Tag Archives: Multifidus Muscles

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Is Back or Sciatic Pain Preventing You from reaching Your Exercise Goals?

We all know the importance of exercise, fitness, and generally staying active in order to age well. For many, exercise and fitness is a way to have fun and stay in shape. Others use activity to manage stress or chronic illnesses (such as diabetes, osteoporosis or heart disease). The benefit of consistent exercise has a positive effect on our physical, mental, and social well-being. It can be very disappointing when low back or sciatic pain prevents you from reaching your exercise goals.

Low back pain (LBP) or sciatic pain is the most common injury/pain complaint for those in the western world. LBP is estimated to affect nearly 80% of the U.S. population at one time or another. Worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.

How can you address your back or sciatic pain in order to get back to doing the activity that you love (whether that is walking, running, or hitting the gym)? First, you need to assess your risk factors.

Risk Factors for Low Back Pain (LBP) or Sciatic Pain:

  • Sitting too much.
  • Slouched sitting.
  • Prior episodes of LBP.
  • Smoking.
  • Poor core and back extensor muscle strength.
  • Lack of a proper warm up and a cool down.
  • High training volumes with inadequate rest (overtraining syndrome).

Some of the specific risk factors for LBP are also risk factors for other types of injury. Lack of adequate core strength (particularly, strength in the outer core and pelvic/hip musculature) can contribute to other types of injuries, so it’s an important to address the weakness sooner rather than later.

Consider the amount of repetitive force your body must absorb even with walking (not to mention during sports or exercise). The outer core muscles are responsible for movement of the trunk and spine as well as aiding in stability. (Although critical for stability, the inner core muscles don’t actually produce any trunk or spine movement.)

The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Imbalances or a lack of strength within the core musculature often will manifest in altered lower body mechanics and an inability for the body to properly absorb and distribute forces. Over time, the body’s tissues eventually break down and can lead to a repetitive use injury in the lower extremity.

As a physical therapist, I always assess the core and hip musculature and look for imbalances in strength when determining the root cause of low back or sciatic pain. In the majority of cases, I find that a component of hip and core muscle weakness has led to the pain.

The good news is that this is a completely preventable problem. Most of us already know that we need to cross train and that proper core strength is important. However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for low back pain (LBP).

Proper core and lumbar extensor strength is the key to preventing an episode of LBP and is also a critical step in avoiding other types of injuries affected by weakness in the core and pelvic/hip muscles. The most important factor in meeting your exercise goals is to be consistent. Don’t let low back or sciatic pain prevent you from staying active and enjoying your favorite activities.

Treatment for back or sciatic pain doesn’t have to include addicting medications, scary injections, surgery or high medical bills. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

The Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package includes:

AVAILABLE NOW ON AMAZON!

Treating Low Back Pain during Exercise and Athletics eBook

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies.

 7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Save 15% with discount code LBP

“As a long time back pain sufferer I can honestly say I’ve tried it all. True LBP will make you desperate enough to try anything. Long story short – Ben Shatto truly rescued me from this vicious pain cycle. Ben’s methods of physical therapy whether it’s hands on treatment or this amazing video packet, his methods prove to be cutting edge and highly effective. Healing takes work and this video package is a fantastic foundation for the healing process to ignite!” –Sandy

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When Can I Return to Exercise after having Low Back or Sciatic Pain?

“When can I return to my normal activity after experiencing an episode of severe low back or sciatic pain?” is a question I am often asked as a physical therapist. Low back pain (LBP) and sciatic pain can be so severe and debilitating that it can completely derailing your training and lifestyle! It’s hard to run, exercise or even move if your back, buttocks or leg hurts.

Believe it or not, in spite of what your back or sciatic pain is telling you, initial activity and exercise are a critical component to treatment and recovery and is backed by extensive scientific research. 

Everyone’s experience with low back or sciatic pain is different. The severity of pain can widely vary. For some, even walking normally can be difficult. A guide for which exercises and movements to perform is critical in order to successfully return to activity.

One crucial indicator that you’re ready to taper back into more regular activity (as you progress your rehabilitation-based exercise) is whether or not you can walk with a normal gait. In particular, can you walk normally with a longer stride length during your normal gait cycle?

