INJURY & PREVENTION

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    Photo Credit: Nicolas Smith

Tackling the True Sources of Low Back Pain

By Mike Clausen

A leg workout is about the last thing anyone with low back pain feels like doing in the gym. But correct leg work can help to correct even entrenched lower back issues. Let's put this in perspective: lower back pain is the leading cause of medical sick leave and disability, and the vast majority of us will experience it at some point in our lives. But most people who have “bad backs” actually have chronic tightness elsewhere in their bodies that is causing the back pain. And the only thing that will fix this is corrective work. And while I can't address every possible source of low back pain, I can tell you about one leading cause that has impacted me personally, and what I have done to rectify it.

Causes and Solutions
Most people who experience pain in their lower back are actually tight in their quadratas lumborum muscle (QL). The QL muscle attaches above the 12th rib and is responsible for lateral flexion (side-to-side) of the spine, elevation or hiking of the ipsilateral (that is, on the same side) hip when the spine is fixed, bilateral extension of the spine (basically, holding you up straight), and stabilization of the 12th rib during inhalation and forced exhalation. In other words, this muscle does a lot. It will get particularly tight if you spend a lot of time sitting, as at a desk or computer, a position where the QL remains constantly contracted. And if you have a tight QL, you will experience it as a deep tightening of the muscles along your spine. The pain can also refer to the complex of your hip and pelvis—specifically, the greater trochanter, ischial tuberosity and sacrioiliac joints. If that's all Latin to you, here's what it means in practice: so much tightness and pain in front and back that you can't stand up straight. That's what most people describe as having their back "go out."  

Pain and tightness in the QL can come from an instability and imbalance caused by muscles that attach to the pelvis. This can originate in postural deviations in the pelvis. But here's the thing: even experienced exercisers can't easily tell what is causing their lower back pain. Until I saw a physical therapist, I was unsure whether my legs were tight and causing the back pain, or vice versa. Don’t self-diagnose yourself, even after reading this article. If you do experience chronic tightness or pain, see a physical therapist to help get to the root of the problem. In my case, I learned that my pelvis is tilted anteriorly and hiked up to the right, partly thanks to a wave surfing incident, but more importantly due to my chronically weak hamstrings and gluteus medius along with overactive quads. This is a recipe for disaster, since each time I did leg exercises, my quads would kick in, I wouldn’t be using the proper muscles, and I would further increase the instability in my pelvis. It's a vicious circle.  

But the cycle can be broken. I now have daily corrective exercise work that I must do to help keep my pelvis in line. I am going to provide you with this workout program—with the understanding that it is just pointing the way toward the kind of thing you will need to develop for yourself, in concert with a physical therapist, if you want to address your lower back issues. In other words, this specific workout may not be for you, but it will give you a sense of what is involved in getting leg work on track and developing a stronger core, leading to fewer flare-ups.  

To Do or Not To Do?
A physical therapist will take some options off the table for anyone dealing with these kinds of referred low back issues. For instance, my PT told me no longer to do lunges, since my hip height when measured before and after lunges was substantially different. The lunges were doing me more harm than good. Also off the table for me—and for anyone with overactive hip flexors and tight quads—is the leg press machine, which puts the body in an unnatural position while forcing those muscles to engage.

My daily corrective work consists of the three exercises I will describe below. I usually spend about 20 minutes per day doing this circuit. If I skip a day, I can notice the tightness start in my back, and then it refers to my hips, quads and IT bands. It can be pretty painful and annoying. So, I make sure to make this my top priority—even over working out. There is no use building up your body on a faulty foundation. If, like me, you've had this issue for a long time, you will not only have to be diligent in addressing it daily, but it will help to have support in the form of body work, both chiropractic (to keep the spine flexible) and deep tissue massage. Here are my three lower-back exercises:  

1.) Standing QL Stretch: Stand next to a wall in a lunge position with your outside leg behind you and the leg nearer the wall forward. Reach up and over your body with the outside arm, and bend towards the wall. Hold this for one minute, as you breathe deeply and on the exhale move your arm further towards the wall. Do this for one minute on each side. This one is not just for the gym—you can easily do this throughout the day. 

2.) Stability Ball Hip Raises: Lie on the ground on your back with the soles of your feet on a firm stability ball. With your arms out to your sides and palms down for stability, raise your hips as high as you can. You will feel the movement in your glutes and hamstrings. Slowly lower your hips back down to the ground. Do 20 of these. If you are having a hard time controlling the stability ball, then you can do these with your feet on the ground as well—but the stability ball will allow you more engagement throughout your core and can only help you more. You can also place a yoga block between your knees and press your knees together when raising your hips. All of this will help to “reset” your muscles. 

3.) Stability Ball Hamstring Curls: In the same position as the last exercise, with feet on a stability ball and shoulders/upper back on the floor, raise your hips so they are elevated in the air. Then “curl” the ball towards your body with your feet. Then, slowly roll the ball back out so that your legs are straight.  Your hips will be off the ground the entire time once you start. Do 20 of these. I will occasionally use the hamstring curl machine, but mostly just stick to using the stability ball as you don’t need to load up the weight for this exercise. You are just trying to slowly increase strength—you don’t want to overdo it and then have hamstrings that are too tight, thus pulling your pelvis in the wrong direction. 

The Full Package
Rectifying entrenched back issues isn't something you can just do in the gym and then forget. In addition to these daily corrective exercises and stretches, I make sure to maintain a proper back arch when working out, sitting at my desk, or training my clients. It’s something I have to constantly remind myself of, as I find myself slouching forward while sitting in my chair or rounding my shoulders forward when training clients, both of which casue me to slouch when standing. By, frankly, sticking my butt out, and maintaining that arch, I can feel my QL tightness diminish. All it takes is being diligent at doing the stretches and corrective work—and reminding myself that doing traditional weightlifting while I’m still injured is an unwise idea. Take care of your body so it will take care of you!

About Mike Clausen: Clausen is the founder and co-owner of DIAKADI Body training gym, voted best personal training gym in San Francisco by CitySearch in 2006. He has been actively involved in sports and weightlifting since high school, and continues to use that knowledge when training his clients. Clausen is both A.C.E. and N.A.S.M. certified and has been training clients professionally for six years. He enjoys making his clients stronger, both physically and mentally, giving them the tools to create an efficient body and to do things they thought were not possible.