Common Treatments for Low Back Pain

Welcome back to Squat University! For the past few weeks we have taken a small hiatus from blogging as we’ve been concentrating our efforts on marketing our 1st book, ‘The Squat Bible’. However, WE’RE BACK and ready to start putting out more empowering content on SquatUniversity.com!

To start our comeback, we wanted to finish off our last section on low back pain during the squat. If you haven’t checked out our previous blog articles, I encourage you to read them before moving on. The information shared will help give you a good foundation for todays more practical topic.

Low Back Pain Table of Contents

Today, we’re going to discuss a few ideas for treating low back pain. However, because low back pain can be caused by so many different factors (muscular strains, herniated discs, spondylolysis, etc) each of these issues will require a slightly different course of treatment. For this reason, the exercises outlined today will be described with the following format.

  • The WHY: Too many people treat pain by the mantra, ‘throw enough mud against the wall and see what sticks.’ Selecting exercises haphazardly in this manner is not only inefficient, it can also be dangerous & exacerbate problems! You MUST have a reason for every exercise chosen. This will allow you to be efficient with your time & effective with your treatment.
  • The HOW: Simple explanations will guide you through each exercise. You’ll find out the proper way to perform each movement and exactly how often you should perform.

** Special Instructions: listen to your body while performing these movements. You should NOT feel any sharp or unusual pain. If your pain gets worse, immediately stop and move on to a different exercise until you can consult with a physician, physical therapist or other medical professional.

Category: Low Back Mobility (Flexion Preference)

  • The WHY: after a small muscular strain injury to the low back, it is common to experience stiffness and spasms. Many will have difficulty moving and will complain that their back feels ‘locked up’. This injury often appears suddenly and the pain does not radiate down the legs. Light stretches to the low back can help improve flexibility and relieve painful pressure symptoms.

Back Mobility Exercise #1: Lower Trunk Rotations

  • How to perform
    • Step 1: start by lying on your back with legs together and knees bent as shown.
    • Step 2: take a breath and as you exhale and lower your legs gently to the right side. You should feel a light stretch in your low back, often on the opposite side of the knees. Inhale and bring your legs back to the start position.
    • Step 3: as you exhale again, slowly lower your legs now to the left side. These movements should be performed in a slow and controlled manner.
  • Recommended sets/reps: 2 sets of 10 side-to-side rocks twice a day, followed by core stability exercises once they can be completed pain free.

Back Mobility Exercise #2: Double Knee to Chest Rocks

  • How to perform
    • Step 1: start by lying on your back with your legs together and knees bent as shown.
    • Step 2: grab both knees and pull them to your chest. This should bring a light stretch to your low back. Keep your upper back relaxed and your head resting on the ground.
    • Step 3: gently release the pull of your knees and let them fall a few inches back to the ground. This will release the stretch on your low back muscles. Lightly rock your knees to and from your chest, moving in and out of a pain free stretch.
  • Recommended sets/reps: 2 sets of 30 rocks twice a day, followed by core stability exercises once they can be completed pain free.

Category: Low Back Mobility (Extension Preference)

  • The WHY: some people develop pain in their low back due to prolonged overstretching of the tissues (muscles and ligaments) that surround the spine. When these soft tissues are overstretched, they can affect the discs that act as shock absorbers for your spine. In severe cases, this can lead to the development of a disc bulge where the soft material inside the disc pushes out of its shell (think of jelly being squeezed out of a donut). At times, a disc bulge can press onto a nerve and send symptoms (pain, numbness, pins & needles feelings) down one or both of your legs. People with this type of injury will often complain of pain if they sit in a slouched position for too long or when they bend over at the waist to pick something off the ground.
  • If you do have radicular symptoms (pain in the leg), I highly recommend you seek out a medical professional as continuing with your usual lifts may injure your back further.

Back Mobility Exercise #3: Press-Up

  • How to perform
    • Step 1: Lay on your stomach with your hands by your shoulders.
    • Step 2: Straighten your elbows and push your chest upwards while keeping your hips on the ground. Make sure to keep your lower body relaxed. Hold this position for 2 seconds before returning to the start position.
    • Repeat this cycle in a slow and controlled manner, pushing a little higher each time as long as pain does not increase. For some, you will notice centralization in painful symptoms (less radiating pain and an increase in pain in the low back). This is actually a good sign and shows the exercise is right for your body (1,2,)

Here’s a good video from Dr. Erson Religioso III from Modern Manual Therapy.

  • Recommended sets/reps: a set of 10 repetitions every 2 hours until pain has ceased. Follow these exercises with core stability work once they can be completed pain free.

