Exercise and Low Back Pain

Pamela Brown, MA, CSCS, CES, PRCS, ACSM-cPT

www.pamelabrowncoaching.com

trainsmart@pambrownfitness.com

Objectives

• What can cause low back pain

• Exercises to eliminate pain

• Any precautions

Causes of back pain

• Movement patterns (how you move)– i.e., carrying, lifting, stooping, etc…

• Postural control– i.e., letting your spine flatten, arch, or rotate excessively

during movement (lack of lumbar stability)– May have strong muscles but lack ability to control

unwanted movements• Lack of mobility at hips, t-spine, and ankles

– Decreases stability at lower back• Muscle imbalances

– Tight lower back and hip flexors due to weak glutes and abdominals

Back pain causes, cont

• Excessive anterior pelvic tilt of pelvis during movement

• SI Joint dysfunction• Gluteal amnesia: gluteals are not functioning

properly– Places more stress on the lower back

• Lack of endurance in lower back muscles– Lack of or poor cardiovascular training or muscle

endurance training

More on postural control

• Common postural flaw: lower crossed syndrome

• Characterized by excessive arch in lower back and “pregnant” appearance

Over-training rectus ab (6-pack muscle)

• Crunches teaches you how to become better at crunches, not movement– Doesn’t teach you how to stabilize spine

• May result in loss of control over rotation– Inhibits obliques from doing their job

• Can lead to hunchback-rounded shoulder appearance– Increases shoulder injury risk

Overall goal

INCREASE CORE STABILITY!!!!– Stability: stiffness; unable to move

• Increasing stability of the spine and pelvis while increasing mobility at hips and ankle– Stability before strength

• Increasing muscle endurance• Increasing muscle activation/coordination

– Using right muscles at the right time in the right way

Exercise Considerations

1. Identify movements that make pain worse and correct

2. Increase flexibility of tight/overactive muscles

3. Activate weakened/underactive muscles

4. Put back into movement

5. Increase muscular endurance

*using lower crossed syndrome as an example

ID patterns

• Handout

• Learn how to maintain neutral spine

• Hip hinge (moving through hips)

#2-Stretch tight muscles

• Tight muscles will not let joint move freely, causing more stress at the joint (the spine and hips)

• Tight muscles on one side of the joint will cause the muscles on the other side of joint to relax

• May need to be released through foam rolling or massage

#3-Activate weakened muscles

• After you increase flexibility of tight muscles, must “turn on” muscles that have been relaxed

• Increases joint stability and decreases stress on joint

#4-Use muscles in movement

• Re-training the body how to use newly stretched and activated muscles in functional movements

Focus of exercise sessions

• Increasing gluteal and abdominal and endurance– Increases core strength even though you’re not

training for it

Types of core exercises

• Use exercises that emphasize neutral, stable spine either in isolation or with extremity movement– Works abs at ideal length and how you use them in daily life

• Suggested to stop use of crunch, sit-up, and leg lift variations until sufficient stability is achieved

• Exercises that trains abs and surrounding muscles as a unit

• Functional exercises indirectly trains abs

– You use abs in every move that you make

Precautions

• Avoid hyperextension or hyperflexion while lifting, reaching overhead, carrying things,etc…

• Avoid twisting in flexed or extended positions• Maintain neutral spine during all exercises and

movements• Stop exercise if pain is present• Consult MD or PT if pain is persistent• Carry loads level with your lower back• Avoid morning exercise that places your spine in

flexion

Exercises

ALL ABOUT MUSCLE ACTIVATION AND TECHNIQUE!!!• Postural control

– Neutral spine• Abdominal brace• Horse Stance• Dead bug• Hip flexor stretch• Inner thigh stretch• Birddog• Front plank• Bridge• LEARN NEUTRAL SPINE AND PLACE INTO FUNCTIONAL

MOVEMENTS

Other considerations

• Cardiovascular exercise: provides oxygen for muscles which increases muscle endurance; increases release of natural pain killers

• Nutrition: healthy food, healthy muscles, ligaments, etc…

• Stress control• Use more bodyweight/functional movements

For more information

• Contact Pamela– coachpamelabrown@gmail.com– Visit www.pamelabrowncoaching.com and

schedule a consultation– Get a Skype movement assessment and/or

program design