Updated: Nov 30, 2022
I hear this question a lot. In fact, over 85% percent of people will experience "non-complicated" low back pain at some point in their lives. Many suffer from chronic low back pain, lasting more than 3 consecutive months, while others have more occasional, but often severe bouts of low back pain.
I believe low back pain is often mistreated by healthcare professionals, and most people don't take the preventative measures necessary in the first place, which is why so many people have chronic low back problems. The former is the fact that many types of practitioners just focus on where the pain IS, not where the pain may be coming FROM. I'm generalizing, but 9 out of 10 patients I see with both acute and chronic low back pain have nothing wrong with their low backs. Problems in other areas causing low back pain, yes, but no structural issues are present in the lumbosacral area.
Function in the low back or lumbosacral area is another issue. What do I mean by function? The muscles are not functioning properly, resulting in compensation, weaknesses, and imbalances above or below the area of pain are typically the cause. Typically in the "core muscles."
"So because I don't have a 6-pack my back hurts?"
Well, no, not exactly... The core muscles comprise of a lot more muscles than your "6-pack" and even if you can't see your muscles, they still need to be working properly to support your body in movements and against gravity. Below you can see the several layers of abdominal muscles, which are each responsible for a different movement or stabilization, as well as the "extra" core muscles such as your glutes, abductors, lats, quadratus lumborum, trapezius, multifidi, and spinal erector which act as stabilizers and anti-gravity muscles. Without them you wouldn't be able to stand straight, bend over, lift anything. You're also prone to injury and dysfunction of the muscles, which of course lead to pain!
"So if I can't really see these muscles how do I know if they are working?"
Ideally, you get evaluated by a chiropractor, physical therapist, or even a corrective exercise-focused personal trainer who can assess exactly which of the several possible muscles are inactivated and weak and which are potentially over-activated or too tight. For the sake of this article though I'm going to share 5 core exercises I recommend to start with, which will help activate and strengthen your core muscles to help avoid or potentially get rid of your low back pain. Check out the video for the actual exercises and explanation, along with reps and sets.
"So couple crunches and I'm good?"
Well, like most things it's really not that easy. Again, is not your "6-pack" or rectus abdominis muscles that typically even need the focus, it's usually the ones on the sides and back, like your obliques and glutes. The video above shows the different ranges of motions and movements you want to perform to have a well-rounded core strengthening routine. If you just do crunches you are only getting 10% of the problem. I also tried to show some progressions of each movement, but it's hard to fully explain in just one video or even one hands-on session. It will take time and dedication to see results, don't be frustrated, and I really encourage you to have a guide on this journey to help you progress with ease.
Another problem I find with most of my low back patients is postural distortion, typically including forward head posture or upper crossed syndrome (I find low crossed syndrome much less common by the way). This is caused most commonly by chronic sitting. As Americans sit A LOT! The average American commutes over 45 minutes, sits for 8-10 hours at a desk, and then commutes again, and once home sits and watches TV for 4-6 hours. Now that may not feel like you, but we all (including myself) sit much more than we should. When seated your core is essentially inactivated, putting more stress on other areas of your spine like your mid-back and neck, hence the stiff shoulders and back you get after sitting for prolonged periods. I teach my practice members "Spinal Hygiene Exercises" which are a combination of core strengthening and stabilization exercises and stretches that support my spinal adjustments, but also counteract the negative effects of sitting and gravity. If you'd like to see my library of Spinal Hygiene Exercise you can sign up here and I'll send you all of my videos, with no spam, I promise.
The one reality though is often people need a guide to help them through this re-training of the core muscles after chronic pain or injuries, and I actually find the combination of specific spinal adjustments and stretches and exercises is the best combination. No approach is one size fits all, which is why my care plans look different for each individual that comes into my practice. If you've been struggling with low back pain and have tried everything else I'd love to have a shot and help you get your life back on track! You can request to schedule a free consultation and if we are a good fit for one another we can move forward with the 1st step in care, the 18-point Neuro-Structural testing I do in my practice here.