Fix your back pain; don’t forget your glutes

Through proper exercise, movement, and posture, you can help low back pain.

Kevin Mullins, a master instructor for Equinox Sports Club in Washington, D.C. understands low-level chronic back pain and found three recurring issues that personal trainers can address with their clients. Excess bodyweight, sedentary lifestyles, and improper exercise selection, are areas a trainer can help a client with, all factors having a correlation to low back pain. It is estimated that over 84 % of the population will experience an episode of LBP, from children to the elderly, at some time during life.

As well, age, stress, occupational factors, lack of flexibility or hyper-mobility, sports, postural habits, and smoking are other contributing factors.

Recovering from low back pain is a long complex road. If you are in pain, but not dealing with any diagnosed or diagnosed medical issue, you fall into the category of mechanical low back pain, or LBP.

Unlike a car, says Dr. McGill, one of the most widely respected spine researchers in the world, where you change one thing and it’s fixed, fixing a back is different. Back pain is more complicated and is much more than just fixing one part. Because, McGill notes, it comes down to cold hard science.

How the  spine functions and it’s relationship the rest of the body is the key to being free of back pain. Through proper exercise, movement, and posture, even disc bulges can be made less painful, and usually pain-free, he notes. 

Of course it’s hard to stick to a program if you are in pain. You lose the very conditioning that could help treat LBP, or even more frustrating, gain unwanted weight.That extra weight is the number one reason clients turn to a trainer, with or without low back pain. Healing starts to occur when you keep the bigger picture in mind; a good diet,adequate sleep, and a matched activity/ training program.

Tip #1 The Big Picture 

A traditional strength training can improve strength and muscle mass. Overall body strength as well as a daily walking regime are important part of a client’s program to become free of back pain.

Tip #2  Bend at the hips, rather than the spine 

There is a direct correlation between posture and pain. You can reduce episodes of back pain by reminding yourself to bend at the hips, which is a ball and socket joint, not the back. The spine does bend, but repeated spine bending, whether it’s picking up a weight in the gym, or swinging a kettlebell, could eventually lead to delaminations in the layers of the discs. Someone swinging a kettlebell, along with their back, instead of stabilizing the spine while doing so, to protect the spine, risks further trauma to an already sensitive back. When you’re performing squats, for example, sink your hips back towards your heels, like sitting onto a low park bench. Keep your eyes forward. Use your hips rather than round your back.

Tip #3  Rethink the core 

To enhance back fitness, you need a strong focus on core strength, as theses muscles play a protective role. The internal and external obliques, transverse and rectus abdominals, and the erector spinae are arranged around the spine and act as guy wires to allow the spine to control movement, bear loads  and facilitate breathing. But all too often you see good athletes and gym members entirely focused on just the rectus abdominis, commonly known as the “6 pack”. If we go back to our car analogy, focusing on only one part won’t solve back pain.

The core musculature extends to the entire body,  from the upper back down to the pelvis, not just the 6 pack.The lats, trapezius, the gluteals, hamstrings, hip flexors and inner and outer thighs all have an impact on the spine. 

Typically what happens with someone experiencing low back pain, is that that pain hasn’t allowed them to adequately train. The outcome is weaker core and gluteal muscles. This is where science comes in.

To see how important the glutes are for strength, try this exercise; Stand on one leg and balance. Then sink your hips back slightly, behind your heel, and see how much more stable standing on one leg feels. This is a great demonstration of the role the gluteals play regarding core strength.

Your progression, with an awareness on good movement patterns, including planks, back rows, squats and bridges, for example, should be aimed at strengthening more and more of your whole body, back to health.

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Trade sit-ups for partial curl-ups & planks


Partial curl-up are a better way to get strong abs than sit-ups. Courtesy photo by Connie Aronson

Partial curl-up are a better way to get strong abs than sit-ups. Courtesy photo by Connie Aronson

My friend Claire is helping whip her new beau into shape, hitting the gym five days a week. Claire also has him doing dozens of sit-ups so he’ll get a movie-star six-pack.  For most people the first thing that comes to mind when you say “abs” is one muscle—the rectus abdominis. She means well, but doing hundreds of sit-ups are hard on your back because of devastating loads to your spine. In 2008, there were 3.4 million emergency room visits—an average of 9,400 per day, for back problems, according to the U.S. Department of Health and Human Services. Back problems are the fifth most common reason for all doctor visits in the US.  Trading the sit-up for safer and more effective abdominal work can help spare this outcome.

