[dobbo99]

As the title says really, anyone got any great suggestions/exercises for strengthening your lower back?
In the gym or not, any suggestions welcomed.

Had a back problem 2 or 3 months back, and been going to physio/chiropractor to help and Im back up and running again now. Ive got a handful of things Im doing, but just looking to vary the work and mix it up a little bit as it gets a bit boring doing the same things.

[Kerr]

I can see the obvious answer coming soon.....

[mowflow]

Warning. This post might be a bit anorak and boring.

Strengthening lower back is tricky as it's not really a muscle group that can be isolated. It's a muscle group that usually works in opposition to other muscles (usually abdomen, hip flexors etc). From hurting it you will now realise just how much the muscles in this area are used, walking, sitting, turning.... pretty much everything will have hurt as the muscles primary use is to work in opposition to your abdomen to stop you from folding over all the time.

The majority of people that suffer from lower back pain get it due to a deficiency of the posterior chain (basically arse down) so it's usually not the back that needs strengthened but rather the glutes, hamstrings, hip flexors, adductors and core. People who sit a lot are most likely to suffer due to the muscles being weakened by being sat on your arse all day and the tendons shortening due to the legs being bent for most of the day while seated.

What to do.

The first thing to do is increase mobility in the area using an effective stretching programme. Focus on hamstrings, gluteus, hips and waist rotation. Lunges, side lunges, holding a squatted position, trying to touch your toes (doing this one properly is tricky as you need to keep your back straight) etc.

Once you have decent mobility you want to strengthen.

Core. plank, side plank, bridges, leg raises. Not sit ups or crunches as it's just abuse for your spine and no more effective. Think of your spine as being like a wire coat hanger. Would you bend it back and forward over and over to make it stronger?

For everything else. Compound exercises will be best as they utilise the muscles of the back in a group movement where they work with/against the muscles that they do doing normal activity. Top would be squats, start with bodyweight and work up. When you get to the point of adding a weight focus on front squat rather than back squat if you are using a barbell (barbell is best as it will make your posture better during the movement).

When you can squat an unladen barbel try straight leg deadlifts/Romanian deadliest with the bar. Get the form right on these basic exercises and you will then be able to start adding weight a little at a time. Don't get ahead of yourself and remember to continue to stretch and improve the motion in this area.

There are loads more exercises but I find if done properly these the most effective as they work everything without putting too much strain on a single muscle group.

[davyk31]

I'm currently suffering from sciatica, came on 2 weeks ago after a couple of weeks of sore legs when walking. Couldn't move for three days, out of bed on fifth day, improved a lot but still a lot of muscle ache in one leg, mainly around my ankle and shin. Standing is sorest and lying flat ain't great.

These exercises sound useful although given I'm no expert I don't totally understand. Any suggestions to clear my pain would be wonderful.

[Desmondo]

Great post by mowflow there, covers lots of information. I'd be inclined to talk to your physio/chiro too as they know what was actually wrong with your back and should be able to give some decent guidance.

[mowflow]

Sciatic nerve pain can be the symptom of what i described above. Worse case scenario is that you have a skeletal misalignment in your lower half or a fallen foot arch. All of it can be fixed but diagnosis is the problem.

As Desmondo says, it's always best to get properly assessed and diagnosed. The trouble is finding somebody good. I've never had much luck with the NHS in this area and have spent a fortune over the years on osteopaths and chiropractors. I now tend to favour seeing physios.

Davy, if I were you I would try icing the area periodically at the moment as you sound beyond being mobile enough to try the lightest of remedial exercises. Some would argue using heat but this pain is normally caused by inflammation so ice will help reduce this where as heat will temporarily improve mobility.

Once you are able to stand without holding your breath or crying then you can move on. Youtube stretches for any of the areas i mentioned or any of the exercises. If you want post them here and i'll try to help.

Another good pointer for anyone with back pain, sciatica or anything else is to get yourself a foam roller. Google "self myofascial release" to find out more. Yes, I know it sounds like an act from one of Wil's posts but it's not.

[dxb335d]

Dead lift in gym.

[makkan00]

Originally Posted by dobbo99

As the title says really, anyone got any great suggestions/exercises for strengthening your lower back?
In the gym or not, any suggestions welcomed.

Had a back problem 2 or 3 months back, and been going to physio/chiropractor to help and Im back up and running again now. Ive got a handful of things Im doing, but just looking to vary the work and mix it up a little bit as it gets a bit boring doing the same things.

