by Bret Contreras January 10, 2010
* Update as of 12/25/13 – This post was written in January of 2010. Four years later, I’ve learned a great deal about back pain. To the point where this article is laughable. There’s much more to pain than biomechanics and posture. Please read up on the biopsychosocial model of pain, along with the neuromatrix (in fact, I’ve written on these – click on the low back reconditioning tab). .
That said, I will keep this article simply because 1) the advice can indeed help certain people with back pain, and 2) it’s a testament to my constant strive for continued learning and education. One last thing – don’t become fearful of movement as this can lead to more pain. Movement is your friend – start with pain-free movement and then expand your boundaries
At some point in time, 80% of people will suffer from low back pain (LBP). As a trained specialist who watches people move all day long, it is blatantly apparent why such a large percentage of people have low back pain: They don’t move correctly! The root of the problem is this:
People move with their low backs instead of their hips!
When the low back moves and the hips stay locked up, the gel inside of the lumbar discs propels toward the outside of the disc and can cause bulges or herniations. This is often the source of lower back pain.
The solution is not as simple as simply learning proper mechanics. Many people are unable to move with proper mechanics due to poor mobility and motor control. It takes some time to reprogram the body to move correctly.
In this blog I will teach you how to get rid of back pain by combining seven different strategies. Since this blog is intended for the common person, I will refrain from using too much technical terminology and try to keep it simple. In the interest of brevity, I will exclude specific exercises and drills, as this blog is intended to entice the reader to learn more about each strategy listed.
1. Improve Soft-Tissue Quality
Over the years people have built up adhesions and scar tissue that needs to be cleared. Furthermore, trigger points need to be desensitized. A muscle cannot function optimally if it has adhesions, scar tissue, and trigger points. By using self-myofascial release (SMR), which is simply a technical term for a “poor man’s massage,” you will restore optimal tissue quality and allow proper functioning of the muscle’s nerves and blood flow.
There are two ways you will address your soft-tissue quality. First, you will use a foam roller. You will roll out your entire back, including the erector spinae, lats, rhomboids, and traps. You will also roll out your glutes, hamstrings, calves, quads, IT band, hip flexors, adductors, and pecs. A simple Google search will allow you to find pictures and videos of foam roller drills for each muscle group.
And second, you will use a tennis ball or better-yet a lacrosse ball for more targeted therapy. You will use the ball to focus on the arches of the feet, the calves, the upper glutes, and the mid scapulae.
Although you can find many different drills on the internet for SMR, the best way to learn the correct application of the foam roller and lacrosse ball is to simply buy them, get on them, and start moving around. Your body will show you how to use them!
2. Improve Soft-Tissue Length
There are many different opinions in the fitness industry regarding the role of static stretching, but I believe it’s the best way to turn off inhibition and increase flexibility. Two main points to static stretching is to learn how to relax into the stretch and to combine rotational aspects into common stretches (PNF techniques) in order to kill two birds with one stone by stretching multiple muscles simultaneously. Never stretch so aggressively that you end up stretching ligaments! In particular, hamstring flexibility and hip flexor flexibility are critical components to minimizing low back stress.
3. Activate the Glutes
Many people have weak glutes. The glutes don’t like to contract unless need-be. They like to let other muscles such as the hamstrings and quads do a job and stay dormant unless you force them to contract. Years of inactivity and sitting (which shortens the hip flexors and causes more glute inhibition) cause the nervous system to literally forget how to use the glutes.
Use two different strategies to increase your mind-muscle connection for the glutes. First, incorporate loadless training into your arsenal, which is just a fancy term for “flexing your glutes.” Seriously, start squeezing your glutes as hard as possible every ten minutes or so throughout the day. Hold the contraction for around one second and then shut them off. Do this around three times during each “session.” This will equate to around 300 maximal isometric contractions per day and will go a long way toward increasing your glute activation.
Second, start doing low-load training which simply means start performing relatively simple glute exercises while focusing on high-quality glute contractions. Some good glute activation exercises include bodyweight glute bridges, quadruped hip extensions, side-lying abductions, side-lying clams, bird dogs, x-band walks, single leg glute bridges, and fire hydrants.
