Overview Of The Masterclass:
When it comes to the right exercises for lower back pain, there is so much confusion out there. Often those struggling with back pain or sciatica, as bad as it can be, are faced with nothing but conflicting information when trying to remedy their symptoms. Our goal with the Back Health Masterclass is to give you the formula required to help you better understand what to do, why to do it and how to move forwards. If you follow the complete guidance, you will find you can start to use the right exercises for lower back relief and avoid stretches and other movements that fundamentally undermine the recovery process. Your body is trying to heal, every day. In addition to doing the right exercises for your low back health, you must also get out of the way and stop making the same old mistakes that have stopped your back healing properly and allowed vulnerability to remain until today.
For your convenience, the video above has timestamps for the major sections of the Materclass, and we have broken those sections down below too so that you can get additional information through this full article.
Your diagnosis: which exercises are right for your back pain?
One of the most pressing questions on your mind when you embark on any course of action to remedy lower back pain is whether the exercises are right for your back pain? People often want to know how their specific circumstances affect the recommended exercises or stretches necessary to provide relief from the lower back pain they’re experiencing. This is the “personalisation” of the exercises for your specific back pain. Unfortunately this stops so many from being able to make progress because it creates a block.
Chasing immediate back pain relief exercises
One of the major traps that you’ve fallen into with your back pain diagnosis is the expectation that there are some special exercises for immediate back pain relief. This “golden solution” is there for your back pain and if you did just the right combination of movements it would unlock everything. You’ll see plenty of “quick fix movements” like this on YouTube. These are the reasons your back pain doesn’t get better long term.
Granted your specific diagnosis can help us know what specific movement you can do to make your back pain feel better immediately, great examples of these are knee hugs, a pain killer and other such approaches. These however are fundamental errors as you are sacrificing short term moment to moment relief for lasting resolution of the problem in your back. Ultimately many of these solutions for lower back pain or sciatica will lead to things worsening over time.
How much does your diagnosis really matter?
It does matter in some regard but the diagnosis is not what dictates which exercises are right for your low back pain. You could have 10 people with an MRI validating an L5 disc bulge and those 10 people would have 10 different sets of symptoms, some of them will even have no symptoms. We discussed this in a recent podcast looking at whether exercises are making your lower back pain worse. In the article and podcast we covered an example of a more serious condition called lumbar spondylolisthesis which illustrated the variance in symptoms perfectly. The movements that were relieving had little to do with the overall progress and pathway required to make things better.
In short, your diagnosis has an impact in understanding the likely challenges your body will face in recovery, but it doesn’t dictate with accuracy what you will need to do to relieve your back pain for the long term when it comes to exercises and stretches.
Personalising exercises to your lower back pain
Where personalisation is made is in the journey. We’ll cover this more later on when we come to principles, but for the time being, know that your back should be stable and resilient, when it fails to do this, injuries happen. When we do not correct these inadequacies, injuries become chronic and easily re-appear. When following a structure that promotes spine stability and strength, through doing the exercises required for good spinal health, you will discover specific movements that prod at those weaknesses you have. That is the personalisation. That is where we can drill down to understand why you cannot protect your spine in the necessary way, understand what is missing, and start to rebuild that specific weakness through exercises for your lower back pain. More on this later.
The wrong exercises for back pain & why there is so much confusion
So why have things not worked so far? The simple answer is that you’ve probably been relying on health care practitioners, be they a GP, Osteopath, Chiropractor or Physiotherapist, or other specialist who just doesn’t know any better. This is not to degrade your practitioner, it is simply to say that many do not know what they do not know.
We cover our story about how Back In Shape came about and our history, clinically, in the Back In Shape Story Podcast episode, however the short of it here is as follows. We were very fortunate to practice in London, the UK and see many thousands of low back pain patients over the years, all of whom had accompanying spinal imaging. This culminated in the creation of our clinic “The Mayfair Clinic” which featured in national media such as the prestigious Daily Telegraph newspaper. The clinic itself was awarded the Queens Award For Enterprise Innovation in 2020 an amazing achievement. This unique experience was only really possible in such a busy capital city. Helping both a volume of patients, over 10,000, all with spinal imaging allows for the development of a unique insight into how the spine works.
