If you’ve been struggling with lower back pain, particularly for a longer period of time or a more severe flare up, exercises can be something that you have an urge to steer clear of. The common thought runs through your mind:
“What if the exercises or stretches make my low back pain even worse?”
This is completely understandable, back pain can take your breath away and make even the simplest of tasks a real challenge, especially in the midst of a flare up. Furthermore, it often happens at the worst of times!
So what should you do? Today we’re going to help you break down this scenario, view things in a fresh light and ultimately help you figure out the next steps to take if you are struggling with lower back pain but worried that your back is too fragile to do exercises or stretches!
Where most of the lower back pain flare ups happen
When it comes to recurrent lower back pain or sciatica, it is helpful to take a moment to consider when these flare ups happen, and where. In the majority of cases, you’re not doing back rehabilitative exercises before your lower back flared up. You’re out there living life doing what needs to be done and hopefully enjoying yourself at the same time. Working life, family time as well as leisure activities are the norm. For some they choose to partake in formalised exercise or resistance training, but we know, at least in the UK this is a woefully inadequate number.
According to an article in the New Scientist, only 1 in 20 adults aged 19 to 64 are partaking in regular strength training, a form of activity that strengthens your muscles, bones, joints, ligaments and tendons. That’s just 5% of the UK population! So chances are this was not how you injured your lower back.
Strength is important as it allows you to climb stairs as you age, dig in the garden, pick up grandchildren and protect your lower back… more on this later.
Considering it is highly probable that you make up the other 95% of the population, it is these other activities of daily life where most of the flare ups happen. It’s moving suddenly in the kitchen, putting on your socks in the morning, putting the child in the car seat, unpacking the shopping at home, repotting your favourite plant, or doing some weeding in the garden. Sometimes it can even be the simplest activity, like getting out of a chair that leads to a flare up in your back pain.
Although it might be that you’re worried that your back pain is being worsened by exercises, it is in the majority of cases that your back pain has been worsened by everything else.
Take a moment to evaluate your daily lower back strain
The lower back is strong but when it is abused over the long term it can begin to fail. From the many thousands of members in our program and patients over the years, it is clear that the majority of back pain comes on steadily, even if not acknowledged at first. Looking back, stiffness in the back, or discomfort is very commonly a factor that precedes a “life changing” episode of back pain or sciatica.
It is the gradual result of poor movement patterns on a daily basis, let us explore a couple.
Getting up from being seated, and sitting down as a major back pain factor
Many, especially as we age, become lazy. We drop ourselves into soft chairs with a rounded back and a thud. Or as we get a little older, hover above the chair before our legs cannot bend any more and then when we see it is safe to do so, drop the rest of the way onto the seat. Both scenarios result in an impact through the lower lumbar spine without the protection of the legs to absorb shock. This might not sound like much but it adds up over the decades. Then the reverse, getting out of the chair, we tip our torso forwards, rounding our lower back and with a push and some momentum topple ourselves forwards and then try to straighten up, usually after being sat for too long in a slouched position.
Take a moment to think how many times you do this every day?
Doing chores over a surface, such as ironing, washing up, cooking & preparing food
In this position we spend time leaning ever so slightly forwards, over a work surface, rounding our lower back and with our centre of mass pushed forwards of our feet, this increases the effective weight of the body on the lower back, again culminating in the increase in strain down there in the lower lumbar spine. Coupled with this, as we are leaning forwards we might be twisting or rotating, to grab the next item of clothing, cutlery or food item to handle.
Again, take a moment to think about the prevalence of such actions?
Getting dressed and undressed in the morning and evening
Depending on the attire, particularly the bottom half, this again involves a significant amount of rounding of the lower back, perhaps some awkward pulling and twisting in order to get the socks on for example. Often this is done early on in the morning before we’ve had a chance to get moving properly, or later in the evening after we’ve been nice and still in front of the television or just relaxing in general, probably in a position which reflection might reveal involved an unfavourable degree of rounding in the lower back.
Why are we covering these areas, wasn’t this about exercises? All will make sense very soon. The point is that you were doing all these things before you had your back injury and you will likely be continuing to do these afterwards, in spite of the pain in many cases! They are the sources of flare ups that plague so many, but why?
Spinal movement is the reason these activities make your back pain worse
All these movements and many more that you’re doing every day involve spinal movement. Let us take a moment to look at the good old surface wound, a burn, cut or graze, over a joint, let us say the knee. The tissue is compromised and trying to heal, especially in the short term. These tissues heal very quickly compared to those that are in the lower back. It might only take a couple of weeks for that wound to be completely healed up and there be no evidence of any damage at all. Unfortunately, the tissues in your lower back are not the same, they heal very slowly.
When you have this surface wound, the worst thing you can do is move or stretch the tissue, it is this pulling on the partially healed tissue that pulls away at the scab formation and re-initiates some minor damage. This is the flare up.
Just like the surface wound, your back is aggravated when it is moved, or when the back has to bear load. You might think that sitting is not a problem but this offers a steady pull on the injured tissues as well as a compression of the lower lumbar spine, coupled with the heating effect of having your back against a seat and you have a real issue.
The one challenge is that the overwhelming majority of spinal injuries result in a degree of instability, the spine at the injured level becomes a little more wobbly in the first instance. This is because it is the tissues that maintain joint integrity that have failed. This instability is why when you’re moving in certain directions you “catch the back” and this sets off the pain again.
