Q&A: Low Back Pain

Q:  I was standing and praying all day in Synagogue for Yom Kippur – at least 3-4 hours at a stretch and I had a long walk there from my house, too.  My low back is aching.  Is yours?  Do you have any exercises I should do?  I hear that I should strengthen my abs but my stomach is strong already.  Please don’t use my name in your blog post. I don’t want people to think I am unhealthy.  It just came up because I was standing so long on Yom Kippur and not something that happens to me all the time.

(Achy Back, Some Synagogue in America–Name withheld upon request)

A:  Dear Achy Back,

Don’t worry. Nobody will figure out who you are!  80% (some experts even say 90%) of Americans suffer from low back pain at some point. The majority of folks suffering are between the ages of 25 and 60.

Most cases are due to poor body mechanics – posture/muscle imbalances and not from things like cancer, arthritis, or fractures, bone loss or kidney stones etc.  Though those things can also cause back pain.   Before simply pointing you in the direction of some good core strengthening exercises (as opposed to ab exercises like situps/crunches), the better more complete approach would be to do a postural assessment to see if any muscle imbalances might be causing your discomfort.

A few postural deviations which can lead to low back pain include lordosis (sway back/overly arched lumbar spine and an anterior pelvic tilt), kyposis (hunch back, rounded shoulders and perhaps a forward jutting head) or hip and shoulder height discrepancies which might indicate a spinal curviture/scoliosis.

For those who tend toward lordosis and have an anterior pelvic tilt, I would strengthen the abdominals and stretch the iliospoas and erector spinae muscles.  For those with kyposis, I would strengthen the mid-trapezius and rhomboids and stretch the chest – the pectoralis major and the anterior deltoids.

Performing traditional ab exercises without proper lumbo-pelvic-hip stabilization has been shown to increase pressure on the discs and compressive forces in the lumbar spine actually.   So I think it would be more prudent to work on core stability before building you some abs.

1. The drawing-in maneuver:   Get on your hands and knees on the floor like a dog.  Make sure your hands are under the shoulders and your ears are in line with your shoulders and there’s a straight line – ears, shoulders and hips.  Knees are directly under the hips.  Maintaining this neutral spinal position, now pull the region just below your belly button toward your spine.
2. You can also lie on your back with your knees bent, feet on the floor, toes pointing straight ahead, arms and palms down at your sides and lift one leg at a time marching.
3. Floor bridge.  Staying on your back with knees bent, feet shoulder width apart, arms by your sides, palms down, push though your heels and raise your hips off the floor as you draw your navel in and activate your butt muscles.  Raise your hips until your knees, hips and shoulders are in a straight line.  Slowly lower to the floor.
4. Floor prone cobra:  Lie on your tummy on the floor, arms at your sides, palms facing the ground.  Draw your navel in, activate your butt muscles, pinch your shoulder blades together as you raise your head and chest off the floor.  (Keep legs and hips on the floor.) Hold for 1-2 seconds and slowly return to the floor keeping your chin tucked.
5. Plank.  Lie with your belly facing the floor, feet together, elbows under shoulders and forearms on the ground.  Draw your abs in and activate your butt muscles.  Lift your whole body off the ground.  The only parts touching the floor are the balls of your feet and toes, and your elbow and forearm and fist/hand.  (If this is too difficult, you could do it in a modified push-up position – knees and hands on the floor)

Once your core is stable, we could build you some abs and strengthen your low back more to further improve your kinetic chain and prevent the low back pain.  Remember not to hold your breath during these exercises!!

Here are a few other tips to prevent low back pain: maintain a healthy weight, stay active, lift with your thighs by bending at the knee instead of the waist when lifting heavy objects and avoid twisting while lifting. Wear low-heeled shoes.