Your average practitioner around the rest of the country simply doesn’t have this exposure, and cannot develop the same degree of knowledge. Many will very rarely work with imaging on patients, and are simply unaware of the major flaw in their understanding of low back pain.
Most practitioners do not understand your back pain in enough detail
The simple truth is that the average practitioner is not aware of how the low back works and how inaccurate their physical examination is. They don’t know what they don’t know. They’re forced to do their best with the tools at their disposal and they do a good job for many. But when it comes to having a deep understanding of what’s a priority for lower back health, they fall short.
The simple reason we have this edge is the tens of thousands of sets of images that have accompanied patients with all manner of lower back pain diagnoses. Through this thoughtful practice, you begin to understand the spine and how it fails in a new light, and more importantly how to restore its strength and recovery. This means you avoid certain exercises and movements, in the short term, and focus on others. It means you realise the futile approach of certain practices that are all too commonly used. Which leads us nicely into the next section.
The main challenge you face in recovering from low back pain
The biggest challenge we all face is the pervasive action of flexion and rounding of the lower back in our lives. Take a moment if you’re outside now to look around you at those sat down, all with rounded lower backs, slouched in chairs. Maybe it is in the office, maybe a coffee shop, maybe on the commute, it matters little. This action of rounding the lower back for extended periods is a major issue. In spite of this, the most common exercises for lower back pain all include flattening your lower back to relieve back pain. This misguided approach is borne out of the feeling that so commonly accompanies back pain, stiffness or tightness in your lower back or thighs.
If you’ve had back pain for any length of time, you have likely already been prescribed knee hugs or cat cow stretch for lower back pain, or if you have an element of sciatica, sciatic nerve flossing.
Exercises that make back pain worse
Although these exercises are pleasant at the time, that does not equate to them being helpful for the recovery of lower back pain. They are like scratching if you’ve been stung by stinging nettles, they feel nice at the time and undermine the healing process allowing the itch to itch more! They interfere with the healing process that is trying to take place.
If practitioners mentioned earlier had more exposure to imaging and a deeper understanding of the spine, they would adjust their approach and not recommend these sorts of exercises. However, in a world where you want to try to help the patient and need something to provide quick relief, they are all too easily recommended.
Make no mistake, these offer no rehabilitative benefit and should be eliminated going forwards. If you commit to doing this, you can now move on to replace these bad exercises for back pain with principles, exercises and stretches from an approach that will restore your back health from the inside out!
Four reasons why the exercises for your back pain didn’t work:
In the video we cover these four reasons for the prescription of “incorrect” exercises and why this is so common. In short this boils down to these four points:
- They’re not taught how the spine works at university. Although the chiropractors and osteopaths this is better, for the average Physio and the GP the level of anatomical knowledge is far inferior to the osteopath and that of the chiropractor at university. However even at the specialist Osteopathic universities, you’re simply taught what the vertebrae are and their structure but nothing about the detailed alignment of the spine and how it works and fails. This is very much a post-graduate interest that few are exposed to.
- Too much reliance on physical examination. This is coupled with a lack of awareness of how little you can tell from a physical exam about alignment of the low back or pelvis. The only reason we know better is through the reality of being humbled by thousands of patients and their accompanying spinal imaging showing just how little you really can know from a physical exam. Common errors include, short legs, anterior pelvic tilts, posterior pelvic tilts, too much low back curve, the list goes on.
- Most Osteopaths, GP’s and Physiotherapists work in generalist practices. They just aren’t specialists in the low back, granted they might see many, but they just don’t have the level of experience and specialist knowledge. Clinically our experience has been almost all spine patients with the majority of those, 80-90% being lower back, the remainder, neck issues too. And our clinic, The Mayfair Clinic, specialized in patients with low back and neck issues, injuries to the spine.
- Focusing on muscles and movement instead of the spine and stability. This final error is focusing on the wrong tissues, the philosophy of back pain, or the lens through which back pain is viewed is too shallow, focusing on tissues close to the surface and movement and stiffness rather than the spine and stability, this is a natural result of the first three errors.