How did it start?
Any history of previous hip/ knee / spinal issues?
Any diagnostics done for your back pain? Such as X-rays, MRI?
Anybody suggested disc issues to you?
Any neural symptoms such as radiation of pain to legs?
What was your fitness level before the injury? what is it now?
What sort of work/job you do?
What exercises are you doing at the moment which are getting bored?
Any understanding of core muscle and large muscles?
From standing position, can you bend and touch your toes without aggravating your pain?

You can discuss it here or send me a pm and I'll try to help you.

[makkan00]

Originally Posted by davyk31

I'm currently suffering from sciatica, came on 2 weeks ago after a couple of weeks of sore legs when walking. Couldn't move for three days, out of bed on fifth day, improved a lot but still a lot of muscle ache in one leg, mainly around my ankle and shin. Standing is sorest and lying flat ain't great.

These exercises sound useful although given I'm no expert I don't totally understand. Any suggestions to clear my pain would be wonderful.

Clinical Question.... Sciatic nerve passes into both legs. It enters into your leg from the gluteal (bum) region. If it was Sciatica, why pain is in one leg and not both.

It may be Sciatica, but I ask my students this question.


Sciatica can be caused by tightness of muscles where the sciatic nerve enters into your leg. So over working some muscles can lead to it.
Postural problems can lead to it. Keeping purse full of junk can contribute to it. Sitting for long time on your work desk can cause it. Also keeping your driving seat far from the gas pedal can lead to it.
Tightness of neural components can lead to it.


Have you had any neural symptoms, such as pin and needles or severe weakness?
Has anybody officially diagnosed you with Sciatica or is it self diagnosis?

If disc problems have been completely eradicated in your case, then you can start with gentle stretching of your sciatic nerve. You need to keep the exercises in 'pain free' range.
That means, when you stretch your leg, if the pain starts, you need to stop the stretch where pain kick in. You can progress the stretching a bit more when pain kick in, but only a tad more.
One exercise is standing and trying to touch your toes. Again, as soon as the pain kicks in, go a bit more. You do these stretches till the pain decreases and you start getting more movement.

Also stretching back muscles (search william flexion stretches for back), hip extensors (gluteal muscles) help you a lot.


PS: I have covered it only on generic base, as I do not know your history, and many other factors. Successful treatment depends on finding the cause and contributing factors, eliminating them or reducing them and then treating your problem.

[makkan00]

Good post. Few things added.

Originally Posted by mowflow

Sciatic nerve pain can be the symptom of what i described above. Worse case scenario is that you have a skeletal misalignment in your lower half or a fallen foot arch. All of it can be fixed but diagnosis is the problem.

Good point. Most of the time, Sciatica originates due to piriformis muscle problems. It could be myofascial issues, tightness of piriformis muscle due to shortening (lack of stretches), or strain of piriformis muscles (athletes, runners).

Originally Posted by mowflow

As Desmondo says, it's always best to get properly assessed and diagnosed. The trouble is finding somebody good. I've never had much luck with the NHS in this area and have spent a fortune over the years on osteopaths and chiropractors. I now tend to favour seeing physios.

Well said. Assessment is the key here. Proper physio / consultant will follow one joint above and one below rule. Dynamic assessment is required to check the gait and any variations in the lower limbs.
I am not going to defend NHS, but unfortunately there is a huge pressure on the clinicians. If you are a junior physiotherapist and you have been told to assess a new patient in 30 minutes and possibly treat and update the notes....then you could do only basics. Also you will not have time to individualized the exercises and hence generic printed exercises are given.

In private setup, restrictions are less and go bit further to explore all possibly differential diagnosis.

Originally Posted by mowflow

Davy, if I were you I would try icing the area periodically at the moment as you sound beyond being mobile enough to try the lightest of remedial exercises. Some would argue using heat but this pain is normally caused by inflammation so ice will help reduce this where as heat will temporarily improve mobility.

Interesting. My question from Davy side is, where should I apply the ice?

Originally Posted by mowflow

Once you are able to stand without holding your breath or crying then you can move on. Youtube stretches for any of the areas i mentioned or any of the exercises. If you want post them here and i'll try to help.

Another good pointer for anyone with back pain, sciatica or anything else is to get yourself a foam roller. Google "self myofascial release" to find out more. Yes, I know it sounds like an act from one of Wil's posts but it's not.

Good suggestion. If you are a DIYer, then giver it a try. Otherwise seek professional opinion.