4. Increase Mobility and Stability in the Hips, Ankles, and Thoracic Spine
The best way to improve mobility is to add strength and therefore stability at new ranges of motion. By performing the right drills, you can simultaneously increase mobility and stability. Learn how to contract the muscles being stretched at the end range of a motion and pull the body into new ranges of motion with opposing muscles. There are many great mobility exercises that can easily be found online.
5. Learn How to Control the Core and Prevent Lumbar Movement
This could very well be the most important tip of all. Most people move by contorting their lumbar spines. Proper movement mechanics usually involves keeping the lower back locked into place (bracing) in neutral position while moving about other joints such as the thoracic spine and hips.
Even while exercising, most individuals have poor lumbar mechanics. They overarch (excessively extend) their low backs during squats, deadlifts, bridging, quadruped, lunging, and back extension movements, they round their lower backs (flexion) during deadlifts, bent over rows, good mornings, and reverse hyper movements, and they twist their lower backs during rotary movements. In all of these examples, this is improper mechanics.
Advanced lifters and high level trainers/coaches often have an insufficient understanding of lumbar mechanics. It takes much diligence to reach optimal core control but it is a critical component to moving, exercising, and eliminating back pain.
An excellent trick to learning core control is to perform anti-movement exercises. Anti-movement exercises teach the lower back how to brace heavily to resist movement and strengthen the core in a manner that uses all of the vital core muscles involved in bracing the core.
There are three types of anti-movement core exercises: 1) anti-extension, 2) anti-lateral flexion, and 3) anti-rotation.
Anti-extension exercises prevent lumbar arching and include front planks and ab wheel rollouts. Anti-lateral flexion exercises prevent lumbar side-flexion and include side planks and suitcase carries. Anti-rotation exercises prevent lumbar twisting and include Pallof presses.
Cable chops and lifts are valuable core exercises as well. These exercises should not be thought of as less difficult or challenging than traditional core exercises. If performed correctly, they are very hard.
6. Increase Hip and Leg Strength
Most people who suffer from back pain have strong backs, and that’s precisely why their backs hurt. They use their erector spinae musculature (back muscles) to lift things rather than relying on the glutes, hamstrings, and quadriceps. By strengthening the hip and leg muscles, the body will be encouraged to lift with the appropriate muscles. This doesn’t mean that the erector spinae will not be involved in lifting mechanics, as they will always contract heavily as stabilizers. However, the lumbar discs will be spared as the lower back will be stabilized to allow the muscles of the hips and legs to be prime movers.
It is imperative to start out with basic exercises and move up through the exercise progressions gradually. One must master bodyweight with a full range of motion before using extra load.
7. Learn How to Move Properly and Incorporate All of the Aforementioned Qualities Into Your Motor Patterns
Contrary to what is often said, one does not need to “lift with the legs.” The low back muscles are stabilizers, while the hips and thigh muscles are prime movers. It is perfectly fine to lift with the hips high as long as the lower back stays in neutral position. This simple act requires many of the qualities listed above, such as hamstring flexibility, glute activation, core control, and core/posterior chain strength. Learn proper movement mechanics and reinforce those movement patterns over and over until it becomes automatic. Finally, keep the load close to the body.
If people learn how to follow these steps, many lives could be improved dramatically. To give you a personal story, a 21-year old former client of mine (now he’s 23) was told by three different doctors that he needed to have surgery on his lower back. He was in and out of the emergency room and constantly taking pain killers. After three weeks of training with me, his lower back pain completely disappeared. Within two months he began performing loaded squats and deadlifts with 135 lbs. Within six months he was squatting 300 lbs and deadlifting 380 lbs. It is now two years later and he has never suffered a single bout of lower back pain despite lifting heavy week-in, week-out. While this story isn’t the norm, it clearly shows that low back pain can be alleviated and a LBP-free life is possible if the correct strategies are employed.
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