This truth is why there is only one way to overcome this in the short to medium term. The good news is, if you can do this, you will find you have much more predictable success with your back pain recovery and you’ll suffer ever decreasing frequency and intensity of flare ups along the way.
Principles for choosing exercises that will not make your back pain worse
Firstly you have to choose the right exercises, a hint here is that we’ve just discussed the issue with movement so a silly exercise like child’s pose stretch or cat-cow stretch are not the right exercises.
Safe exercise choice for lower back pain: spinal stability
You must begin to choose exercises that promote spinal stability, it is a failure of stabilisation that leads to the pain or flare up. Therefore when choosing exercises, these should focus on building the ability to provide stability to that injured spine. Your muscles are working to compensate in the short to medium term for the lack of joint stability so this is a vital first step!
This however, is where your pain will likely come in again! Chances are, if you are at the point where daily living is resulting in flare ups of your back pain or sciatica, your ability to provide spinal stability is inadequate. This is a problem!
Do not be alarmed at this, doing the right exercises that are safe, off weight bearing is the safest first step. For example, you might well choose a simple psoas engagement to begin first off, even on the bed! If you find even this is painful to begin with, that’s ok, there are additional strategies, such as using a towel to help provide support that will help you make this simple exercise even easier. A more challenging variation that you can also do on the bed, before you make the transition to the floor, could be the modified dead bug exercise. The principles are the same, you are required to hold your spine still as the musculature on one leg or other, is pulling on your spine.
Think about this now: If you cannot even lie on your bed and do this without pain, how poor is your control?! But at the same time, if you’re getting out of bed in the morning and doing anything else at all, you’re willing to do more strenuous activities, aren’t you! These other “daily life” activities provide no cumulative benefit, only cumulative risk. So if you’re willing to flare up your back doing those, then do these exercises first! Additionally, the only way to learn to do this is to do it. You wouldn’t stop a child from learning to walk because they fell over the first time, and you wouldn’t expect them not to fall over either. It’s part of learning.
Start with the safest position, lying down on the bed, spend some time each day practising this, until you can do it without pain, then move on!
Incorporate “true to life” activities first for your lower back pain recovery
The squat, you might be thinking that will and does cause me back pain! That’s ok. You might also be worried about doing such an exercise, you should be!
But do you have the same fear of getting in and out of a chair?
Getting off the toilet seat?
Getting in and out of bed?
You might, but you do them anyway! Don’t you!
So why be so fearful of a squat specifically? Just like the example above, when you allow your spine to move without controlling it – spine stability – you’ll aggravate your lower back. You are already doing many squats every day without thinking about it, you might be aggravating your back each and every time, but you get no reward out of it.
Instead, in spite of the short term pain, start learning how to do the squat properly, without the spine moving. Just like the previous exercise, there are modifications you can make to help you learn how to do this without aggravating your lower back but you have to do them to figure that out. Until you figure this out you will continue to get in and out of various chairs without control. So do not be fearful of this movement. Just like a child learning to walk, spend some time each day figuring it out, until you find the easiest version of a squat that you can do without making the pain worse.
That’s your starting point.
From there you can see the gap between where you can get to safely, and your chair, seat or toilet. Chances are there’s quite the difference, so you need to get to work filling that gap. Sometimes this can literally mean getting bumper seats for the short term because things are so bad, but take action!
But my low back pain is so bad I cannot even do those exercises
Some of you really will be in a bad way, and if you’ve got this far, well done. This is a natural concern for so many. You’re probably thinking, this must be causing such terrible damage to my back!?
Consider the following…
Even when your back pain is so tremendously bad, your surgeon or doctor will likely still get you to come to their office or practice, knowing that this involves a drive (getting in and out of the car) they will ask you to probably sit down or stand. You’ll then likely leave the office, maybe to return at a later date. The point here is while simple activities of daily living are not ideal and flare things up, they are not severe enough for the surgeons, doctors and other healthcare practitioners to get you to “come in to see them”.
Also consider no matter what the injury is, you will not leave that office under any different circumstances. The disc is still bulging, the damage is still there, in every single scenario.
Seriously, think about it.
Short of the emergency case where they call an ambulance and you get whisked off to accident and emergency to have an emergency operation, you are still walking around after the appointment with exactly the same injury.
Even hands-on therapies or treatments do not change the underlying injury in an instant!
In every case you will still go home, get in and out of the car, get on and off chairs, and so on. The difference is, that if you do exercises that involve spinal stability, with care and reflection, that are reminiscent of real-life activities, in a few short days, you will become better at these activities, this instantly reduces your likelihood of injury and your back injury becoming worse.
With time and practice, the benefits will compound. Start out with “safe exercises” focusing on spinal stability, make sure that they are “representative of real life movements you’re already doing” and steadily over time you can add complexity. This is the only way forward, and as much as this might be a shift in the way you’ve viewed things to date, know that literally every professional and specialist will be approving the logic of this reality by their actions as we’ve discussed above. Of course, this will not immediately dispel your uncertainty, and you will second guess yourself, but if you’re in dire straits, we’re here to help you, that is why we have the Premium Membership and why we practically insist, you get involved in the community and our weekly live coaching calls. Don’t do it alone! We’re here to help!