[dobbo99]

How did it start?
I play a lot of Golf, which gives me tight hamstrings, so Im constantly stretching. One session on the range, I was tilting my pelvis and something reacted. that was at lunchtime, and by 5pm I was on the floor and my back had just spasmed/locked, specifically on my right side. Had a day in bed (not good I know) because it meant I could relax, got some proper pain killers from GP and it eased up.

Any history of previous hip/ knee / spinal issues?
Yes, knee, although not on the same side. Left knee op in May 2011.
Ive struggled with what I think is imbalance since that point, but Im told that Im relatively even.

Any diagnostics done for your back pain? Such as X-rays, MRI?
Nothing

Anybody suggested disc issues to you?
Chiropractor suggested prolapse disc, but has never been confirmed

Any neural symptoms such as radiation of pain to legs?
Nothing in my legs at all. Just lower back and rear of pelvis.

What was your fitness level before the injury? what is it now?
I would say better than good level of fitness. Ive given up football (as result of knee injury). Gym, or gym classes twice a week, or swimming, or biking.
Its currently not as good, Ive started back in the gym but Im a bit wary of doing anything too major involving my back.

What sort of work/job you do?
Office based, sit at a desk most days. I have a lumbar support on my chair.
I do try to get up every half hour.

What exercises are you doing at the moment which are getting bored?
Exercises are more stretches that I have been set from physio/chiro. Its not that I don't like them, but surely there is only so much stretching that will benefit me?
My back feels weak, and doesn't feel like its developing.

Any understanding of core muscle and large muscles?
I probably have a better understanding than most.

From standing position, can you bend and touch your toes without aggravating your pain?
Some days yes, some days no. I cant pinpoint what makes it worse some days.

Ive paid (quite a lot now) to see a few different people, and Im just not confident that what they are suggesting is improving me, its just managing the condition. Nobody seem to be able to tell me whats wrong specifically.
I can have a massage/manipulation session which stretches all the muscles relating to my back.

Im 35, 6'4" tall, just under 15stone.

Appreciate your comments so far

[mowflow]

It's sounds like Makkan is a professional in this field so he's probably best for advice but I can't help pitching in my theory.

This is purely my opinion and I'm far from a professional in this area. Based on your answers I would definitely say this is due to a weakness in the muscles around your arse, hamstrings or hips. I would look to strengthen these muscles while improving on flexibility. Straight leg deads for the hamstrings along with squats and regular deads as it's a triple extension of the hips. Golf is a very hip dominant activity. Only do the later 2 exercises if your knee is strong and has a full range of motion.

I went to a seminar by strength coach Alan Cossgrove years ago, at the time he was Tiger Woods strength coach, these exercises were the base of his programme. He also talked about greatly improving his drive using heavy kettle bell swings to improve hip drive.

Due to your previous knee injury I would also seek out a good independent sports physio who should be able to address any imbalances.

[rich1068]

I believe makkan00 is a pro. Physiotherapist I think.

This is all very close to home. After a period of intermittent, moderate back pain I slipped a disc a couple of years ago. I wouldn't recommend it. The pain is truly eye watering. The MRI scan pictures were fascinating though.

I don't have much to add other than recommending moderate very low impact exercise, very careful stretches and pain killers when you need them. This can be a good long walk and some ibuprofen, simple as that. Be very careful of the gym.

As mowflow pointed out it is difficult to get good treatment due to what I would imagine are time and budget restraints. I stopped going to a physio because it was like starting again every week. Waste of time but not their fault. And be wary of chiropractors. I've used them plenty of times but they can have an agenda. It is border line quackery at the end of the day.

[misterS3]

Pilates - go to a class once a week and you'll notice the difference in a few months. I did for a year (stopped out of laziness but must get back) and my golf was much improved. Stable/strong core. 3 minute planks no problem. Now i can barely manage 1 minute! And i have tight hams/calves/achilles.

Physio: Yes
Chiros: No

[makkan00]

Great, lets start with this video. A brief description of whats going on spinal level.

Originally Posted by dobbo99

How did it start?
I play a lot of Golf, which gives me tight hamstrings, so Im constantly stretching. One session on the range, I was tilting my pelvis and something reacted. that was at lunchtime, and by 5pm I was on the floor and my back had just spasmed/locked, specifically on my right side. Had a day in bed (not good I know) because it meant I could relax, got some proper pain killers from GP and it eased up.

Twisting, loading, and over reaching kills your back. In golf you have to swing your body which places enormous pressure on your spine.
I guess you need to concentrate on your core muscles while playing golf. We'll discuss the core muscles later.

