Everyone is different but I've had back issues most of my life and I've tried most of the things you mentioned. Some have helped significantly. Mostly the mobility and core work. But the one thing that made the most improvement was ART and rolling. I found that the root of the problem with me was my hips. Rolling and using a ball (I use a lacrosse ball) has helped tremendously. Loosening up the piriformis was especially significant.
For most of my life I've had at least 2 bad back episodes per year. These were ohcrapIcan'tevenrolloverinbed episodes. Since I started on my mobility/core/rolling regimen (over 2 years) I have had exactly zero bad episodes. It does act up occasionally but no crippling pain and much shorter recovery times. I don't think people with bad backs are ever completely free of back pain but it is very manageable.
I would like to add a bit to it. Everyone is different but I've had back issues most of my life and I've tried most of the things you mentioned. Some have helped significantly. Mostly the mobility and core work. But the one thing that made the most improvement was ART and rolling. I found that the root of the problem with me was my hips. Rolling and using a ball (I use a lacrosse ball) has helped tremendously. Loosening up the piriformis was especially significant.
For most of my life I've had at least 2 bad back episodes per year. These were ohcrapIcan'tevenrolloverinbed episodes. Since I started on my mobility/core/rolling regimen (over 2 years) I have had exactly zero bad episodes. It does act up occasionally but no crippling pain and much shorter recovery times. I don't think people with bad backs are ever completely free of back pain but it is very manageable.
One of the investment with the biggest ROI so far for me has been a lacrosse ball. It's just great to use for rolling especially the glutes. If someone actually takes the time to do rolling and I mean actually spend some time doing it and not just a 5 min quick dash just to run through the motions (I did that for a long time), it is very helpful. Someone who will just do it to check it off the list of things like warm ups for example, will just feed themselves a fall sense of security because they'd only be getting immediate stretch reflex relief and not any long term benefit.
Another good benefit of rolling comes in helping with step I.
I found it hardest to accomplish that step. There are still too often times where I am just degrading the quality of my back by just sitting and even though I know it's bad for my back, the environment you find yourself in makes it very hard to not sit or engage in old and in grained motor patterns. You have to do something with your time outside of back rehab, and the tendency is to fall back to defaults.
So what I do is that I tend to do the rolling and mobility work when I am watching tv etc. . Even while one or two tabling poker, you can easily be on a yoga mat doing some sort of rolling.
It accomplishes many goals all at once:
- You are lying down and resting your back when you'd otherwise probably be failing at step I by sitting or something similar
- Since your primary activity is TV, books, poker etc. you end up spending more time rolling than you would if you were just rolling because it would probably get boring after 5 minutes.
- The more time you spend away from your usual bad motor patterns (without boredom and annoyance) the better you'll get at adopting the newer patterns you are trying so hard to learn.
great summary, would be superb if you point out more videos of good form ex. and stretches
great work!
great work!
p.s
In fact i am going to meet Dr. McGill this September. Im gonna visit a seminar he is going to have in Dublin/Ireland. Its a McGill course 1 http://www.backfitpro.com/courses.php
So i guess it will cover the fundamentals and a bit more. Im really excited about it
pps Anyone had expirience with Trigger Point Therapy?
http://www.amazon.com/Trigger-Point-...+point+therapy
Im really interested in this aswell i think its really easy to self treat.
In fact i am going to meet Dr. McGill this September. Im gonna visit a seminar he is going to have in Dublin/Ireland. Its a McGill course 1 http://www.backfitpro.com/courses.php
So i guess it will cover the fundamentals and a bit more. Im really excited about it
pps Anyone had expirience with Trigger Point Therapy?
http://www.amazon.com/Trigger-Point-...+point+therapy
Im really interested in this aswell i think its really easy to self treat.
p.s
In fact i am going to meet Dr. McGill this September. Im gonna visit a seminar he is going to have in Dublin/Ireland. Its a McGill course 1 http://www.backfitpro.com/courses.php
So i guess it will cover the fundamentals and a bit more. Im really excited about it
pps Anyone had expirience with Trigger Point Therapy?
http://www.amazon.com/Trigger-Point-...+point+therapy
Im really interested in this aswell i think its really easy to self treat.
In fact i am going to meet Dr. McGill this September. Im gonna visit a seminar he is going to have in Dublin/Ireland. Its a McGill course 1 http://www.backfitpro.com/courses.php
So i guess it will cover the fundamentals and a bit more. Im really excited about it
pps Anyone had expirience with Trigger Point Therapy?
http://www.amazon.com/Trigger-Point-...+point+therapy
Im really interested in this aswell i think its really easy to self treat.
Also, I personally don't have any experience of trigger point therapy but I am sure someone here does.
i know that mobility should not be an issue especially in the early stages of recovery, but... my doctor said that i should be able to touch my toes without bending my knees... but im like 30cm away and he wants me to push it and stretch my hammies
ive seen some discussions about it where ppl like McGilll say this hamstring stiffnes is neurological and not soft tissue matter, what is your experience with this?
ive seen some discussions about it where ppl like McGilll say this hamstring stiffnes is neurological and not soft tissue matter, what is your experience with this?