The ability to walk normally (notice that I didn’t say without discomfort) is an important milestone. It means that the spine is being stabilized well enough from the core musculature and that the nerves in the leg are not too tight or inflamed to tolerate and accommodate for the stretch that will occur from other activities.

If you are unable to walk normally, then the emphasis should be on regaining lumbar and lower extremity range of motion in addition to performing core and lumbar stabilization exercises. Limit your sitting, but do not try to taper back into other activities (at least not yet).

It’s critical to remember that everyone’s recovery will be different. Recovery and tapering back into your normal activities should be entirely symptom dependent. Listen to your body on what it can handle. The pain will tell you if you need to stop.

When to Return to Exercise after having Low Back or Sciatic Pain:

Follow the rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. You must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.

  • Don’t resume your running, jogging or other training activities until you can walk normally at a quick pace.
  • Be sure to slowly taper back into your training as your back begins to feel better. Don’t quickly resume your prior training volume. Instead, taper back up.
  • Prior to activity and training, perform a very thorough warm up (including press-ups, superman exercises, and bridging). Then transition into an activity specific warm up.
  • Continue with a core and lumbar strengthening program at least until you resume your full volume of training.

Prior to returning to your full and normal training activities, insure the following:

  • Complete lumbar mobility has returned.
  • You no longer have sensations, weakness or instability within the spine.
  • If you experienced leg pain, your involved leg is as flexible as the other. The pain is now either gone or centralized (meaning that you’re not experiencing pain in the leg).
  • Your hip mobility on both sides is equal.
  • Your involved leg is as strong as the other leg, particularly hip abduction (glutes medius) and the hip external rotators. Test this by jumping up and down on one leg. Do you feel strong? Is there pain associated with this? If the strength isn’t there or the pain remains, you are not ready to taper up to full training activities.
  • You can jog, run, sprint, and jump without pain.

With proper treatment, low back or sciatic pain should resolve in as quickly as two weeks. Severe episodes can take 4-6 weeks or longer. Continue with your rehabilitation protocol until you’re performing all exercises normally.

Treatment for back or sciatic pain doesn’t have to include addicting medications, scary injections, surgery or high medical bills. For the approximate price of just one co-pay to see a doctor, you will receive my easy to read book with step-by-step instructions and a complete video package designed to help you prevent and self-treat reoccurring low back pain episodes.

The Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package includes:

AVAILABLE NOW ON AMAZON!

Treating Low Back Pain during Exercise and Athletics eBook

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain. LBP has reoccurrence rates as high as 90%. If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management. Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level. Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies. 

7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics. An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Save 15% with discount code LBP

“As a long time back pain sufferer I can honestly say I’ve tried it all. True LBP will make you desperate enough to try anything. Long story short – Ben Shatto truly rescued me from this vicious pain cycle. Ben’s methods of physical therapy whether it’s hands on treatment or this amazing video packet, his methods prove to be cutting edge and highly effective. Healing takes work and this video package is a fantastic foundation for the healing process to ignite!” –Sandy

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3 Mistakes Athletes and Weekend Warriors make that cause Low Back Pain

As low back pain sufferers already know, it’s very difficult to exercise and train at a high level when you are experiencing low back pain (LBP). Nothing will derail your best laid training plans and routines faster than a severe episode of low back pain. LBP is the most common injury and pain complaint for athletes and non-exercisers alike. It’s estimated to affect nearly 80% of the U.S. population at one time or another, and it’s one of the top reasons for physician visits.

Fortunately, most LBP is mechanical–meaning it’s from a physical or structural cause not related to conditions such as cancer or infections. The problem with this type of LBP is that it usually comes back. People who have had an episode of mechanical LBP are 90% more likely to experience it again.

If you want to train hard and compete at a high level or even just enjoy the weekend’s events, then avoiding LBP is critical. Avoiding the following three most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services. More importantly, avoiding injury and LBP insures that you can keep training to your heart’s content!

The 3 Most Common Mistakes:

Sitting too much.

Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP. Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments. Even if you exercise regularly, many of us still work in an office setting which forces us to sit more than we should. This excessive and prolonged sitting not only impacts our spine, but it also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.