Originally Posted by dobbo99

Any history of previous hip/ knee / spinal issues?
Yes, knee, although not on the same side. Left knee op in May 2011.
Ive struggled with what I think is imbalance since that point, but Im told that Im relatively even.

Cartilage? Arthroscopy, which surgery was that? Do you have leg length difference? One leg slightly shorter than the other?
Or significant weakness in the muscles of one leg?
These leads to bio-mechanical variation in individuals and ultimately hip / spine issues.

Originally Posted by dobbo99

Any diagnostics done for your back pain? Such as X-rays, MRI?
Nothing

Anybody suggested disc issues to you?
Chiropractor suggested prolapse disc, but has never been confirmed

Any neural symptoms such as radiation of pain to legs?
Nothing in my legs at all. Just lower back and rear of pelvis.

That tells you that your disc prolapse is on early stages. If you watch that video again, then lets say that your jelly like substance is still in the disc and there is no or very little pressure on any spinal nerve root. Hence no radiation of symptoms.

In that case, first thing is pain control and muscle easing medication. Some rest to assist the jelly like substance to push back to centre and gentle core muscles / stretches at early stage.

Originally Posted by dobbo99

What was your fitness level before the injury? what is it now?
I would say better than good level of fitness. Ive given up football (as result of knee injury). Gym, or gym classes twice a week, or swimming, or biking.
Its currently not as good, Ive started back in the gym but Im a bit wary of doing anything too major involving my back.

What sort of work/job you do?
Office based, sit at a desk most days. I have a lumbar support on my chair.
I do try to get up every half hour.

What exercises are you doing at the moment which are getting bored?
Exercises are more stretches that I have been set from physio/chiro. Its not that I don't like them, but surely there is only so much stretching that will benefit me?
My back feels weak, and doesn't feel like its developing.

- Swimming and bike helps to keep you fit but on cardiovascular level. You need more specific work out for your back. Swimming does help to keep your back straight but it develops endurance of the muscles.
- Office based job does not help, but frequent breaks, and awareness of ergonomics and posture does help. If you keep your posture correct, use right type of chair/ desk/ computer and take frequent breaks, then it avoids any further aggravation of the issues.
-About the exercises. Lets start with basic concepts.
Our spine has two type of muscles.
Large and superficial: Which helps us to move and with the posture.
They are responsible for the movement of the upper body.
Small and deep muscles: They are multiple.
They are there to stabilize the spine and transmit the forces effectively. When we say effectively, that means transmission of forces through muscles than bones (vertebrae / spine) and discs. So any weakness in these muscles mean ---> more load on spine and disc.
Most notorious muscle to loose its strength is multifidus. Scientific studies shows that if you hurt your back, all other muscles return to its base level, but in 2/3 of population multifidus never returns back.

Now to make the things further complicated, if you have weak core muscles, and you try to load your spine and move about, then deep muscles are not going to support your spine properly. More forces will transmit through your bone and discs and if you add any rotation to it, disc will give way.

Also a reference to another study which showed that all elite athletes had very strong core muscles. And with that you have more control on your central part of the body, and you use it as a base. And then use the peripheries (arms / legs) to play the sports.

Now as we are not athletes or not elite class at least, our starting point should be core muscles.

Originally Posted by dobbo99

Any understanding of core muscle and large muscles?
I probably have a better understanding than most.

If your physio gives your generic back exercises (covering large muscles) then they are not effective.
Once the pain has subsided (reasonably or lets say 4-5/10 on a pain scale), then you can start with core muscles strengthening.
You can find the core muscle exercises on youtube, or google. If you struggle, then I will see if I can get an e-print and send it to you.

Originally Posted by dobbo99

From standing position, can you bend and touch your toes without aggravating your pain?
Some days yes, some days no. I cant pinpoint what makes it worse some days.

Kindly do a bit more research on yourself and try to find
-aggravating factors
-easing factors

This is one of the biggie on which help the clinician to assess the patients. Some of my patients tell me that I never thought about it.
But trust me, nobody else can manage your body better than you. Once you establish those, tell it to your professional and they'll be able to give you diagnosis and possible treatment.

Originally Posted by dobbo99

Ive paid (quite a lot now) to see a few different people, and Im just not confident that what they are suggesting is improving me, its just managing the condition. Nobody seem to be able to tell me whats wrong specifically.
I can have a massage/manipulation session which stretches all the muscles relating to my back.