Ultimately the principles that we’re about to get into are logical, tested and based on how your spine works in real life. This is why more and more health care practitioners, from GP’s to surgeons and other osteopaths and chiropractors refer their patients to the Back In Shape Program to complement the work they are doing in their clinical time with a robust approach to rehabilitation that stands up to scrutiny and gets results.
Principles For Back Health: Effective Low Back Pain Recovery Strategy
The principles we’re about to cover are drawn from the full Back In Shape Program, the form the basis for the help and guidance we offer our members and why what we say works the way it does. As we move into this section, consider that your spine has an injury, that is why you have back pain. If you’ve been unfortunate enough to be told that tight muscles are causing your back pain, you’ve been misled. Muscles do not cause back pain and they do not tighten for no reason, they go into spasm because you have injured a joint, this is something that we explore in great detail in the podcast episode on why your tight muscles are not the cause of your low back pain, it should help you rethink muscle spasm in your lower back from this point on!
Spine stability: build a stable spine for your lower back
The first principle is about maintaining neutral, learning to safely control the spine. Your injury in the lower back, let us say the L5, S1 segment, is not going to be helped by moving around lots! When you have an injury the stabilizing structures of the joint have been damaged, so movement can occur uncontrolled in that joint. Your first step needs to be to help provide stability to the spine as a whole and the segment as best you can.
It is the failure to control these movements that catches you out daily and is the reason for recurring relapses from ordinary daily tasks. Building stability in the spine and control over neutral first is vital.
Hip strength comes before flexibility for lower back health
So many get focused on stretching the muscles of the hips, gluteals, hamstrings etc, trying to relieve their back pain. The way in which they often do this makes things worse but this is not rehabilitation. In the early days strengthening comes long before flexibility but both are important. The majority of people are terribly inadequate in their hip strength and cannot move through good ranges of motion with their own bodyweight, let alone anything more.
Focusing on building good strength in the hip region, whilst also observing a stable spine is the next principle that must be observed.
Your low back rehab must be true to real life
This is to say that the movements that you’re doing must be reminiscent of real life movements. The squat for example is used every day. Learning to get out of a chair with a good squat is vital to starting to eliminate your back pain for the long term. Doing peculiar abstract movements that are not true to real life or vaguely reminiscent of real life activities is futile.
How often do you curl up into a ball and rock back and forth? This is not a rehabilitating exercise!
Safe exercises for back pain always comes first
Whenever you’re rehabilitating your lower back pain, safety must be the first concern. We need to do the movements correctly, and the exercises should have clear benefits, for example doing a burpee is just not at all necessary. Even jumping squats is not a clever move, although you might be doing this well it offers almost no additional benefit to regular squats but lots of complicating factors and unnecessary risk!
When we put together the full Back In Shape Program, these principles and a few others were front and center when structuring the program and the progression that we used over the course of the program. So let’s get into it.
Stage one: relief exercises for your lower back pain
It is important to draw the distinction between relief for your immediate pain and relief for your injured back. This is the distinction between knee hugs and what we’re about to cover. The former simply relieves the pain, like scratching the itch we mentioned earlier. On the other hand, these next 4 practices, exercises and stretches relieve the strain in your lower back and help healing take place, relieving the pain properly! You will continue to do the practices in this stage in stage two and three as well.
At this point it is worth making sure you;ve watched the video, so skip ahead to this timestamp for the live demonstrations of the below.
Bracing your core to protect your spine
This exercise is about using your own core musculature to brace the spine and provide stability, this is done off weight bearing in the safest possible manner. You must make sure that you do not move your spine. A common error is to do a pelvic tilt, especially if you’ve done yoga or pilates in the past, you will do this without even thinking. Break the habit!
Do 10 repetitions at a time holding the engagement for 1 to 2 seconds.
Mobilise your hips with a neutral lower spine
Here we are referring to the proper technique with which we work to help maintain a degree of hip flexibility on a daily basis. Later on this will be cumulative and start to improve our hip flexibility but in this stage it is simply working to offset the strain from daily life. Too many people do these incorrectly and allow the back to move, remember spine stability!
Hold these stretches for 30 seconds and try to complete 2 rounds on each leg.