Even if you are running, exercising, and training during most days of the week, we all spend too much time sitting. To make this worse, many of us are sitting with chronically poor posture.

  • Limit the amount of sitting that you spend at one time. Ideally, move from your sitting position every hour to walk preferably. If you aren’t able to walk, then try to shift your position at least once every twenty minutes. Frequent position changes can help you to avoid LBP. Avoid a long car trip directly before or after a long run, race or event. For destination events, it’s best to arrive at least a day or two early and wait a day prior to returning home.
  • Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.

Poor core training.

Everyone has heard about the benefits of core training. However, most people aren’t doing it correctly. This isn’t about sit ups or crunches. Proper core strength involves training your abdominal muscles and back extensors to produce a rigid cylinder when exercising and moving. The core muscles are not prime movers, but stabilizers. They must be trained this way. The strength needs to be proportional front to back to insure this rigid cylinder for proper spinal stabilization. In general, most of us don’t spend enough time strengthening a key core muscle in back known as the multifidus (shown below) nor do we spend enough time strengthening the back extensors in general.

The core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form a round rigid cylinder that is utilized to support the spine. Ligaments and boney articulations are also important in spinal stabilization. Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement. The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those who work on core strength may not be performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP.

To learn how to effectively exercise and work the core muscles in order to prevent or self-treat LBP, be sure to check out my Treating Low Back Pain (LBP) during Exercise and Athletics Book and Video Package. USE DISCOUNT CODE LBP AT CHECKOUT FOR 15% OFF!

Not performing a proper warm up. 

An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level. A proper warm up should include: a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.

Cardiovascular Warm Up

To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine. I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body. It starts to prime the nervous system for activity. It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury). The cardiovascular warm up will vary and is dependent on your activity or sport.

Dynamic Warm Up

After the initial cardiovascular warm up, progress into a dynamic warm up series. This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.

The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity. This will almost always include the hamstrings, hips, and pelvis. Adequate lower leg mobility is important in order to perform your specific exercise or activity. The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis.

More mobility in the lower legs and pelvis means less need for mobility in the spine. This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury. The point is to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.

One example of this is to mobilize your hamstrings by using the foam roller (as demonstrated below).

Spine Specific Warm Up

I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups. Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention. Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury. The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine. It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.

Examples of a spine specific warm up may include performing press-ups and the superman exercise (as demonstrated below).

Sport Specific Warm Up

This warm up will vary significantly depending on the type of endeavor you are about to participate in. For example, a sprinter will need a very different warm up compared to an ultramarathon runner or someone performing in a CrossFit competition. For runners, the warm up varies. Are you racing on a flat course or are you heading out for a very hilly trail run?

It’s important to evaluate the requirements for the event and be ready to perform the actual movements required to compete at a high level. A proper warm up allows your body to immediately perform at its peak and reduces the risk of injury. Regardless of the sport or event, this is also the perfect time to make sure all of your equipment is appropriate for the conditions of the event.

Don’t skip the warm up regardless of your training or event time and/or location! You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.

It’s important to identify the common mistakes that can cause LBP. By implementing these prevention strategies, you can avoid injury and keep training. Fitness is a lifelong pursuit. If you are injured or just not having fun, then you will not stay engaged and motivated in the long term. Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP. In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

I WANT TO GET RID OF MY BACK PAIN!

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A Core Stability Exercise that Anyone Can Do

Proper core and lumbar extensor strength is the key to preventing an episode of low back pain (LBP) as well as an important component to treating LBP. Low back pain is estimated to affect nearly 80% of the U.S. population at one time or another. In general, most of us don’t spend enough time properly strengthening our core muscles. In this video post, you will learn how to engage your abdominal muscles with a simple ball exercise that I recommend to all of my patients initially in my LBP rehabilitation program.

The core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine. Ligaments and boney articulations are also important in spinal stabilization. Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

The Multifidus Muscles

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core muscles. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement. The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those working on core strength may not be performing the correct exercises. Performing proper core exercises (and particularly, lumbar stabilization exercises) are the primary treatment modality for LBP.