From your statement it appears that
1- one or more discs have poor outer portion. When disc protrudes, then you get the pain, muscles go into spasm and you cannot move it.
(applicable if the pain is more central)
Also worth of mentioning that one the disc start wearing out, then you cannot stop it. Also it never gets back to 100% of what it was.
In these situations you avoid any movements which aggravates the disc issues and you strengthen the core muscles.
2- one or more muscles get strained and go into spasm and you struggle to move.
(applicable if the pain is more around the spine i.e right or left side back muscles)

To summarize,
- Find contributing factors to your pain and avoid them
- Start with core muscles strengthening and that is the key to control back pain and avoid any excessive pressure through your spine / discs.
- Watch few manual handling videos and follow the correct methods/ techniques
- Posture is the biggest factor in the back problems. You may not be able to see that, but postural awareness is one of the biggie to look into.

[makkan00]

Originally Posted by mowflow

This is purely my opinion and I'm far from a professional in this area. Based on your answers I would definitely say this is due to a weakness in the muscles around your arse, hamstrings or hips. I would look to strengthen these muscles while improving on flexibility. Straight leg deads for the hamstrings along with squats and regular deads as it's a triple extension of the hips. Golf is a very hip dominant activity. Only do the later 2 exercises if your knee is strong and has a full range of motion.
.

What you have mentioned is secondary contributory factors in back pain. Main and primary is muscles around the spine. They should be ruled out first before you move to peripheries.

There are two school of thoughts.
1- Strengthen the peripheries (arms / legs) and then move to the spine.
I guess thats what you are trying to say.

2- Strengthen the core muscles to improve you base. Strong core = strong base to strengthen the peripheries and improve your sports.

Scientific studies favor second option. And retrospectively, when you study all the top athletes, they all had one thing in common. Excellent core muscles, irrespective of their sports (football / tennis).

[makkan00]

Originally Posted by rich1068

I believe makkan00 is a pro. Physiotherapist I think.

Ssshhh!
I am known as a coder on this forum and thats more than enough
I still miss Harley street clinic though

Originally Posted by rich1068

This is all very close to home. After a period of intermittent, moderate back pain I slipped a disc a couple of years ago. I wouldn't recommend it. The pain is truly eye watering. The MRI scan pictures were fascinating though.

True, but it can vary. Disc prolapse is silent killer. You only feel the pain when the damage has been done.
Remember that we only get one spine and its life time is approx 70-100 years. So in a way, its brilliant piece of body part.

Originally Posted by rich1068

As mowflow pointed out it is difficult to get good treatment due to what I would imagine are time and budget restraints. I stopped going to a physio because it was like starting again every week. Waste of time but not their fault. And be wary of chiropractors. I've used them plenty of times but they can have an agenda. It is border line quackery at the end of the day.

If you give honest and proper feedback to your physio that there is no progress, then I'm sure that honest physio will discharge you rather keep charging you.

No comment on chiropractors, especially if you have disc issues.

[makkan00]

Originally Posted by misterS3

Pilates - go to a class once a week and you'll notice the difference in a few months. I did for a year (stopped out of laziness but must get back) and my golf was much improved. Stable/strong core. 3 minute planks no problem. Now i can barely manage 1 minute! And i have tight hams/calves/achilles.

Physio: Yes
Chiros: No

+1

[mowflow]

I went to a chiropractor once and it was a huge mistake. The guy was like one of those doctors you see in cowboy films selling snake oil from the back of a wagon. I also tried osteopaths and they all seemed to do the same thing. Bit of a rub followed by the same fold arms, hold breath, pressure and POP! Thing. It seems satisfying at the time but 5 minutes out the door you realise it was a waste of money.

Only people ever to fix me have been physiotherapists. The guy I use now is so good at putting all the guys at our gym back together that we have given him a permanent room at the place.

[dobbo99]

makkan, Im subscribed!
this is more information than I seemed to have obtained from 'paid' help

I think I may have a disc problem, but I also feel that I need to be doing great strength work to improve things, rather than just stretching.
I don't think my strength is that bad, I can plank for 2mins, lifting weights is fine, swinging a golf club is fine. but I still have an aching niggle in the base of my back.

Over the last couple of days Ive noticed that if I clench my buttocks, or suck in my abs, any aching I have from my back disappears almost 100%. more so if I suck in my abs.
So is this tensing of the muscle then generating better 'support' to the other areas?

Im going to put together a list of weighted moves, and try those for a couple of weeks and see what happens, if I aggravate it, then I'll stop.

will PM you.

[mob17]

Makkan is there anything you don't know? Lol

[davyk31]

I have to agree, Makkan has been extremely helpful to me as well, thanks!!