Low Back Health

What is a healthy low back?

A healthy low back can move freely in different directions without pain. More importantly, it means you can do all the activities that are important to you.

When you have a healthy back, you can do your normal, daily activities. These might include putting on your shoes and socks, picking things up from the floor, leaning back to look up at the ceiling, rotating to look behind you, picking up your kids, etc. It might also include doing sports or other physical activities. To do these things, your back should be able to bend forward and backward, to the sides, and rotate. These are all normal movements and none of them are “bad.”

Having a healthy back does not necessarily mean you can lift heavy weights or do flips. You might be able to do those things, but even if you can’t, your back can still be “healthy.”

What things are not good for the low back?

The same things that are harmful to the rest of the body can also be bad for your low back. Expecting your back to hold a lot of weight or doing a lot of repetitive movements can stress your low back. A good warm up and the right preparation can help, but if you do a lot of an activity that your body is not used to without gradually building up to it, you are increasing your risk of injury.

• Let’s take golf for an example. If you were new at playing: 
  • You begin by taking lessons for one hour at a time, two days a week. 
  • After a few weeks, you start taking three lessons per week. You also start hitting the golf balls harder as you get better at your swing. 
  • Another few weeks go by and you play nine holes at a golf course. 
  • This schedule goes on for a few weeks—it’s three lessons and one nine-hole game each week. 
  • Then you play your first full round of 18 holes.
• In this example, the “load” on your body gets bigger slowly over time. This approach gives your muscles, tendons, joints, and other tissues the chance to get stronger and get used to the movement. 
• If you didn’t take it slow and just went out one day and played 18 holes of golf, there’s a good chance your back would be very sore afterwards. You might even get injured. 
• When you prepare yourself, you protect yourself. 

Pain Happens

Even people who have a healthy back also have pain sometimes.  Usually though, the pain doesn’t last a long time. The person can move gently to loosen up and start to feel better quickly. 

So having some pain doesn’t always mean your back is unhealthy. Back pain is actually very common. Acute pain is pain that is really severe and is felt all of a sudden. Acute pain is often the body telling you that something is injured or is in danger of being injured. It gets our attention so we can take action to avoid or reduce the injury. In that sense, pain is helpful and a big part of our safety and health. 

If someone has been in pain for a long time, it’s different. In some cases, the injury has healed completely but the person still has pain. This video by one of the leading researchers on the science of pain offers a helpful explanation, Tame the Beast.

Motion is Lotion

Your body was designed to move. Sitting still for several hours over the course of many days isn’t healthy. It can lead to stiffness in your low back and make it harder for you to move.  

Sitting itself is not bad. But too much of anything isn’t good. If you sit or stand most of the day it’s important to change positions a lot. Taking time to stretch or move your body in different directions is what keeps the stiffness away. 

How Often Should Movement Breaks Happen 

Everyone is different. So you should try different things and see what makes you feel your best. If you have been sitting, set an alarm to remind you to take a few steps around the room every half hour. Or, if you have been standing, have a seat. The key is to avoid long periods in the same position.

Movements to Start With

Start with the movements and stretches that feel good. If it hurts, don’t do it right now. You can always try again later.

Remember that you are different from other people. What might work for someone you know may not be the best place for you to start. Choose exercises and do them in a way that feels right to you. The most important thing is to get started. You can always adjust the exercises and/or intensity as you go.

Neutral Spine

An important aspect of low back health is finding the neutral spine position. Neutral spine is what we call the natural curve of your spine. Everyone has a different neutral position. Some people have more curves in their spine, others have less. Knowing where your neutral spine position is and holding that position helps prevent extra pressure on your back. It also lowers your risk of getting hurt when you exercise and do daily movements like reaching, stretching, and walking. 

Getting used to finding your neutral spine position and being able to hold it there is the goal. Finding it doesn’t mean you’re tense or holding your muscles tight. It’s not a workout. It’s just about finding that neutral position and feeling aligned in your body.

Finding Neutral Spine

The Hip Hinge

Once you’re able to find your neutral spine position, you can move while staying in it. The hip hinge is where you bend forward at your hips while holding your spine in neutral. Learning how to do this can help release back pain. It can also help with other leg movements like squatting or lunging.

Hip Hinge for Low Back Pain

The Squat

This exercise is an excellent way to train the body. The leg and lower back strength that is developed by squatting is used in daily activities. It makes things like getting up from a chair or the floor, walking up stairs, or picking something up from the floor feel easier.

Segmental Cat/Cow

The Cat/Cow is a great exercise for spinal mobility. It takes your spine through its full range of motion, from neck to tailbone. It is also very gentle because you are on your hands and knees. This puts the spine in a horizontal position so it’s not bearing any weight. This version of the Cat/Cow is segmental which means it stretches each segment or part of the spine. In this version, you move very slowly so you can practice controlling each part of the movement.

Segmental Cat-Cow

Low Back Mobility & Strength Class

If you’re looking for specific exercises to start with, this class is the place! This is a free, online 45-minute class. It guides you through the movements and exercises that can help build strength and back health. The Live Class Schedule can be found here, offered every other Tuesday.

Walking

Although it might not feel like much, walking is wonderful for the body. Walking can help keep the back and hip muscles loose. It can even clear your mind and improve your cardiovascular fitness. The more you walk, the better it is for you. If you are already taking a daily walk, well done!

Walking for Health

Progressive Loading + Recovery = Adaptation

“Progressive Loading” is building strength slowly over time.
“Recovery” is rest in between strength-building sessions.
“Adaptation” is your body changing and growing in strength and ability.

