5 myths of low back pain rehabilitation

When it comes to rehabilitating the lower back, there’s a huge amount of information out there. Some of it is valuable, some should be used with caution, and some is just plain wrong. The problem is, that if you try something that’s not recommended for you, it might be that it just doesn’t work, or you could actually exacerbate the problem and make it worse.

That’s why I wanted to do a tutorial that busts some of those commonly held myths about treating low back pain.

MYTH 1: You have to strengthen the muscles of the torso

You might think this one is a slight technicality, but to me it’s important how we define ‘strengthen’ in this context.

If you’re struggling with lower back pain, the last thing you want to do is go to the gym and overwork or fatigue those back muscles by trying to build up the amount of weight you’re able to lift, push or pull. Instead you need to build up the endurance of those core muscles so they work to protect your back.

Let’s take a step back.

There are two definitions of strength – one of endurance and one of strength. While people use the word strength, really what they’re doing, through core strength exercises, is building up those core muscles to combat fatigue.

Core strength, when defined properly, is the ability to apply force against a maximal load. How much can you lift?  If you join my How to build core strength and stability programme there are elements of this, but when it comes to overcoming lower back pain we really need to be looking to build the endurance of the core muscles so that in time, yes you might be able to lift / push / pull more weight, but your lower back will also be supported throughout the rest of the day. Because you’ll have built the integrity within your core muscles to protect your spine.

MYTH 2: Performing sit ups helps

If you’ve followed me for any time at all you’ll know that I’m not the world’s biggest fan of sit ups. In fact, I would call sit ups an unnecessary exercise. There is no real functional use for them and there are much better exercises.

Why do I say this?  One word: Compression!

Let’s look at what the sit up is doing to your spine, and hopefully you’ll see what I’m talking about. Put simply, as you flex your spine forwards and backwards, your back muscles muscles are activated to compress around or squeeze the spine. You can see a diagram of this in the video above.

And not only this, but flexing backwards and forwards can cause damage your spinal discs too as the vertebrae put pressure on them. Worst case this could lead to a herniated or bulging disc. In reality, it is unlikely that is unlikely to happen in the short term, but it’s not really a risk that’s worth taking and is very unlikely to actually help the situation.

MYTH 3: Bending from the knees is better

Attend any manual handling type course and I’ll put money on them telling you to make sure you bend from the knees. It’s a common phrase we hear time and time again. But is it truly the best way to lift a heavy item?

When you bend the knees to an extreme extent and they go in front of your toes, you are in fact putting too much pressure on those joints. The range of movement is too great. If you repeatedly do this you’re likely to wear out your knee joints, causing pain, stiffness and other issues. Knees are actually more effective when they’re not so bent.

Of course, another option is bending from the back, flexing only the spine. That’s not such a good idea either. Unless you make sure to brace your abdominals…but even then.

So what’s the answer? If we want to optimise the pressure between knee and lower back, it’s the hips we need to focus on. They’re the big, powerful joints that are built for this stuff. Aim for a more vertical shin, hips higher than knees with a natural curve to your back. And drive the movement through your glutes. Hips are more adept at managing the load and they’ve got the muscles and the range of movement to do it.

There is a place for different kinds of lifting, depending on the dimension of the load, the lifter, the number of times you’ll be lifting. But you need to understand the load and the pressures you’ll be placing on the different joints to work out which is better for you.

MYTH 4: Stretch out your hamstrings

I find that everyone loves a hamstring stretch, but I promise it’s not going to do anything to help. The main reason is that the tightness is a symptom of rather than the cause of your lower back pain. I’ve done a few videos now on why not to stretch your hamstrings if you have lower back pain. As back pain gets worse your hamstrings will get tighter and as it starts to get better your hamstrings will loosen. There’s no point expecting those hamstring stretches to make any difference to how your back is feeling. It doesn’t work that way around.

Want to know why your hamstrings tighten in this way? I explain all in the tutorial above.

MYTH 5: Focus on training individual muscles

People assume that if you use exercises like sit ups, crunches, side bends, back extensions etc. to train each muscle, or group of muscles, individually, they will eventually all come together as a strong unit. Unfortunately, this is a misconception. To strengthen the torso or core as a whole you need to train it in that way, including as many different muscles as possible, not just superficially but deep into the layer. Think rectus abdominus and obliques, gluteal group, lats. It needs different exercises, different positions.

Simply doing a few back extensions (the back pain sufferers’ favourite!) will not have the same impact.

If you’re suffering from low back pain I can help. Enrol in my How to Overcome Low Back Pain Online Course or if you feel like you’d like some personal support and guidance alongside, try my How to Overcome Low Back Pain Online Coaching.