Do you often get lower back pain? You’re not alone. Lower backache dominates all the aches and pains suffered by millions within the population. A Google search produces more entries for lower backache than all the other types of ache put together.
Why is lower backache so prevalent? And what can you do to alleviate your lower back pain? This post will reveal the most common cause of lower backache and present a recipe for improving it.
Causes of lower back pain
As with most aches and pains, the causes are many and varied. Causes can include
- Disc bulging
- Poor posture and movement
I would regard the first four on the list as related to the skeleton, sometimes irreversible, and often requiring medical diagnosis or treatment.
I regard the last on the list as being muscular in nature, usually reversible and not requiring medical treatment. Many of our clients come to us with lower back pain, and it’s almost always caused by poor posture and faulty movement patterns.
So, with that in mind, the rest of this post will discuss the type of lower back pain associated with poor posture and movement. We present a recipe to help you alleviate your lower back pain in that instance. It’s a sequence of activities you can perform at home with only a foam roller. It won’t work for everyone. But, done regularly, it should work for most people whose lower back pain is caused by poor posture or movement.
The most common postural issue causing lower back pain is a forward tilted pelvis.
Let’s look at the forces acting on the pelvis. In the schematic, the pelvis is tilted forward because the forces acting on the pelvis are imbalanced.
Tight hip flexors act to pull down the front of the pelvis. There are two main muscles. The rectus femoris acts on the pelvis to pull it down. And the iliopsoas acts on the spine, pulling it out of shape and taking the pelvis with it via the sacroiliac joint.
At the same time, a strong upward force is exerted by tight and overactive lower back muscles and tight lats, which influence the lower back through their connection with the thoracolumbar fascia.
The muscles that oppose these strong forces are weak or inactive. The abdominals are weak, elongated and switched off. And the glutes and hamstrings are also lengthened and inactive.
What causes these forces to become imbalanced?
When you sit, the muscles that cross the hip at the front – the rectus femoris and iliopsoas – are in a shortened state. If you sit for long periods most days of the week, as many people do, your hip flexors can become short and tight, and they will exert a downward force on the pelvis. Sitting also lengthens the glutes and hamstrings, which become inactive. And finally, sitting requires very little core strength or balance, so the abdominals become weak and inactive.
The lower back
What about the lower back? Why is that tight and active? There are two reasons for this.
First, imagine your pelvis was tilted forward, and you did nothing to compensate. Your spine would no longer be vertical and would lean forwards. You’d end up staring at the ground if you did not find a way to adjust your posture. Most people will arch their lower back to compensate so that they continue to look straight ahead. This isn’t a conscious action; it just gradually happens over months and years and is usually unnoticed.
Second, sitting is often accompanied by slouching or hunching over a plate, keyboard or steering wheel. Those positions make you round your upper back. Repeated prolonged sitting will then cause muscles at the front, mainly the chest and intercostals, to become short and tight. Your upper back will then become stiff in that rounded position. When that happens, if you made no postural adjustments, you’d end up staring at the floor. The compensation is, of course, arching the lower back again.
So, the lower back gets called into play when postural deviations occur, especially those caused by sitting. It’s this inappropriate overactivity that can cause chronic lower backache.
A recipe to help you alleviate your lower back pain
As you’ve seen, a widespread cause of lower backache is postural deviations both above and below the lower back area. Some tight areas create large forces, and some weak areas exert smaller forces.
The way to begin correcting these imbalances is to try to reverse them. So, we need to lengthen the tight muscles and strengthen the weak ones. We will also work on the principle of ‘lengthen before you strengthen’. That means you will lengthen tight areas before you strengthen weak muscles.
Here’s the recipe, in order
- Lengthen the hips
- Strengthen the glutes and hamstrings
- Lengthen the lower back and lats
- Strengthen the abdominals
- Lengthen the chest and open the ribs
- Mobilise the thoracic spine
- Strengthen the thoracic spinal erectors
As you can see, we are lengthening the areas we’d previously identified as tight. And we’re strengthening those areas that are weak. We’re also lengthening before we strengthen.
Of course, presented like this, the recipe isn’t that useful unless you’re a personal trainer or rehab therapist. You need to know what activities sit under each of the items in the recipe. We’ll label all these activities as ‘exercises’ and see what they look like in a moment.
But first, let’s talk about lengthening.
We’ll use two techniques: foam rolling and static stretching. Both activities have controversies.
Foam rolling does not break down scar tissue or muscle adhesions, as is often claimed. But it will give you a temporary increase in range of motion, improving your subsequent stretch and reducing inhibition of the muscles we are trying to strengthen.
There is also controversy about whether foam rolling or sports massage has a lasting effect on muscle tightness and trigger points.