Decompress your lumbar spine for back pain relief
We demonstrate the lower back towel decompression for lower back pain in the video here. This exercise is one of the best stretches for long term back health. The average adult spends 9 hours a day sitting, nearly always with a rounded lower back. This stretch resets the lumbar alignment, unloads the discs, releases tension on the muscles and ligaments of the lower back too. It is an essential relief exercise for your lower back.
This low back stretch can be done for 2 minutes to 5 minutes.
Reduce inflammation build up in your lower back
Avoid heat! Icing the lower back instead works wonders. Remember heat is great for muscles but not for injuries in locations where there are confined spaces. The spine is different to other areas of the body, we have many bony holes and inflammation building in these areas will create pressure which irritates the nerves and results in more muscle spasm, more back pain, more sciatica. Do not use heat as it only exacerbates this, even though it feels nice at the time.
Ice the lower back for 3 to 5 minutes ONLY, multiple applications are fine but no longer than 5 minutes in one go.
The four exercises, practices, and stretches above form the basis of this relief routine. This is a way to relieve strain on the injured tissues, and help aid the healing process and reduce the likelihood of daily aggravations without making the injury worse through short sighted gimmick exercises.
This however is NOT rehabilitation! It is worth doing and doing continually going forwards but it is the next parts that are actually helping you rebuild your lower back health.
Stage two: rebuild your lower back strength after injury
If you’re like the tens of thousands of people that we’ve seen either in clinical practice or members come through the Back In Shape Program, we know that you’re not bed bound. You might well be in a lot of pain, but you’re still doing many things every day, even if it is done in spite of the pain you’re in. In spite of this many of the activities you are doing are being done in ways which allow your back pain to be aggravated or worsen.
You might think these exercises are too much for you, but as we discuss on the video, you’re already getting out of bed, off the toilet seat and onto the sofa, so you better do a squat and learn how to do it correctly, so you can make those other squats safer!
The movements in this stage are real-life movements and so you can do them, you probably cannot do them well, that’s ok. It might even hurt your lower back at first, but you will only get past this point by doing careful and diligent practice.
Exercise one: Build spinal control off load
This first exercise is there to help your spine maintain neutral in a centered position in spite of being pulled off to the one side. Control is vital here, and the spine will want to tilt to one side, flatten or arch depending on which part of the movement you’re in. This is no different to the strains on your back when rolling over in bed, when getting into or out of bed. Ideally this is core strength exercise is done on the floor but to begin with doing it on the bed is no problem at all.
Shoot for 10 reps of this exercise.
Exercise two: getting out of a chair, the squat
This exercise is being done countless times every day, you may as well start learning to do it correctly, keeping your spine neutral, your hips strong and your knees steady learning this movement in a way that does not aggravate your lower back can take some time, but it will pay off in a huge way considering how many squats you are doing every day already.
Aim for 10 reps of this exercise.
Exercise three: brushing your teeth, the hip hinge
This movement is done numerous times every day, and not just here, but when you’re washing your hands in the sink and preparing food. All too often you allow the movement to go through your lower back rounding at the bottom of your spine. Learning this vital movement, the hip hinge for lower back health and resilience is a must. It will again make your activities of daily living safer too!
Aim for 10 reps of this exercise.
Exercise four: going up a step or staircase, the reverse lunge
The ability to load through one leg without your spine buckling and twisting is important, but this complex movement often sounds scary. It is however a very simple movement that you’re likely already doing by way of going up stairs to go to bed, or even up a curb while out of the house. Appreciating these truths will help you stop holding yourself back and start making progress towards doing these movements safely!
Aim for 10 reps of this exercise.
How to safely strengthen your back with these exercises
Much of the early benefit in starting these movements is that your skill becomes more proficient. You are more controlled and more body conscious as you move. This reduces the frequency of flare ups through haphazard movements that expose and exploit the injury in your lower back. But doing these movements can create challenges so here are some simple steps to have success when starting these movements. Learning to become proficient at them will allow you to move to stage three where you build strength and long term resilience on top of a good foundation.
- Start from the safest point that doesn’t aggravate your back pain more. This might mean that the movements are very limited to begin with. This is very common for those with back pain, especially longer standing cases. You must find the easiest possible level, and then you can build more movement.
