Out of all the injuries someone will go through in their life, there is none more prevalent and debilitating than that of a low back or spinal injury. Not only does the injury drain you of your power, strength, and mobility, it can also impact your mental wellbeing, and can be very tricky to fix.
Many diagnoses come from observing MRI scans, and if something appears “off” on the scan, it is assumed that this specific area of the body must be the source of pain. This presumption could be incorrect for many reasons. First and foremost is that disc bulges are extremely common and very often show up on MRI scans. Researchers estimate that at least one third of healthy, pain free 20-year-olds have some sort of bulging disk in their spine. Not to mention the number increases by 10% for every decade of life. This means that about half of all 40-year-olds likely have a disc bulge yet experience no back pain whatsoever.
In 2006 a group of researchers collected 200 MRI scans of individuals without any history of back pain. Those who developed severe pain during the study had new MRI’s taken and these results were compared to the original MRI’s. Shockingly, around 84 percent of these individuals who developed pain had absolutely no change in their spine from the original scan. In fact, some people even had improved markers compared to their original MRI. This study proves that abnormality in the MRI does not always correlate to that area being the root cause of pain. This is because it’s very hard to distinguish whether this is a day-old injury or one, they’ve had for 20 years.
The MRI is also a very incomplete picture of how the spine functions. Most people with back pain experience pain doing different motions. For example, one of my clients with a bulging disk had absolutely no pain when he was standing or walking. However, whenever he bent over to pick something up, he felt it almost immediately. Other clients experience pain in extension, others in rotation, others with a combination of the two. Each of these individuals require drastically different treatment plans, but the only way we would be able to see that is by having them perform these movements. This is one of the very rare cases where a picture is not worth a thousand words. It’s simply a picture, and one we really shouldn’t be placing that much emphasis on. This is not to say to completely throw away the advice of your doctor. In fact, I would argue your doctor should be the first stop along the way to help with the diagnostic portion of your treatment plan. Even if a herniated or bulging disc is not the root cause of the problem, it is still a good idea to get a breakdown of what you’re dealing with. Disc issues can transfer to facet joints in the spine and eventually lead to things like plate fractures or spondolythesis. Always make sure to keep your doctor in the loop throughout your recovery process. If you have not seen any progressions in terms of movement and pain management, or if you are experiencing incontinence (loss of feeling or numbness) in your low body or pelvic floor, it may be time to discuss surgery options with your physician.
TREATING YOUR BACK WITH MOVEMENT
So, if we want to fix our backs through movement, what can we do about it? In Physical therapy and movement-based therapies such as the ones we perform at LYMBR, we take our clients through something called a Movement Screen. Obviously, all back injuries are different, but most of them fall under the following categories.
- Flexion intolerance (bending over to pick up a box)
- Extension intolerance (arching your back)
- Rotation with extension intolerance (Think golf swing)
- Load intolerance (Think barbell squat)
Our therapists are trained to help with any of the movement maladies mentioned above. However, there are 3 things you can do that can help no matter what you’re going through.
1. First and foremost, take a look at your hips. Research has shown that rigid hips are a huge risk factor in the development of low back pain. Stiffness in the hip complex can lead to the spine moving out of neutral alignment during sport or day to day movement. Things like getting in and out of your car can become extremely painful as your tight hips result in the lower spine sustaining uneven forces as it moves into low positions. Another huge portion of the hip complex are the glutes. Many people do not have full access to their glutes due to pain in the hip complex. When we experience pain, the brain shuts down the neural drive to that particular part of the body in order to protect it. Mobility and activation exercises such as assisted hip airplanes, and glute bridges are beautiful corrective movements to help reintegrate the glutes into your biomechanics and assist in fixing back pain.
2. Once these mobility restrictions have been addressed, you can start to build in better core exercises. I emphasize better because you’re not going to be doing a thousand crunches. In fact, the only three exercises you should be worrying about are referred to as “The McGill big 3”. These exercises were developed by famous Physical Therapist and spinal reconstruction wizard Stuart McGill. These exercises are phenomenal for spinal mechanic coordination, and are amazing for those with back pain as they are performed without placing excess stress onto areas of the back that are aggravated due to injury. Start with the Cat-cow stretch and perform this for 1-2 minutes before jumping into the following three exercises. (All exercises are demonstrated below.)
- McGill curl-up: do 3 sets of 5, 3, and 1 holding each rep for 8-10 seconds.
- Side plank on the knees: do 3 sets of 3 holding for 10 seconds each rep.
- Bird dog: Do 3 sets of 3-5 reps holding each position on each side for 10 seconds. Make sure to keep your back nice and straight and only extend from the hip and shoulder.
3. Lastly, and this is very important, stop thinking of back pain as a low back problem. Your spine is one cohesive structure, and without all parts working together, you will never be entirely pain free. Just as the hips can create pain in the low back, restrictions at your thoracic (mid-spine) can be just as problematic. Stretches such as a “prayer stretch” or the Feldenkrais shoulder and neck integrator can be extremely helpful in loosening up the mid back.
MRI’s can be extremely helpful in understanding the diagnostic breakdown of your body. However, targeting one specific area of pain based on the results of an MRI is what I would call rearranging deck chairs on the titanic. It’s a nice gesture, but this is doing very little to contribute to the solution to the current problem. Addressing the root cause of spinal dysfunction is the best way to remedy pain and promote a healthy, fully functioning body. If you are experiencing back pain, we encourage you to come into our studio for an assessment and stretch with one of our stretch therapists. Our therapists can assist in eliminating any movement and mobility restrictions and get you on the path to recovery. Below you’ll find links to all the exercises listed above, as well as an option to book a session on our website.
EXERCISES
CAT COW: As you breathe in, arch your back and look up to the ceiling. As you breathe out round your back and drop your chin to your chest. Repeat for 5-10 breaths, do one or two times.
ASSISTED HIP AIRPLANE: Keep the leg up throughout the exercise. Open your pelvis up and hold for 2 seconds. Repeat going the opposite direction. Repeat this for 5-10 times on each leg. Do it twice.
MCGILL CURL UP: Bend one leg up, and place that same side hand underneath your low back. In this exercise imagine your head is on a scale. All you have to do is get that scale to read zero. Very slightly lift your head and hold for 10 seconds. Do this for 5 reps, 3 sets.
BIRD DOG: Hold the top position for at least 3 seconds. Do 8 reps on both sides while pulling your belly button towards your spine. Repeat 1-2 times.
PRAYER STRETCH: You can use a stationary bench or foam roller for this exercise. I prefer a stool or roller chair. Keep your weight back and extend your arms forward. Make sure to keep your weight back as you drop into the stretch or you will fall forward. Repeat for ten reps holding the bottom of the stretch for 2 seconds.
FELDENKRAIS SHOULDER AND NECK INTEGRATOR: Grab your forhead and rotate backwards, repeat this 10 times on both sides. Breathe in as you turn back. Breathe out as you turn forward.
Movement is medicine! These exercises and stretches are great to do even when you’re back is feeling really good – be proactive with your health and keep moving.
Written by Conner Fritchley, LYMBR Master Trainer, Darien Stretch Therapist.