Your body adapts to what you do. Here, “load” means the physical demand placed on your body. If you sit a lot and don’t get much activity, the “load” on your body is low. Over time, your body will adapt to that low load and physical activity will begin to feel difficult. 

But, if you walk a little bit each day, your body will get used to it and walking will become easy. If you start walking further, and add time to recover from those long walks, that will start to feel easier over time, too. Recovery is a big part of how your body adapts. Recovery includes things like eating healthy food, drinking water, and getting enough good quality sleep. It’s also important to have “rest” days where you do low intensity activity like a shorter, slower walk or a stretch class. 

Teaching your low back to adapt to movement applies to weight training, too. You can begin by just using body weight movements. Over time, your body will become used to the exercise and it will start to feel easy. That’s when you want to add in some extra weight or resistance. You can use exercise bands, free weights like dumbbells or barbells, kettlebells, medicine balls, machines, and other equipment. The key is to add a little bit over time, keep including time to recover, and do both consistently. These muscles will protect and support your low back. 

Remember, your body is made to move. It is designed to get strong and it can recover from injury with the right approach.

“Rest is best?”

Resting does not mean laying in bed for hours. We now know that active rest is one of the best strategies for reducing back pain. Active rest does not mean doing high-demand things like lifting heavy boxes, shoveling your driveway, or doing heavy yard work. It means that you should do easier things like walking and light housework.

“I won’t know what’s wrong unless I get an x-ray.”

Imaging (like an x-ray or MRI) is simply a snapshot of your spine at one moment in time. It doesn’t tell the whole story. An “abnormal” x-ray or MRI does not always explain pain. In fact, some people who have “abnormal” pictures aren’t in pain. A sore back doesn’t always need an x-ray or MRI. Many times, back pain can be reduced with exercise and movement.

“Strengthen your core!”

A strong core (known as abdominal muscles and all the muscles surrounding your trunk) does support your spine. But your core can’t do it alone. So many things can make your back feel better including good sleep, healthy foods, and movement. Usually, low back pain feels better when you do a combination of exercise, eating well, and sleeping. 

“I will need medications for the rest of my life.”

Medications can help ease pain in the short-term, but rarely are they a great long-term solution. Adopting healthy habits, adjusting to how you move, and using a simple exercise routine can reduce your back pain faster and keep pain away longer than using medicine alone.

“Never bend forward”

Trust us, the human body is not that fragile! It is quite durable and capable of healing. Avoiding a movement after an injury can help, but after you’ve healed, you should be able to move normally again.

Do you currently have lower back pain, or have you had it in the past? You are not alone.

Low back pain is very common. Doctors around the world are starting to talk more and more about it. They talk about why it happens, things that can make it worse, and how to feel better. A few years ago, a well-respected medical journal called The Lancet, said: 

• Most episodes of low back pain don’t last long, but they happen over and over.  
• People who smoke, are obese, and who don’t get a lot of exercise aren’t as healthy. They are more likely to have low back pain. 
• When possible, being active, working, and doing normal activities are ways to manage your low back pain. A positive attitude helps, too. 
• A lot of things can cause low back pain. How you feel can depend on how healthy you are, how you think, how you process pain, etc. 

This is the final article in the series: Low Back Pain: A Call For Action

Sleeping with Low Back Pain

You may need to learn how to sleep in new positions. Certain positions can make your low back sore and others will help it feel better. There are also pillows and mattress pads that can help keep you more comfortable.

Sleeping Positions For Low Back Pain

Setting Up a Spin Bike – Back Position

With more people exercising at home, there are now a variety of different workouts and equipment you can order. One of the popular options is a spin bike for cycling classes. Exercising on a regular basis has many health benefits, but it is important you are exercising properly. Below are basic guidelines on how to set up your spin bike correctly to optimize your workout. As you are adjusting your bike, make sure the knobs are fully tightened before sitting on the bike.

How To Set Up A Spin Bike Properly

Things That Can Add To Low Back Pain 

• Low back pain can happen because of an injury, like if you lift something too heavy. But the pain you feel can also get worse (or better) depending on whether you have other illnesses and your mental state. Even other things that affect your mental health like financial or social stress can make back pain worse. 
• When you have one condition that combines with another, it’s called comorbidity. When it comes to low back pain, there are many common comorbidities. Asthma, diabetes, headaches, and depression are just a few examples. An annual physical can help you understand your overall health and whether it’s affecting your low back pain. 
• Being in pain can be stressful. It can cause you to miss work or not be able to do things that used to be easy. If your low back pain is adding stress to your life, talking about it with a therapist can help.

Mobility Videos

Use it to improve it! It’s important to gently move in every direction to help get more flexible. Here are some safe stretches you can try that can help you feel less stiff.

Lumbar Hamstring Flexibility and Low Back Pain

World’s Greatest Stretch

Stability Videos

When you can use your muscle strength to control your movements, you can move more safely. This can make your low back feel better and protect it from injury. Here are some exercises that can make your low back more stable.

Strength Videos

The key to getting stronger is to do it slowly and safely. That means slowly doing more and more as your body is ready to. It also means letting your body recover by resting and eating and sleeping well. Here are some exercises that can help you get started.

Your physical medicine team at Crossover is made up of experts in physical therapy, chiropractic, acupuncture and fitness. You are connected to them and they are connected to your whole care team. They can diagnose what is causing your back pain, work with your physician to order images if needed, and customize a care plan to get you moving, pain free, again. There is no reason to wait to see if the pain goes away, or gets worse, because you can start a conversation with us any time, and without the need for a referral.