More quality research needs to be done on this topic. But I feel I don’t need to read the research to decide on foam rolling. Having worked on my own body and with many clients, it is my view that it is effective at alleviating tightness and tender spots for weeks or even months.
Posture issues and movement dysfunction, if not corrected, will eventually see a return of tightness and trigger points. But, in the short term, foam rolling will reduce these and enable better biomechanics and a greater range of motion.
You should probably know that foam rolling can be extremely painful. But grit your teeth and ride the initial pain, and you should find that the pain dissipates quickly. You should also find that next time, it will be less painful.
Static stretching also has its advocates and detractors. Research tells us that it will undoubtedly improve range of motion temporarily. But a biomechanical principle is that a muscle’s length is a time average of the various lengths it assumes in everyday activities. That means if you stretch regularly, you should see longer-term improvements in range of motion and mobility.
The prevailing view is that mobility exercises are the best way to improve joint range of motion and movement patterns. But those types of drills require a lot more instruction and a trained eye to watch for and correct faulty movement.
In the context of this recipe to alleviate your lower back pain, we are using static stretching to increase joint range of motion temporarily. That way, we can temporarily reduce the inhibition of the muscles we want to strengthen.
Below is the recipe in full, with exercises listed and short videos of each.
Lengthen the hips
Two main muscles are implicated in tight hips in most people: the rectus femoris and the iliopsoas. We need to lengthen these muscles before strengthening the glutes, which are reciprocally inhibited by tight hips. Strengthening the abdominals will also benefit from lengthening the hip flexors.
Foam roll the rectus femoris
The ‘rec fem’ is a thigh muscle that crosses both the knee and the hip. Because it crosses the hip, it acts as a hip flexor with the proximal (near) end chronically shortened in prolonged sitters. Foam rolling will increase range of motion temporarily and may have a long term benefit on any trigger points within the muscle.
Stretch the rectus femoris
To lengthen the rectus femoris properly, you must tilt your pelvis posteriorly. Visualisations include ‘pull up on your pubic bone,’ and ‘imagine you had a tail, now try and tuck it between your legs,’ or ‘tuck your tail’ for short. Hold the stretch until the muscles relax. Do it on both sides but note any differences between the two sides as this might tell you something about left-right imbalances.
Stretch the iliopsoas
The iliopsoas combines the iliacus and the psoas muscles, both of which have a hip flexor function. It’s not easy to foam roll or self-massage, so we’re just using a stretch. It starts in a similar way to the rectus femoris stretch and requires you to tuck your tail.
Strengthen the glutes and hamstrings
Many exercises are effective at strengthening the glutes and hamstrings, but not many of them use bodyweight only.
This is an excellent exercise that will
- Strengthen and activate your glutes
- Activate your hamstrings
- Strengthen your tail tuck
- Stretch your hip flexors
If your hip flexors are tight, you may not feel your glutes working, so be sure to lengthen your hip flexors first.
Lengthen the lower back
A muscle often involved in lower back pain is the quadratus lumborum (QL).
Simply rolling this muscle can sometimes instantly alleviate your lower back pain. But we will also stretch it. We’ll also lengthen the spinal erectors of the lower back and the line of tension that passes from the glutes, up through the thoracolumbar fascia and into the lats.
Foam roll the QL
This is a little awkward, and it can be pretty intense when you find a tender spot. But stick with it because the discomfort usually dissipates quite quickly. Because you are also rolling part of the thoracolumbar fascia, this roll will help to increase the range of motion on both the QL and the lower back stretch.
Stretch the QL
Ensure you twist to point your chest up.
Stretch the lats and lower back
Perform this one as reps and hold the final stretch. Use this to stretch the lower back too by tucking your tail. This exercise has the added benefit of extending the upper back, helping with one of the activities later on.
Strengthen the abdominals
Again, numerous exercises will accomplish the goal of strengthening the abdominals. But we’re going to keep it simple and stick to two movements.
We’ll target the transverse abdominis, which is a crucial muscle for core strength and stability. It acts by stiffening the lumbar spine to reduce unwanted movement in that section of the spine. But we’re also going to strengthen the tail tuck by targeting the rectus abdominis, otherwise known as your six-pack. This muscle acts to pull up on your pubic bone, helping to re-align your pelvis.
Plank with tail tuck
If your lower back and hip flexors are tight, your lower back will be lordotic and will sag during this movement unless you consciously counter that position. So, you’re going to pull up on your pubic bone to tuck your tail and return your spine to a neutral position.
This exercise is literally curling your tailbone off the ground, so it’s excellent for strengthening your ability to pull up on your pubic bone to align the pelvis better.
