Low back pain is one of the most common injuries I see as a physical therapist . Unfortunately according to the statistics, back pain is something that most of us will experience at some point in our life. Whether someone’s back pain started after a heavy squat day, doing too many deadlifts or simply just bending over to tie your shoe, I commonly see three BIG mistakes in the recovery process.
Let’s brake down each mistake and what we can do instead.
Mistake #1: Focusing too much on hamstring stretching
If I had a $1 for every time someone told me “I think it’s because my hamstrings are tight”…While it’s true some people do have tight hamstrings, it’s usually not the biggest culprit of back pain. In reality, most of the people who tell me they have tight hamstrings do not in fact have tight hamstrings, their hamstrings just feel tight. Usually the hamstrings feel tight because the muscle is actually weak. So someone who has weak hamstrings and is constantly trying to stretch them is actually making their hamstrings weaker.
3 Areas to mobilize instead
Most of the time the quads, hip flexors and thoracic spine are the main areas where mobility work needs to be focused. When the quads and hip flexors are tight it pulls the pelvis forward into an anterior pelvic tilt (think arched back, butt sticking out). In this position, the glutes and abs are put at a disadvantage and can’t fully contract.
Try it, stand up, tilt your pelvis forward so there is an arch in your back and try to squeeze your glutes and abs. Now tuck your bottom under just slightly so your pelvis is in more of a neutral position and squeeze your glutes and abs. You should feel like you can create a much stronger contraction in the neutral position.
Stiffness in the thoracic spine (aka the mid back) also needs to be addressed because when the upper back isn’t moving as it should, that movement needs to come from somewhere and usually that somewhere is the lumbar spine. In general, our upper back should be more mobile, while our lower back stays stable.
The bretzel is my FAVORITE exercise and targets all three of these areas. Check out the video below to learn how to do it. This is one exercise I frequently use with my physical therapy clients.
Mistake #2: Avoiding movement.
I get it, low back pain is scary and it’s not fun. You don’t want to hurt yourself worse so you stop going to the gym. Maybe you take some walks but overall you stop being as active as you previously were. This is NOT the answer. Let me say that again, avoiding movement is NOT the answer. While it’s true we may need to modify certain movements, we NEED to be moving. We NEED to be loading our tissues. This is how healing occurs. Loading our tissues is what stimulates healing and improves strength. Appropriate load and movement will also have an analgesic effect, while being sedentary can really make the problem worse.
Let me reiterate though that the key word is APPROPRIATE loading. No, you should not try to squat or deadlift your 1 rep max when your back hurts. N,o you shouldn’t try to run a marathon if you can’t even run a mile without pain. However doing exercises such as hip hinges with no or little weight, bridges, planks and air squats are great places to start. This is also where seeing a physical therapist in Durham is so important. Having guidance in knowing what an appropriate load for YOU is will be key in getting you back faster.
Mistake #3 Never letting you spine round
Have you ever been told it’s dangerous to let your back round? What if someone told you it’s dangerous to bend your elbow? You would think they are crazy because our elbows are supposed to bend and straighten. Well, your spine is no different. It should flex (bend forward) and extend (bend backward). This is a NORMAL part of human movement. Our society has created a phobia around letting the spine round. So many times I see patients who have absolutely no flexion in their lumbar spine and it keeps them from touching their toes (despite all their hamstring stretching). Using drills like the Jefferson curl or an assisted sit up (see below for videos) work great for teaching the lumbar spine to actually flex and restoring full movement to the spine.
Now, just like with anything else we need to build capacity and can’t jump straight to heavy lifting. I’m not suggesting you throw 3 plates on the bar and start lifting with a rounded spine but using an exercise like the Jefferson curl is a great way to start to slowly build that capacity of moving with a rounded spine. Why is this important? Well, have you haver had to pick your baby up our of the tub or crib? You probably have to round your back to do that. Ever had to awkwardly grab a box out of the car? You probably had to round your back to do that.
And finally, just to give you a good laugh….
Have you ever made one of these mistakes? If so it’s never too late to correct yourself.
Still struggling with back pain? Click HERE to get started on finally solving your back pain for good!