- Begin with the simplest exercises and add complexity. Start out with exercise one and get comfortable that you can do this and know what to expect, even if it is with a small amount of movement. Next you can add exercises two and three following the same framework. Finally adding in exercise four which is load bearing and unilateral and will be the most complex of the four.
- Focus on good technique above all. You’re learning to do these movements, take your time and practice the technique, be patient as it does take some time for you to get competent, you didn’t learn to do anything in life in 5 minutes so don’t be so hard on yourself! Practice!
- Pain is an indication you did something wrong, not the exercise is wrong for you. Technical imperfections and allowing spinal movement to occur is an indication that you’ve failed to hold the spine steady, this is incorrect technique. Use step one to make things easier if this is the case. It could also be that you just got tired and the fatigue resulted in a loss of form and control at rep 8, with time this will happen later and later and then not at all!
Stage three: healing your back pain for lasting results
This doesn’t need to be complex but it does need to be done. Too many people who have injured their back shy away from any load bearing exercises instead opting for pilates and other “core exercises” but they miss the point of rebuilding entirely, resulting in strong cores and weak spines!
Add load to your spine to rebuild your back healing
Your lower back is a load bearing structure and to rebuild its capacity to bear load you must use load. This means conservatively adding resistance slowly over time to the movements we have discussed in stage two, particularly the last three exercises. This helps guide the remodeling process within the back and will often lead to a back that is more resilient than before the injury!
Your muscles are a suit of armor for your spine
The great thing about rehabilitation is that your muscles, when working correctly with the right rehabilitation program, will change relatively quickly, not overnight but still quickly. Much faster than the ligaments, joints and discs that you’ve injured in your spine. During this interim period, your pain will often not be present or much reduced. The muscles are providing a protective cocoon to shield your lower back from the strain while it is continuing to remodel and respond at a slower pace.
Improve your hip strength and flexibility now
Here you will be improving your hip strength, which will in turn allow you to explore deeper ranges of motion and improve your competent range of motion, it might also be worth adding in some more intensive flexibility work at this time, as you further help improve your ranges of mobility on the main exercises mentioned in the last stage. This further helps your lower back as stronger hips that are more mobile can do more of the work so your lower back is required to do much less. This reduces the likelihood of your lower back being overworked and re-injured!
Just because the pain is gone doesn’t mean you need too stop!
Just like if you have ever had a broken arm or leg, the cast stays on long after the pain stops. The structures in your lower back heal slowly, and it is not uncommon for the pain to go long before true healing and remodeling has taken place. This is the classic case of “I thought I was better then my back went again!” You must continue with the progression of your exercises for the months and years to come. Consider it part of your new back health practice. This will be what allows you to do the things you love. It’s not too time consuming so keep it a priority!
Lifestyle habits that stop your back getting better
We’ve come a long way and if you follow everything so far you’ll do great only if you don’t fall at the last hurdle. That is that you must apply your great technique and new knowledge to your daily life. It is no good doing perfect squats if you plunge into an armchair with a rounded back. Or completing the towel exercise only to curl up into a ball on your path to getting off the floor.
In short there is a reason we talk about making the exercises true to real life. It is because they are and you must apply what you’ve learned to everyday living. Failure to do so will leave you repeating the same mistakes of old and abusing your lower back. There is just no need for this.
Start thinking about things like your desk setup at work or home, think about how you instinctively go down onto the floor to pick something up on one knee instead of bending over with your back. A small investment in a shoe horn could even be a great purchase to make things like putting your shoes on much easier in the early days where your back is weak and hips inflexible. You won’t make all these changes in one day, but as you become more aware you’ll gradually make amendments and alterations that will result in a more back friendly environment. Before you know it, it will be second nature.
Get the expert help with the Back In Shape Membership
Although many can be self starters, it is so much easier when you are following a full program with support. Premium membership to the Back In Shape Program gives you over 300 video segments and everything you need to relieve your back pain or sciatica effectively. You’ll also build resilience and get long term results. Not only that, the membership includes unrivalled support from our team through our private group which is dedicated to supporting members, reviewing your exercise videos, answering questions and generally providing that expert hand holding as you move forwards through the program. We also hold weekly live coaching calls to help members in real time with demonstrations and more. Rest assured you’re in safe hands with a program that can truly get your Back In Shape, even if you’ve struggled in the past.