Exercising Strategies for Alleviating Lower Back Pain

When I speak to people struggling with lower back pain, they often ask the same questions: should I continue to exercise? What exercises should I do? And how do I make sure I don’t make it worse? 

In this tutorial I want to set out the journey you’ll go on and what you should be doing. As well as how I can help you to implement lots of positive changes, step by step without aggravating your lower back pain.

The importance of understanding lower back pain

The first thing I want to say here, is that your lower back pain is specific to you, you will have your own triggers. There will be specific postures, and scenarios that make it better or worse. The first step is to get to know and understand your own lower back. Because that’s the only way you’ll be able to learn how to do the right thing for it. 

When you join one of my online programmes, or work with me face-to-face, the first step will always be an assessment of your lower back pain. This will involve you answering some questions. In fact, there are 3 questionnaires for you to answer before we even get anywhere near a consultation. That’s because if I want to do my job properly, I need all the information you can provide. 

These questionnaires help me to gain an understanding of what's causing the lower back pain, and then start to reduce or eliminate the cause, which should, over time, improve things. Pain will usually come and go based on movements, postures, positions and load bearing. So the better we can understand all these different things, the better it's going to be for your lower back pain in the future. 

And the quicker we recognise what‘s going on, the faster we can get you back to doing the things you want to do.

When it comes to alleviating back pain the key is to start small

If you want to sort out your lower back pain, you need to start small, particularly when it comes to exercise. The main objective is to start with what you know you can do. So if you are able to walk around your block without any pain, then that’s a great start point. It may not seem like much, but it’s a step in the right direction. You’re being active without pain. And that's the goal here. Because it’s vital we start to dial down the pain, which is basically doing things that don't aggravate it. After all you have to be able to live life, carry your shopping, get up the stairs, drive your car etc. We need to work out what’s possible and make sure you’re doing as many of these things as you can.

Starting small could look like going for a walk around the block every day for a couple of weeks. Once we know that’s OK, we might add one more exercise in. Perhaps the plank? So we could do a walk around the block then do three sets of plank for 10 seconds. Perhaps we do that for a couple of weeks giving us time to understand if it’s working without aggravation. It’s worth noting here that by aggravation we mean pain that might occur during, immediately after or 24 hours(or more) later. Or it might even be simply a little stiffness when we get up in the morning. That’s why we take our time. We need to allow time to assess what’s going on in a controlled way before adding in more variables. 

Continuing the assessment

Alongside these small activities, we’ll conduct a physical assessment. This consists of three things.  We assess the lower back, the hips and the core. The goal is to identify the weak link in the system. Just because the pain is expressed through the lower back doesn’t mean it comes from there. We’ll start the process by looking at the questionnaires and building a full picture of what’s going on, so we can start to work out exactly where the issue is. Then we’ll move on to a few physical tests – these can all be accessed via the portal if you’re working with me via my online programme:

• Assessing the lower back for the physical postures, positions, movements and loads.
• Assessing the hip for the range of movement, stability and how the muscles function around the hip. 
• Assessing the core in terms of stability, strength and endurance.

Once all of this information comes together, we can start thinking about things we can do to reduce the pain, alleviate symptoms and more importantly address the cause.  

Foam rolling 

In the video above I talk a lot about the types of muscles around the hips and tops of the legs, and how when these are struggling you can end up with pain similar to sciatic or nerve pain.

Once we can understand which muscles are involved, foam rolling can be useful to help desensitize these muscles and loosen them up a little.  The thing is, it needs to be done correctly. If you go too hard, too soon, it could cause a problem, but it needs to be hard enough to work out the muscle tension and potentially relieve some of the problem. There are also other reasons why the muscles may be tight, so this needs to be carefully assessed and managed accordingly. 

As part of the process of online questionnaires, assessment and review, we’ll look at the muscle sensitivity from the trigger points and the tight muscles around the lower back and the hips. This helps us understand what's going on in the area and informs what we need to do next. 

Stretching

Gentle stretching might seem an obvious start point for a stiff or achy back, but it’s important to say that if we've got tight muscles in the lower back, it's not always a good idea to stretch them. This is because they could be tight for a particular reason, which we need to understand. In some cases, by stretching, we’ll initiate what’s known as the stretch reflex. That’s the ability of the muscle when it loosens to tighten back up again. Once it's longer this reflex shortens it again, causing tightness. This is where massage may be a more useful approach. Ultimately we need to remove the symptom before we can get to the cause.

If the issue is in the hips - perhaps stemming from a lack of stability or range of movement in the joint, stretching may be more effective. But it’s not a one size fits all method or strategy. It really is a case of the questionnaires and assessments informing the advice given.  Because we’re working with what your body is telling us. And that allows us to build your unique program for overcoming your specific lower back pain.

Exercise

Once we’ve mastered some simple activities that are possible without aggravating the pain, we can look at developing some strength, stability and endurance. Strength is the ability to get into a position and stay there for a short period of time, endurance is the ability to stay in that posture. 

You need the strength to get there first. Take the example of a plank. There are plenty of people who don't have the strength to get into a full plank - elbow to toe. If that’s the case, it might be possible to start from the knees and come up. If we find they have the strength to do that, then what we need to do is build the endurance on top of that, to allow them to get there and stay there. We follow the steps systematically, we look at the timing of the muscles, check the stability of the core and where there are any adverse stresses going on with the way the body is moving. 

We build the strength and endurance gradually, so we start to see progress. But only after we’ve begun to reduce the pain by starting simply, foam rolling and massaging where appropriate. It is never simply a case of jumping this step.  

Movement 

Once we've got the endurance, the stability and the strength in place, we’re working on posture and movement. Specifically these fundamental movements: lifting, carrying, pushing, pulling, getting up, rotating, walking and running. 

There are little workshops online to help you understand everything, so whether you choose to work online or face-to-face with me you’ll have a good overview of how to build your exercise plan. As well as this principle of starting small, following the process and getting back to the sport you love. That might be sooner, it might be later. It all depends on your back pain and how diligently you work at it. In some respects the more serious the original injury, the longer it's going to take naturally, the less serious the injury the quicker it’s likely to be. But put the right building blocks in place, follow the process and you will get there.