I would definitely discourage you from doing that.
Here's what McGill has to say about 'silly stretches' like the one your doctor wants you to do:
More details you can read on page 184 of Low Back Disorders (I think it's chapter 10)
On page 215 (chapter 12) you can also see two images of a proper way to stretch the hamstrings and quads which spare the back joints!
Here's what McGill has to say about 'silly stretches' like the one your doctor wants you to do:
"Silly streches," like pulling the knees to the chest and toe touches are often prescribed to patients to do in the morning. These can cause instability! Paradoxically, the stretch receptors in the back are stimulated, providing a false sense of relief that may last about 20 minutes
On page 215 (chapter 12) you can also see two images of a proper way to stretch the hamstrings and quads which spare the back joints!
How do you guys protect your lower backs on bench press? Many of the manoeuvres that are shown in instructional videos (e.g. the So You Think You Can Bench-series) focus on arching the back and getting into a position that protects the shoulder (I believe that is one of the main purposes?). However, when I try to apply this it feels extremely uncomfortable on my lower back, sometimes even painful.
Am I doing it wrong?
Am I doing it wrong?
I would definitely discourage you from doing that.
Here's what McGill has to say about 'silly stretches' like the one your doctor wants you to do:
More details you can read on page 184 of Low Back Disorders (I think it's chapter 10)
On page 215 (chapter 12) you can also see two images of a proper way to stretch the hamstrings and quads which spare the back joints!
Here's what McGill has to say about 'silly stretches' like the one your doctor wants you to do:
More details you can read on page 184 of Low Back Disorders (I think it's chapter 10)
On page 215 (chapter 12) you can also see two images of a proper way to stretch the hamstrings and quads which spare the back joints!
Awesome work SS!!!
I have that book. Its fantastic. I've read most of it more than once. I still go back to it to look things up on a regular basis. Its an easy read and very informative. The one (barely) negative in it is that they suggest not to stretch the muscle you're applying pressure to when you're doing self treatment. Doing so is actually a very good thing, very effective when you do it right, and is similar to doing ART on yourself. The diagnosis parts of the book are excellent and interesting.
Yes you're doing it wrong. You need to tighten your abs so the your low back arches less. most of your arching should come from the thoracic spine (the part of the spine where all our ribs attach - between the neck and low back), which has more much mobility than the lumbar (low back) spine. Many people dont use much thoracic arch when they bench, frequently because of limited mobility. This is part of why rolling and stretching your thoracic spine is important for low back health when you bench. Its also very important for shoulder health as well.
cliffs: If you feel low back pain while bench pressing when you are making big arch in your low back, lessen the arch in your low back by tightening your abs.
p.s
In fact i am going to meet Dr. McGill this September. Im gonna visit a seminar he is going to have in Dublin/Ireland. Its a McGill course 1 http://www.backfitpro.com/courses.php
So i guess it will cover the fundamentals and a bit more. Im really excited about it
pps Anyone had expirience with Trigger Point Therapy?
http://www.amazon.com/Trigger-Point-...+point+therapy
Im really interested in this aswell i think its really easy to self treat.
In fact i am going to meet Dr. McGill this September. Im gonna visit a seminar he is going to have in Dublin/Ireland. Its a McGill course 1 http://www.backfitpro.com/courses.php
So i guess it will cover the fundamentals and a bit more. Im really excited about it
pps Anyone had expirience with Trigger Point Therapy?
http://www.amazon.com/Trigger-Point-...+point+therapy
Im really interested in this aswell i think its really easy to self treat.
How do you guys protect your lower backs on bench press? Many of the manoeuvres that are shown in instructional videos (e.g. the So You Think You Can Bench-series) focus on arching the back and getting into a position that protects the shoulder (I believe that is one of the main purposes?). However, when I try to apply this it feels extremely uncomfortable on my lower back, sometimes even painful.
Am I doing it wrong?
Am I doing it wrong?
cliffs: If you feel low back pain while bench pressing when you are making big arch in your low back, lessen the arch in your low back by tightening your abs.
Cha, actually my remaining symptoms only arise if I bend my back backwards. I am not talking about benching but general daily activity.
Obviously, in Mckenzie 3 since your joints are not under much load, I am able to extend through the lumbar region as well but when I am standing and bend backwards, I feel a mechanical pain. I am re-gaining torsional control well but the above is the only problem left and not much improvement.
1. Is that bending of the back backwards a faulty motor pattern where I am using the lumbar spine too much?
2. Even if I am able to work more on thoracic mobility and reduce the pain caused by extending the spine, is my limited ability to bend backwards using my lumbar spine, still a cause for concern? (since I used to be able to do a lot more in the past) OR I should have never been doing that in the first place and it was just a faulty movement that now I can't even do even if I try because of my injury?
Obviously, in Mckenzie 3 since your joints are not under much load, I am able to extend through the lumbar region as well but when I am standing and bend backwards, I feel a mechanical pain. I am re-gaining torsional control well but the above is the only problem left and not much improvement.