Lengthen the chest and open the ribs
Lengthening the chest muscles may not be as obviously linked to lower back pain as other activities. But you can be sure that if your chest is tight, it will pull your shoulder blades out of position and contribute to poor upper back posture and stiffness. When you’ve stretched your chest muscles, you’ll feel your chest open and lift, and your upper back become straighter.
Your ribs can become chronically compressed by frequent, prolonged sitting, so we’re also going to open those up.
Stretch the chest muscles
A one-sided doorway stretch is a great way to lengthen the chest muscles. Doing it one-sided allows you to identify the differences between the two sides better.
Upper back roll
To be clear, we’re not using the foam roller in the usual way to loosen tender and tight muscles. We’re using it because it has the right shape to extend the upper back over the top of it. You’ll need to drive your ribs down to prevent the lower back from arching.
Mobilise the thoracic spine
This is really a continuation of the stretching that we have just done, except that we are performing this exercise in a more dynamic way that mobilises the thoracic spine.
Both exercises are rotations that will mobilise the thoracic spine and improve your range in the strengthening activity. Why do we need two exercises that rotate? Strictly, we don’t. But the second is included because it is a whole-body stretch. It will mobilise and stretch your hips and your thoracic spine, so it’s a great exercise to include in any mobility routine.
Lumbar locked rotation
If you can’t sit on your heels and position your elbow between your knees, perform this exercise on your hands and knees. Just be sure that you prevent your hips from moving away from the starting position. That’s much easier to do if you’re locked in place with your elbow tucked between your legs than on all-fours.
Spiderman with thoracic rotation
This is an advanced stretch. Don’t worry if you can’t get in position. If you perform all the other exercises, it’ll still be a highly effective sequence. But if you can perform this exercise, you’ll feel a difference in your overall mobility.
Strengthen the thoracic spine
Here, we need to strengthen those muscles that extend the upper back. Those muscles may have become lengthened and weak from spending a lot of time in various seated postures.
Locking the lumbar area with a strong core engagement is crucial. Don’t focus on how high you can rise. Instead, focus on the quality of the core contraction and subsequent thoracic extension.
Consistency and awareness
If you have compromised posture, movement dysfunction, and lower back pain, there’s a reason for it. You weren’t born like that. Your lifestyle and habitual movements and positions have created the imbalances that are now affecting you. If you do nothing to change those habits, you’ll be fighting a constant battle.
To make progress, you’ll need to
- Perform this sequence regularly
- Become aware of your everyday movements and postures
Regular corrective exercise
If you manage to alleviate your lower back pain, that’s great. But your task is not complete. If you stop doing the exercises at that point, the problem will return. You’re probably going to have to do this for a lifetime. You may improve your movement and posture habits and require this kind of corrective sequence less often, but you’ll still need to return to it frequently.
When you first start performing these drills, you may find that your muscles get sore. If that’s the case, perform it every second or third day. Once you are accustomed to it, you should be able to complete it daily. Once you alleviate your lower back pain, you can drop back to doing it three to four times a week.
Become aware of your posture and movement
If you’re seated, your hips are shortened. There’s very little you can do about that; it’s almost the definition of a seated position! But it may help to use the back rest so that you are not constantly using your hip flexors to remain upright.
Mainly, you’ll need to adjust your seated positions to avoid upper back rounding. Ideally, your hips and knees will be at 90 degrees, your elbows will be slightly above the level of your desk, your shoulder blades will be back and down, and your eyes will be level with the top of your screen.
Slouching and slumping on a sofa are two of the main culprits for stiffening your upper back in a poor shape. So, be very conscious of your seated postures and straighten yourself often.
It’s a good idea to get up and mobilise often. Stretch your hips, squeeze your glutes, tuck your tail and mobilise your upper back.
You should also be aware of other movements in everyday life. For example, if you’re reaching up, do you extend your lower back or upper back? Many people arch their lower back. Instead, tighten your core and consciously extend the upper back when you reach up.
When you get out of a chair, do you arch your lower back as you stand up? Instead, try tucking your tail as you stand up.
When you bend down to pick something up, do you round your lower back? If you do, you’ll be using your lower back to stand back up.
There are numerous examples where you might recruit the lower back muscles instead of other muscles. Become conscious of how it feels when your lower back muscles fire, and then identify the occasions where they activate. Alleviate your lower back pain by consciously recruiting the right muscles while engaging your core to switch off the lower back.
You now have a systematic approach to help you alleviate your lower back pain. Execute it regularly to banish it forever.
But be aware that this may not work for you. If that’s the case, either you have different postural issues to those described here, or your pain is not related to posture or movement dysfunction.
Give it a try, stick with it, do it regularly and see if you can alleviate your lower back pain once and for all.