In this video, I demonstrate an easy and effective way to actively engage the inner core abdominal muscles. This exercise is typically safe even early on during the rehabilitation process for low back pain. 

For more information on how to effectively exercise and work the core muscles in order to prevent or treat LBP, be sure to check out my book, Treating Low Back Pain during Exercise and Athletics. You will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP. In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

AVAILABLE NOW ON AMAZON!

In addition, check out this sample video, Segment 2: What are the Core Muscles?, taken from my Treating Low Back Pain (LBP) during Exercise and Athletics Video Package which you can purchase HERE.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

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What’s inside of the Treating Low Back Pain during Exercise and Athletics Video Package?

Did you know that an estimated $50 billion dollars is spent annually on back pain related issues?  It affects nearly 80% of the U.S. population at one time or another.  It’s one of the top reasons for physician and physical therapy visits and one of the most common reasons for missed work days.  The best training plan in the world won’t do us much good if we’re unable to implement that plan due to pain and/or injury.

WomanWithLowBackPain

When reviewing research or anecdotal evidence online, there is no shortage of articles, blogs, and opinions regarding low back pain (LBP).  But what about a specific resource for the athlete, the weightlifter, the CrossFitter or the runner who is experiencing low back pain during exercise?  How does an athletic population know how to handle episodes of LBP?  What specifically can an athlete or active person do to avoid low back pain to lessen the risk of injury and lost training days?  Is there a specific step-by-step plan that really works?

The prevention and rehabilitation strategies outlined in my rehabilitation guide, Treating Low Back Pain during Exercise and Athletics, answer those questions.  You will learn how to safely self-treat your low back pain and helpful methods for a speedy recovery.  (Not to mention, possibly saving you time and money by avoiding a physician visit!)

The good news is that participating in sports, running, CrossFit, and weightlifting doesn’t increase your risk of developing LBP.  On average, being in good health, physically fit, and active actually decreases your risk.

The Treating Low Back Pain (LBP) during Exercise and Athletics Video Package includes:

Treating Low Back Pain during Exercise and Athletics eBook

product-cover-lbp

In this eBook, you’ll learn why it is critically important to prevent the first episode of low back pain.  LBP has reoccurrence rates as high as 90%.  If you have already experienced an episode of LBP, you’ll learn why exercise is an important component to long term management.  Most importantly, you will understand how to avoid pain and injury in order to take your training to the next level.  Topics include:

  • Specific strategies for LBP prevention.
  • How to address specific causes of LBP.
  • Best practices on how to prevent and self-treat when you experience an episode of LBP.
  • A step-by-step LBP rehabilitation guide complete with photos and detailed exercise descriptions.
  • How to implement prevention and rehabilitation strategies.

7-part Series of Instructional Videos

Nearly 60 minutes of actionable advice to prevent and treat LBP as it relates to active individuals, sports, and athletics.  An in-depth look at treating LBP with a 7-part series of instructional videos in which I address the following:

  • Potential Risk Factors for Lower Back Pain
  • What are the Core Muscles?
  • Prevention during Exercise (Part 1 and 2)
  • Initial Treatment
  • Further Treatment and Taping
  • Long Term Management Strategies and Final Recap

Want to peek inside the video content?  Watch now as I describe what really the “core” is and why it matters.

Preventing and Treating Overtraining Syndrome eBook

product-cover-ot

In this BONUS eBook, you’ll learn how to recognize the risk factors and symptoms of Overtraining Syndrome (OTS).  You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”).  This will speed up your results, so that you can train harder and more effectively than ever before!  Topics include:

  • How to recognize the warning signs.
  • Specific strategies for OTS prevention.
  • How to self-treat OTS.
  • How to safely overreach.
  • A complete guide to Foam Roller Stretches and Mobilizations with photos and detailed exercise descriptions.

Is your low back hurting? Are you ready to take your training to a new level?  What are you waiting for?  Let’s get started! 

Purchase Package

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When to Return to Activity after Experiencing Low Back Pain

“When can I return to my normal activity after experiencing an episode of severe low back pain?” is a question I am often asked as a physical therapist.  Low back pain (LBP) can be so severe and debilitating that it can completely derailing your training and lifestyle!  It’s hard to run, exercise or even move if your back, buttocks or leg hurts.  You either won’t try or if you do, you suffer through it only to be rewarded with worsening symptoms later on.  However, in spite of what your back pain is telling you, initial activity and exercise are critical when treating LBP. 

