Dr. Kyle: Cracking Down on Low Back Pain

 

2 people with low back pain attempt 10 minutes of moderate exercise on an elliptical machine. One reports that the pain is better. The other reports that the pain is worse.

What’s the deal?

It turns out that one of the main predictors of stubborn low back pain is hip mobility. You may have heard of the term “hip hinge” before, and this refers to bending at the hips while keeping a neutral spine. Elliptical machines in particular work the gluteal muscles group and keep the spine relatively straight.

When restrictions in the hip develop, the body is unable to “hinge” properly and the low back folds forward to compensate. Over time this repetitive flexion of the lumbar spine causes accumulative stress that is linked to pain!

Could it be serious?

If the pain intensity does not change with alterations in posture, loads and movement, it may not be mechanical in nature. Some “red flags” that may indicate something more serious include:

• Bowel or bladder incontinence
• Numbness in the groin region
• Unexplained weight loss
• Low back pain with fever
• Progressive and constant low back pain

Once these red flags have been ruled out and your back pain has been deemed mechanical in nature, it’s time to develop a plan of management.

What to Do

The first step is to remove aggravating factors. If your back pain is worse bending forward, stop bending forward. If your back pain is worse bending back, stop bending back. To a point. The trick is to find that pain free range of motion and to work within it.

Train the hip hinge! A major part of the process is cueing patients to bend at the hips and not with the low back. This will keep the back straight and reduce shearing forces through the spine.

Next, we train the exercises or movements that take the pain away. For many this involves abdominal bracing to stabilize the spine. A few key exercises include:
• Modified curl up
• Bird dog
• Side plank

Fine Tuning

The final step is to develop strength and endurance. Try to include exercises that challenge one side of the body at a time. This includes lunges, suitcase carries, and one arm rows.

As always, consult the expertise of a registered healthcare professional before starting a strength and conditioning program. Check out my Instagram page @drkylearam for more videos of exercises to prevent low back pain. It’s time to get you out of pain and back on the elliptical!