As health and fitness professionals we like to think of ourselves invincible. After all, we help people feel better, and accordingly, we should never do anything to appear less than indomitable. We also all know this is simply not true.
Recently, I was going through a movement phase of training; lots of kettlebells, medicine balls, battle ropes, and calisthenics, etc. During one particular movement, I felt a little twinge in my low back, so being invincible I kept working out. The next day it was a little worse, but being invincible, I kept on plan. It took a few days before I actually took the advice that I would have given to any of my clients; back to basics.
Low back pain (LBP) is defined as localized pain or ache below the costal margin (lower edge of the chest) and above the gluteal folds (below the buttocks but above the thigh). Acute LBP is pain experienced between 6 and 12 weeks, and chronic LBP is pain experienced for greater than 12 weeks. Low back pain is the leading cause of disability worldwide and costs the United States over a $100 billion annually in health care costs and lost productivity. Although diagnosing the cause of LBP is outside the scope of practice for a Medical Fitness professional, once a client is cleared for exercise, basic movements that correct faulty motor patterns and increase muscular endurance should be suggested.
1. Corrective, therapeutic, and perfect-motion motor-patterns exercise as determined by the initial assessment
- Identify and remove movements that cause pain
- Ensure proper posture and gluteal activation during activities of daily living (ADLs)
- Form, form, form
- Perform abdominal bracing to encourage co-contraction (not to be confused with abdominal hollowing which may be counterproductive as it engages only one or two core muscles)
2. Build whole-body and joint stability (mobility at some joints such as the hips and stability through the lumbar/core region)
- These exercises increase stability without exacerbating the original injury
- These movements should challenge endurance and increase motor control
- Bracing and co-contraction of the core should be performed during these movements
- Unilateral movements that encourage core activation without aggravating the injury.
3. Increase endurance
- Isometrics should be held for less than10 seconds; to increase endurance, increase repetitions
- A pyramid pattern (5 reps on each side, 4 reps, 3 reps, 2 reps, 1 rep) allows the most repositions to be performed with the least amount of fatigue.
Although this is a plan to alleviate LBP, the simple concept of back to basics is something we all know, but often neglect. Regardless of the injury, disease, or dysfunction, getting back to basic mobility and stability exercises is the only way to start progressing again. Additionally, basic movements should be revisited often to avoid future lifting injuries. The table below provides some examples of exercises that can help increase core strength, as well as alleviate and reduce to risk of LBP.
| EXAMPLE EXERCISES FOR LOW BACK PAIN | |||||
| Corrective and Therapeutic | Whole body – joint stability | Endurance | Strength | Power | Avoid (until appropriately progressed) |
| -Abdominal bracing -Wall roll -Floor roll -Glute bridges -Clamshell -Single leg squat matrix -Low-load cardiovascular exercise such as walking |
-Cat-camel stretch -Modified curl up -Opposite arm/leg raise and Dead bug -Quadruped bird-dog -Side bridge/ modified plank -Rolling bridge -Push-ups (Modified, Staggered hands, Unstable surface) -Body rows |
-Start with 0-10 second isometrics. -Increase the number of reps not the length of the isometric hold. -A pyramid pattern can provide ample repetitions as well as ample rest. |
-Focus on ADLs -Unilateral farmers walk -Lateral cable hold-press |
-Plyometrics -Medicine ball slams -Whirling m/b to slams -Medicine ball catch |
-Heavy lifting -Prolonged sitting -Twisting movements |
| McGill, 2010, Solomon, 2015 | |||||
Education for Fit Pros
Information from this article was pulled from the Foundations of Medical Fitness 20-hour online course. Enroll now to expand your skills and reach a market that needs you! You’ll receive a certificate of specialization as a Medical Fitness Specialist upon completion.
Dan Mikeska has a doctorate degree in Health Science and a master’s degree in Human Movement, as well as certifications from NASM, ACE, the Cancer Exercise Training Institute and the Exercise Is Medicine credential from ACSM. He currently owns NOVA Medical Exercise and is adjunct faculty for A.T. Still University’s Master of Kinesiology program.