Everyone’s experience with low back pain is different and the severity of pain can vary wildly.  For some, even walking normally can be difficult.  This is why having a guide on which exercises and movements to do and not to do is so important.  One critical indicator that you’re ready to taper back into more regular activity (as you progress your rehabilitation-based exercise) is whether or not you can walk with a normal gait.  In particular, can you walk normally with a longer stride length during your normal gait cycle?

The ability to walk normally (notice that I didn’t say without discomfort) is an important milestone as it means that the spine is being stabilized well enough from the core musculature and that the nerves in the leg are not too tight or inflamed to tolerate and accommodate for the stretch that will occur from other activities.

If you are unable to walk normally, then the emphasis should be on regaining lumbar and lower extremity range of motion in addition to performing core and lumbar stabilization exercises.  Limit your sitting, but do not try to taper back into other activities (at least not yet).

It is critical to remember that everyone’s recovery will be different.  Recovery and tapering back into your normal activities should be entirely symptom dependent.  Listen to your body on what it can handle.  The pain will tell you if you need to stop.

When to Return to Activity after Experiencing Low Back Pain:

Follow the rule of thumb for movement:  If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening.  You must stop that activity.  If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving.

  • Don’t resume your running, jogging or other training activities until you can walk normally at a quick pace.
  • Be sure to slowly taper back into your training as your back begins to feel better.  Don’t quickly resume your prior training volume.  Instead, taper back up.
  • Prior to activity and training, perform a very thorough warm up (including press-ups, superman exercises, and bridging).  Then transition into an activity specific warm up.
  • Continue with a core and lumbar strengthening program at least until you resume your full volume of training.

Prior to returning to your full and normal training activities, insure the following:

  • Complete lumbar mobility has returned.
  • You no longer have sensations, weakness or instability within the spine.
  • If you experienced leg pain, your involved leg is as flexible as the other.  The pain is now either gone or centralized (meaning that you’re not experiencing pain in the leg).
  • Your hip mobility on both sides is equal.
  • Your involved leg is as strong as the other leg, particularly hip abduction (glutes medius) and the hip external rotators.  Test this by jumping up and down on one leg.  Do you feel strong?  Is there pain associated with this?  If the strength isn’t there or the pain remains, you are not ready to taper up to full training activities.
  • You can jog, run, sprint, and jump without pain.

With proper treatment, low back pain (LBP) should resolve in as quickly as two weeks.  Severe episodes can take 4-6 weeks or longer.  Continue with your rehabilitation protocol until you’re performing all exercises normally.

I highly recommend continuing with a lower extremity stretching protocol and lumbar and pelvis stabilization exercises as a method of prevention for future episodes of low back pain.  There are countless “core” exercises and back stretches that you can perform, but which ones are best to help you to recover faster and experience less pain?  Research is clear that performing proper core exercises and particularly, lumbar stabilization exercises are the most effective treatment modality for LBP.  If you want to learn how to self-treat your low back and learn how to effectively exercise and work the core muscles in order to prevent or treat LBP, CLICK HERE.

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

BUY NOW

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The Number One Reason Preventing You from reaching your Exercise Goals

We all know the importance of exercise, fitness, and generally staying active.  For some of us, we look to exercise and fitness as a way to have fun and stay in shape.  Others use activity to help manage stress or chronic illnesses such as diabetes, osteoporosis or heart disease.  Exercising and staying active is an important component to aging well.  It can be very disappointing when you don’t meet your training or exercise goals.  One of the most common reasons for not meeting goals is also one of the most preventable reasons:  injury!  Nothing derails a perfectly developed training plan like an injury.

The most common injury for those in the western world is low back pain (LBP).  LBP is estimated to affect nearly 80% of the U.S. population at one time or another.  And worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.

Risk Factors for Low Back Pain (LBP):

  • Sitting too much.
  • Slouched sitting.
  • Prior episodes of LBP.
  • Smoking.
  • Poor core and back extensor muscle strength.
  • Lack of a proper warm up and a cool down.
  • High training volumes with inadequate rest (overtraining syndrome).

