Fix your back pain; don’t forget your glutes

Through proper exercise, movement, and posture, you can help low back pain.

Kevin Mullins, a master instructor for Equinox Sports Club in Washington, D.C. understands low-level chronic back pain and found three recurring issues that personal trainers can address with their clients. Excess bodyweight, sedentary lifestyles, and improper exercise selection, are areas a trainer can help a client with, all factors having a correlation to low back pain. It is estimated that over 84 % of the population will experience an episode of LBP, from children to the elderly, at some time during life.

As well, age, stress, occupational factors, lack of flexibility or hyper-mobility, sports, postural habits, and smoking are other contributing factors.

Recovering from low back pain is a long complex road. If you are in pain, but not dealing with any diagnosed or diagnosed medical issue, you fall into the category of mechanical low back pain, or LBP.

Unlike a car, says Dr. McGill, one of the most widely respected spine researchers in the world, where you change one thing and it’s fixed, fixing a back is different. Back pain is more complicated and is much more than just fixing one part. Because, McGill notes, it comes down to cold hard science.

How the  spine functions and it’s relationship the rest of the body is the key to being free of back pain. Through proper exercise, movement, and posture, even disc bulges can be made less painful, and usually pain-free, he notes. 

Of course it’s hard to stick to a program if you are in pain. You lose the very conditioning that could help treat LBP, or even more frustrating, gain unwanted weight.That extra weight is the number one reason clients turn to a trainer, with or without low back pain. Healing starts to occur when you keep the bigger picture in mind; a good diet,adequate sleep, and a matched activity/ training program.

Tip #1 The Big Picture 

A traditional strength training can improve strength and muscle mass. Overall body strength as well as a daily walking regime are important part of a client’s program to become free of back pain.

Tip #2  Bend at the hips, rather than the spine 

There is a direct correlation between posture and pain. You can reduce episodes of back pain by reminding yourself to bend at the hips, which is a ball and socket joint, not the back. The spine does bend, but repeated spine bending, whether it’s picking up a weight in the gym, or swinging a kettlebell, could eventually lead to delaminations in the layers of the discs. Someone swinging a kettlebell, along with their back, instead of stabilizing the spine while doing so, to protect the spine, risks further trauma to an already sensitive back. When you’re performing squats, for example, sink your hips back towards your heels, like sitting onto a low park bench. Keep your eyes forward. Use your hips rather than round your back.

Tip #3  Rethink the core 

To enhance back fitness, you need a strong focus on core strength, as theses muscles play a protective role. The internal and external obliques, transverse and rectus abdominals, and the erector spinae are arranged around the spine and act as guy wires to allow the spine to control movement, bear loads  and facilitate breathing. But all too often you see good athletes and gym members entirely focused on just the rectus abdominis, commonly known as the “6 pack”. If we go back to our car analogy, focusing on only one part won’t solve back pain.

The core musculature extends to the entire body,  from the upper back down to the pelvis, not just the 6 pack.The lats, trapezius, the gluteals, hamstrings, hip flexors and inner and outer thighs all have an impact on the spine. 

Typically what happens with someone experiencing low back pain, is that that pain hasn’t allowed them to adequately train. The outcome is weaker core and gluteal muscles. This is where science comes in.

To see how important the glutes are for strength, try this exercise; Stand on one leg and balance. Then sink your hips back slightly, behind your heel, and see how much more stable standing on one leg feels. This is a great demonstration of the role the gluteals play regarding core strength.

Your progression, with an awareness on good movement patterns, including planks, back rows, squats and bridges, for example, should be aimed at strengthening more and more of your whole body, back to health.

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Why Full Sit-ups Can Back-fire

Core training is the foundation of great athletic performance, whether you’re a seasoned pro or week-end warrior. The core consists of the lumbo-pelvic-hip complex, and the thoracic and cervical spine-not just “abs”. 29 muscles attach to this powerhouse allowing   efficient acceleration, deceleration, and stabilization during dynamic movement. The abdominal wall, part of the core, is like an anatomical corset which also includes the deep transversus abdominis, which are below your belly button, internal obliques, the lumbar multifidus, pelvic floor muscles and the diaphragm. In any athletic move, these muscles work together, like a large stable column, to fire quickly and efficiently. This core, the body’s stabilization system, is like a good foundation on a home: if it’s not built right, the house will have problems somewhere down the road. In the gym, for example, someone lying on a weight bench lifting a bar for a chest press might have their lower back several inches arched in the air, demonstrating an inefficient core. So there is some misunderstanding of what kind of ab exercises work best to keep your mid-section strong .The full sit-up, for example, can place devastating loads on your spine. Simply modifying the sit-up to a partial curl-up, with the head and shoulders lifting a few inches off the floor, would be better.

In a New York Times article last month, titled Core Myths, the belief that the core means only the abs was challenged, for there is no science behind the idea. Stuart McGill, a professor of spine biomechanics and chair of the Department of Kinesiology at the University of Waterloo in Canada, compares the spine to a fishing rod supported by muscular guy wires. If all the wires are tensed equally, as in the whole lumbo-pelvic –hip complex, the rod stays straight. A core exercise program should emphasize all the muscles that girdle the spine, not just the abs, to ensure balanced strength. In his lab, he’s demonstrated how an average sit-up can exceed the limit known to increase the risk of back injury in normal American workers. In fact, in 1991, the safety of the full sit-up test was deemed no longer recommended for school-aged children as a means to test their abs. Instead, the partial curl was recommended.        

The full sit-up is 3 muscle actions: neck flexion, spine flexion, and hip flexion. It’s important to be able to sit up, no doubt, but repeated sit-ups   can place hundreds of pounds of compression on the lumbar disks. Hooking or holding the feet down places even greater stresses to the low back. Ironically, the bent knee sit-up has been taught to minimize the action of the hip flexor in the sit-up, though it is not correct. The abs can only curl the trunk. The sit-up is a strong hip flexor exercise whether the knees are bent or straight.

 Instead of full sit-ups, research shows that although there is no ideal exercise for each individual, the traditional crunch, or many variations of a curl-up, with the head and shoulders lifting a few inches off the floor, holding briefly, is a good exercise to challenge the abdominal muscles while imposing a minimal load to the lumbar spine. Speed of movement has an impact also. In The Journal of Strength and Conditioning Research May 2008, curl-up speeds were shown to have a significant impact on spinal loads, and that the combination of slow and moderately controlled speeds  is generally recommended for health and fitness programs. In their opinion, at the competitive level, coaches can choose fast explosive trunk exercises, but to also aim for a more varied program that includes trunk endurance, strength and good motor patterns that ensure spinal stability.

McGill says that 3 exercises, done regularly, can provide a well-rounded core stability program: practice the curl-ups, learn how to do a side-plank (lie on your side and raise yourself in a straight line, and the “bird dog” (from all fours, hands and knees, you raise an alternate arm and leg level  for 4 or 6 seconds) .


 Connie Aronson is an ACSM Health & Fitness Specialist in Ketchum, Idaho

Printed in the Idaho Mountain Express August 28, 2009