Category: Low Back Stability

  • The WHY: the low back has a tendency to become unstable. When this happens our body develops compensations that lead to stiffness, decreased power production and eventual pain. Therefore, in order to improve how the body handles the stresses of daily movement & sporting activity we need to learn how to properly stabilize the low back with bracing. This act involves activation of all the abdominal muscles of our core (abs, back, diaphragm and pelvis) to create 360° of stiffness around our spine (3,4).
  • Core stability exercises should be a part treating every type of injury to the low back, however may need to be performed AFTER mobility work for those with muscular strains or disc issues. This is the first step for those who have chronic low back pain that is made worse with bending backwards into an extended position (possible spondylolysis).

Low Back Stability #1: Bird Dog

  • How to perform
    • Step 1: start in an all-4’s position (also called quadruped).
    • Step 2: brace your core muscles as if you’re about to receive a punch to the gut.
    • Step 3: raise your right arm and extend your left leg (opposites) at the same time as far as you can without your low back moving at all. Hold this end position for 5 seconds before returning to the start. Balancing a PVC pipe evenly on your back can give you some helpful feedback.
  • Recommended sets/reps: 2 sets of 10 reps on each side.

Low Back Stability #2: Standing Punches with Band

  • How to perform
    • Step 1: assume your squat stance while holding a resistance band that is pulling to the side.
    • Step 2: brace your core and perform a small 2 inch squat (hips push back and chest moves forward in a hinge motion).
    • Step 3: while maintaining your braced core, extend your arms and push the band forward with both hands. The further away from your body you push the band, the more you should feel your core working to maintain this mini-squat position. Slowly bring your hands back to your chest before punching out again.
  • Recommended sets/reps: 2 sets of 15 repetitions.

Low Back Stability #3: Single Arm Banded Raise

  • How to perform
    • Step 1: Assume the same mini-squat position as in Stability Exercise #2 but this time face away from the attachment of the band.
    • Step 2: while holding the band in one hand, brace your core and then raise your arm as far as you can forward (keeping your elbow completely straight). You’ll notice the further forward you raise your arm, the harder it is to maintain your braced position. Do NOT let your low back arch excessively!
    • Step 3: slowly lower your arm back to the start position before rising for another repetition.
  • Recommended sets/reps: 2 sets of 10 repetitions on each arm.

Low Back Stability #4: No Hands “Zombie” Front Squat

  • How to perform
    • Step 1: assume a front squat position with the barbell across your chest.
    • Step 2: extend both arms in front of your body (zombie position).
    • Step 3: brace your core and perform a controlled front squat while maintaining the bar on your shoulders. If your core beings to falter, your chest will drop and the bar will likely fall from your chest.

Here’s an example from my friend Robb Philippus (Follow him on IG @Quadslikerobb)

  • Recommended sets/reps: 3 sets of 3-5 repetitions. Start with just the barbell and add weight as you can while maintaining perfect form. Don’t try to overload this movement too soon as it can lead to possible shoulder issues.

Final Thoughts

Treating low back pain is no easy feat as there are many factors that need to be considered. While the tools described today are a good start, you must also look beyond the low back and examine the rest of the body (hip, ankle, knee and thoracic spine for example) to make sure you’re catching all of the possible ‘weak links’ that could contribute to the painful symptoms.

My goal is to provide you with tools on how to handle minor low back issues. It is your responsibility to seek a qualified physical therapist or medical doctor to manage any serious and/or chronic issues. My hope is that these exercises can increase your performance and keep your pain free!

Until next time,

SquatBottom
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

With

Kevin Photo
Dr. Kevin Sonthana, PT, DPT, CSCS

Resources

1) Werneke M, Hart DL, Cook D. A descriptive study of the centralization phenomenon: a prospective analysis. Spine. 1999;24:676 – 683.

2) Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. 2004; 29:2593-2602

3) Grenier SG & McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabil. 2007; 88:54-62

4) Gardner-Morse MG & Stokes IAF. The effects of abdominal muscle coactivation on lumbar spine stability. Spine. 1998; 23(1):86-92.

Published by

Dr. Aaron Horschig

Doctor of Physical Therapy, CSCS, USAW coach and athlete.

3 thoughts on “Common Treatments for Low Back Pain

  1. I’ve been having lower back pain, working out when body’s moving I’m ok, when I sit and everything relaxes that’s when it’s worst or when I really feel it , ever hear something similar or have idea if it’s pulled muscle or something worse thank you

    Like

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