Some of the specific risk factors for LBP are also risk factors for other types of injury.  Lack of adequate core strength (particularly, strength in the outer core and pelvic/hip musculature) can contribute to injuries such as:

  • Iliotibial band syndrome (ITBS)
  • Hip bursitis
  • Runner’s knee (Patellar Femoral Pain Syndrome)
  • Piriformis syndrome
  • Meniscal injuries in the knee
  • Achilles tendinitis
  • Plantar fasciitis

Although this is not a complete list, it highlights many of the most common injuries affected by weakness in the core and pelvic/hip muscles.

Consider the amount of repetitive force your body must absorb even with walking (not to mention during sports or exercise).  The outer core muscles are responsible for movement of the trunk and spine as well as aiding in stability.  (Although critical for stability, the inner core muscles don’t actually produce any trunk or spine movement.)  The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).  Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Imbalances or a lack of strength within the core musculature often times will manifest in altered lower body mechanics and an inability for the body to properly absorb and distribute forces.  Over time and many miles, the body’s tissues eventually break down and can lead to a repetitive use injury in the lower extremity.

As a physical therapist, I always assess the core and hip musculature and look for imbalances in strength when determining the root cause of an injury.  In the majority of cases, I find that a component of hip and core muscle weakness has led to the injury.

The good news is that this is a completely preventable problem.  Most of us already know that we need to cross train and that proper core strength is important.  However, too many of us either don’t dedicate enough time to the process or we aren’t performing the correct exercises.  Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for low back pain (LBP).

Proper core and lumbar extensor strength is the key to preventing an episode of LBP and is also a critical step in avoiding other types of injuries affected by weakness in the core and pelvic/hip muscles.  The most important factor in meeting your goals is to be consistent in your training by avoiding injury!  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional and unnecessary costly medical bills!

BUY NOW

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The 3 Most Common Mistakes Athletes make that can cause Low Back Pain

Whether you are an athlete or weekend warrior, we all want to perform our best.  Many of us live for the weekends so we can participate in the next run, Spartan race, CrossFit Team WOD, or any number of other adventures.  However, no one is immune to one of the one of the most prevalent medical conditions treated in the United States and throughout the western world–low back pain (LBP).

If you want to train hard and compete at a high level or even just enjoy the weekend’s events, then avoiding LBP is critical.  Avoiding the following three most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services.  More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content!

The 3 Most Common Mistakes:

 

Sitting too much.

Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP.  Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments.  It also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.

Even if you are running, exercising, and training during most days of the week, we all spend too much time sitting whether it’s at our job or traveling each weekend for destination races and events.  Even worse is sitting with chronically poor posture.

  • Limit the amount of sitting that you spend at one time.  Ideally, move from your sitting position every hour to walk preferably.  If you aren’t able to walk, then try to shift your position at least once every twenty minutes.  Frequent position changes can help you to avoid LBP.  Avoid a long car trip directly before or after a long run, race or event.  For destination events, it’s best to arrive at least a day or two early and wait a day prior to returning home.
  • Sit with correct posture.  Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve.  A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.

Not training the core properly or adequately.  Don’t forget the back extensors!

Proper core and lumbar extensor strength is the key to preventing an episode of LBP, which is estimated to affect nearly 80% of the U.S. population at one time or another.  In general, most of us don’t spend enough time strengthening our core muscles (particularly, the back extensors).

The core muscles are part of the body’s natural method of stabilizing the spine.  The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine.  Ligaments and boney articulations are also important in spinal stabilization.  Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).

The Multifidus Muscles

  • The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown above).  The TVA wraps all the way around the stomach and attaches to the spine.  This is what helps to form the cylinder.  When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
  • The other muscles that help to support the spine are known as the outer core muscles.  These muscles are responsible for movement of the trunk and spine as well as aiding in stability.  The inner core muscles do not actually produce any trunk or spine movement.  The outer core muscles consists of the following muscles:  lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors).  Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.

Those that work on core strength may not be performing the correct exercises.  Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP.  To learn how to effectively exercise and work the core muscles in order to prevent or treat LBP, CLICK HERE.