1. Is that bending of the back backwards a faulty motor pattern where I am using the lumbar spine too much?
2. Even if I am able to work more on thoracic mobility and reduce the pain caused by extending the spine, is my limited ability to bend backwards using my lumbar spine, still a cause for concern? (since I used to be able to do a lot more in the past) OR I should have never been doing that in the first place and it was just a faulty movement that now I can't even do even if I try because of my injury?
1 - I dont know for sure, but I think the reason you feel pain when you bend back while upright and not while laying down with no load is the way the spine loads, and your kissing spinous issue is probably activated more easily while standing.
2 - You probably remember from reading LBD that everyone's lumbar spine has less mobility than their thoracic spine.
I wouldn't be trying to bend backwards (aside from doing something like the McKenzie 3 that doesn't cause pain) if I were you.
That "kissing spinous" issue you have probably has a lot to do with your symptoms.
2 - You probably remember from reading LBD that everyone's lumbar spine has less mobility than their thoracic spine.
I wouldn't be trying to bend backwards (aside from doing something like the McKenzie 3 that doesn't cause pain) if I were you.
That "kissing spinous" issue you have probably has a lot to do with your symptoms.
Yea. Sounds its a case of that.
Looks like a visit to the professor in Canada followed by some beers with you and Yugo is almost 100% to happen now.
Here's a couple of thoracic mobility drills by McGill for those interested:
sound quality on this video isn't the best but it gives a more clear picture of what's happening
Looks like a visit to the professor in Canada followed by some beers with you and Yugo is almost 100% to happen now.
Here's a couple of thoracic mobility drills by McGill for those interested:
sound quality on this video isn't the best but it gives a more clear picture of what's happening
Also Zografa,
The reason why doctors all over the world regard flexibility of back as very important is mostly due to a study done in Boeing many decades ago where they wanted to classify what is a 'unhealthy back' vs a 'healthy back' but there was a conflict of interest as the study was being funded by Boeing and their aim was a reduction in compensation they would have to give out as a consequence of a worker getting and staying injured.
The study concluded that a back that was flexible was a healthy back.
This wisdom has permeated clinics who treat backs all over the world but sadly it is a very misrepresented, narrow minded and ultimately flawed view of what constitutes a healthy back.
The reason why doctors all over the world regard flexibility of back as very important is mostly due to a study done in Boeing many decades ago where they wanted to classify what is a 'unhealthy back' vs a 'healthy back' but there was a conflict of interest as the study was being funded by Boeing and their aim was a reduction in compensation they would have to give out as a consequence of a worker getting and staying injured.
The study concluded that a back that was flexible was a healthy back.
This wisdom has permeated clinics who treat backs all over the world but sadly it is a very misrepresented, narrow minded and ultimately flawed view of what constitutes a healthy back.
https://www.youtube.com/watch?v=BP-kUXhkZBU
modified sphinx is a great ex. for mobility in thoracic region
modified sphinx is a great ex. for mobility in thoracic region
https://www.youtube.com/watch?v=BP-kUXhkZBU
modified sphinx is a great ex. for mobility in thoracic region
modified sphinx is a great ex. for mobility in thoracic region
If you have any questions on how that above works, ask me and i will try to explain.
Exceedingly relevant:
http://www.npr.org/sections/goatsand...have-back-pain
http://www.npr.org/sections/goatsand...have-back-pain
She tried to figure out what all these different people had in common. The first thing that popped out was the shape of their spines. "They have this regal posture, and it's very compelling."
And it's quite different than American spines.
If you look at an American's spine from the side, or profile, it's shaped like the letter S. It curves at the top and then back again at the bottom.
But Gokhale didn't see those two big curves in people who don't have back pain. "That S shape is actually not natural," she says. "It's a J-shaped spine that you want."
And it's quite different than American spines.
If you look at an American's spine from the side, or profile, it's shaped like the letter S. It curves at the top and then back again at the bottom.
But Gokhale didn't see those two big curves in people who don't have back pain. "That S shape is actually not natural," she says. "It's a J-shaped spine that you want."
good stuff nuclear
I agree with the doctor in the end. The woman should have realized the reason why those women are able to sit for hours stooped is because they've been active all their lives, not because their spines are J shaped. My spine is J shaped and I have back problems.
You see a lot of people in India who are able to sit in crazy positions without pain.
One of the remedies we hear her do with a client (shoulder position to have palms face forward) is something that McGill has been advocating for years. It is very helpful in engaging the lats. Once they are engaged, you don't necessarily need to keep the palms facing up. McGill and KStarr both say you should always be in that position.
I agree with the doctor in the end. The woman should have realized the reason why those women are able to sit for hours stooped is because they've been active all their lives, not because their spines are J shaped. My spine is J shaped and I have back problems.
You see a lot of people in India who are able to sit in crazy positions without pain.
One of the remedies we hear her do with a client (shoulder position to have palms face forward) is something that McGill has been advocating for years. It is very helpful in engaging the lats. Once they are engaged, you don't necessarily need to keep the palms facing up. McGill and KStarr both say you should always be in that position.
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