Dr. Stuart McGilll, a professor of spine mechanics and chair of the Department of Kinesiology at The University of Waterloo, points out that spine disks only have so many bends in them before they become damaged. Keep the bends for essential tasks, such a tying shoes, rather than using them in ab training, he recommends. The Army agrees. In 2011, after 30 years, the Army’s Physical Readiness and Combat Tests deemed the sit-up test as an ineffective assessment of a person’s core in relation to their battle strength.In sports that require repeated hyperextension—like gymnastics, diving, volleyball, weight lifting, golf, football, tennis and rowing—the incident of back injury is 11 percent, according to the International Journal of Applied and Basic Sciences. In football lineman, it may be as high as 50 percent. The types of injuries vary with age. In adolescent athletes, nearly 70 percent of lumbar spine injuries occur when forces are exerted on skeletally immature spines, whereas the majority of adult back injuries are related to muscle strain and disc disease.

If you want a stronger, tighter core, instead of full sit-ups, try the traditional crunch or many variations of a curl-up. Lifting your head and shoulders a few inches (around 30 degrees) off the floor and holding briefly is a good exercise to challenge the abdominal muscles while imposing a minimal load to the lumbar spine

Muscle  function
The four layers of abdominal muscles are like a woven basket encompassing the belly. The long vertical rectus abdominis runs vertically from the sternum to the pubis crest and is trained when you do an exercise such as the crunch. The external and internal oblique muscles rotate and side-bend the trunk. The deepest layer, right below your belly-button, named the transversus abdominis, plays a significant role in stabilizing the trunk, specifically the spine, during all movement. All the abdominal muscles hold in our organs and help us in forced exhalation, as in coughing, urinating or giving birth. But the most critically important function throughout the day—writes Judith Lasater, Ph.D., P.T., author of Yoga Abs Moving From Your Core—is stabilization, to keep the back free of pain and the abdomen strong.

Very few sports require fully flexing the spine, as in a full sit-up. Rather, the core transmits power from the hips through the torso as in pitching a ball or running. Here, the abdominals work together with muscles in the lower back, hips and pelvis, known as the core, stabilizing the spine. The core and spine can handle large forces vertically, but not in extreme flexion, as in sit-ups, twisting or bending.

For example, a 154-pound man standing upright has 154 lbs. of pressure on the L3-L4 disc, which the spine can easily handle. Sitting and bending forward 20 degrees, the pressure on L3-L4 bumps up to 264 lbs. In the bent-knee sit-up the pressure almost triples, up to 396 lbs. Simply modifying the sit-up to a partial curl-up, with the head and shoulders lifting a few inches off the floor, eliminates these huge compression forces on the discs.

In a June 2009 New York Times article titled “Core Myths”, the marginalized view of the core being “abs “was challenged by McGill. He compares the spine to a fishing rod supported by muscular guy wires. If all the wires are tensed equally, as in the whole lumbo-pelvic-hip complex, the rod stays straight. A core exercise program should emphasize all the muscles that girdle the spine, not just the abs, to ensure balanced strength. In his lab, he’s demonstrated how an average sit-up can exceed the limit known to increase the risk of back injury in normal American workers.

The full sit-up is three muscle actions: neck flexion, spine flexion and hip flexion. It’s important to be able to sit up, no doubt, but repeated sit-ups do place hundreds of pounds of compression on the lumbar disks. Hooking or holding the feet down stresses the low back even more. Ironically, the bent-knee sit-up has been taught to minimize the action of the hip flexor in the sit-up, though it is not correct. The abs can only curl the trunk. The sit-up is a strong hip flexor exercise (used in climbing stairs or skipping), whether the knees are bent or straight.

McGill says that the following three exercises, done regularly, can provide a well-rounded, core-stability program: practice the curl-ups, learn how to do a side-plank (lie on your side and raise yourself in a straight line) and try the bird-dog (kneel on your hands and knees, legs hip-width apart, raise an alternate arm and leg to hip height and hold for four or six seconds).

Claire tried all three, smitten over both the planks and her slim new guy.