Not performing a proper warm up. 

An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level.  A proper warm up should include:  a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.

Cardiovascular Warm Up

To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine.  I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body.  It starts to prime the nervous system for activity.  It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury).

The cardiovascular warm up will vary and is dependent on your activity or sport.  I will typically start by performing a light jog or possibility some jumping jacks.  Then I may progress into some more intense heart rate increasing exercises, such as  jump roping or any other form of standing movement (jumping, bounding, and burpees), in order to increase my heart rate.  The goal is to increase your heart rate and promote blood flow throughout the body.  The warm up shouldn’t be overly intense.

Dynamic Warm Up

After my initial cardiovascular warm up, I progress into my dynamic warm up series.  This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.

The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity.  This will almost always include the hamstrings, hips, and pelvis.  Adequate lower leg mobility is important in order to perform your specific exercise or activity.  The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis.  More mobility in the lower legs and pelvis means less need for mobility in the spine.  This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury.  You want to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.

Within the dynamic warm up, you would perform exercises such as:  forward and backward leg swings; side to side leg swings; squats with rotation; and press-ups.  Utilizing a foam roller as part of a warm up is acceptable.  However, I don’t advocate static stretching before activity as it has been shown to decrease force production and performance.

Spine Specific Warm Up

I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups.  Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention.  Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury.  The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine.  It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.

Sport Specific Warm Up

This warm up will vary significantly depending on the type of endeavor you are about to participate in.  For example, a sprinter will need a very different warm up compared to an ultramarathon runner or someone performing in a CrossFit competition.  For runners, the warm up varies.  Are you racing on a flat course or are you heading out for a very hilly trail run?

Examples of running specific exercises include:  butt kickers; strides or bounding; and warm up sprints.  Even running a little on the actual terrain you will be competing on is a good idea.

It’s important to evaluate the requirements for the event and be ready to perform the actual movements required to compete at a high level.  A proper warm up allows your body to immediately perform at its peak and reduces the risk of injury.  Regardless of the sport or event, this is also the perfect time to make sure all of your equipment is appropriate for the conditions of the event.

Don’t skip the warm up regardless of your training or event time and/or location!  You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.

An inadequate cool down is another common mistake.  Be sure to take the extra time to cool down and stretch.  Start with a slow jog, and then progress to walking until your heart rate returns to normal.  This is an excellent time to utilize the foam roller as well as performing static stretches and press-ups.

It’s important to identify the common mistakes that can cause LBP.  By implementing these prevention strategies, you can avoid injury and keep training.  Fitness is a lifelong pursuit.  If you are injured or just not having fun, then you will not stay engaged and motivated in the long term.  Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP.  In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

BUY NOW

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When to Return to Running after Experiencing Low Back Pain

mta_returntorunning

http://marathontrainingacademy.com/return-running-experiencing-low-back-pain

Marathon Training Academy

September 13, 2016

In this guest post for Marathon Training Academy, you will learn why initial activity and exercise are critical when treating low back pain (LBP) and how to determine if you are ready to return to running after experiencing an episode of LBP.

WomanWithLowBackPain

Low back pain (LBP) can be so severe and debilitating that it can completely derailing your training. It’s hard to run if your back, buttocks or leg hurts. You either won’t try to do it or you try to suffer through it only to be rewarded with worsening symptoms later on. However, initial activity and exercise are critical when treating LBP. Continue Reading

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The Number One Reason Why You Won’t Reach Your Training Goals

MTA_NumberOneReason

http://marathontrainingacademy.com/number-one-reason

Marathon Training Academy

June 6, 2016

In this guest post for Marathon Training Academy, you will learn how to effectively exercise and work the core muscles in order to prevent or treat low back pain (LBP) as well as other common running injuries affected by weakness in the core and pelvic muscles.

The number one reason why runners won’t reach their goals is also one of the most preventable reasons: injury!  Nothing derails a perfectly developed training plan like an injury.

The most common injury to runners is also the most common injury for those in the western world: low back pain (LBP).  LBP is estimated to affect nearly 80% of the U.S. population at one time or another.  And worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence.  Continue Reading