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Why does your Lower Back Ache?

Ask a Pro!

Low Back Pain (LBP) is such a common thing that most of us just ‘put up with it’ and ‘hope it goes away’.. am I right?

Well, I get lots of people come to me for advice about LBP and (to an extent) if I know the cause of the pain, I can fix it!

See, I like to think I know a fair bit about most issues and can apoply my knowledge to most problems to find a solution.

But sometimes you’ve just gotta ask a Pro!

Fortunately for me, I have a good friend who happens to be a Low-Back Pain Specialist and I often seek him out for knowledge.

It clicked with me the other day, rather than me asking for knowledge, him teaching me and then me giving it to you.. why not skip the middle man and have Jake give you the knowledge himself?

Well, that’s exactly what I did!

With a big bit of generosity, my buddy Jake Guinness has typed us up a full-on piece about everything Low-Back related!

So, with no more of me taking over, I hand you over to the man himself: Jake Guinness!

What is lower back pain how can it be identified

Lower Back Pain (or LBP) is the pain that you associate with muscle tension, stiffness, mild discomfort during movement or certain seated positions.

Back pain can either be acute (which means the pain subsides after 12 weeks or less) or sub acute (less than 6 weeks in duration) or chronic (constant pain and continual discomfort).

With regards to fixing it, there are some factors we can control and some we can’t, but back pain is usually attributed to more than one factor:

Non modifiable factors include

1 – Increasing age

2 – Number of children

3 – Reoccurring incidents

4 – Scoliosis (a curving or s shape of the spine)

Modifiable

1 – Lack of fitness/physical inactivity

2 – Smoking

3 – Obesity

4 – Psychological stress

5 – Physical trauma

6 – Awkward posture

7 – Frequent bending or twisting

8 – Heavy lifting, repetitive lifting

9 – Jarring, gripping, vibration, repitive actions

10 – Prolonged sitting or prolonged standing

Back pain is extremely common. (Palmer and Walsh et el 2000) state 49 % of uk adults either do suffer or will suffer from back pain at some point in their life; with 44 – 77 percent of LBP having a relapse in symptoms with the absence of any further strengthening work.

Sufferers tend to stop seeking professional help after 3 months, allowing the symptoms to constantly persist, and existing on a cocktail of anti inflammatory’s and limiting their movement to prevent further and persistent discomfort.

Back pain can have a significant impact on peoples’ psychological and physiological health. It can cause you to lose work and if persistent can affect your mental health. The irony is that in most back cases it isn’t related to pathology and can easily be managed with the correct guidance and progressive movement.

Causes

Due to huge inactivity, being overweight, poor posture or general lack of functional movement , muscles become faulty and the recruitment of those muscles becomes very poor causing lower back pain to persist. Muscles like the transverse abdominus and multifidus, internal obliques and gluteus maximus become under-active, thus other muscles have to compensate and huge muscular imbalances occur. This alters the movement and control at the hips to result in an anterior pelvic tilt which leads to continual irritations of the spine.

You can identify it through very tight hamstrings and poor posture:

How many people can easily touch their toes with the appropriate amount of flexion and with ease?

The feet can also play a huge role in LBP. Inversion (outward roll of the ankle and foot) and pronation ( inward roll of ankle and foot) is very rarely picked up on during childhood and the use of improper footwear and lack of insoles causes huge anterior rotation of the pelvis and causes huge muscular imbalances which really over emphasise a condition called lordosis (a curve in the back) .

Some people are born with it, others can prevent it others can manage it. Lordosis when correlating with a person’s feet places an excessive mechanical load on the lower back.

This why movement screening and indentifying weak muscles is so important with LBP intervention. The way we move directly correlates with a healthy back. This type of assessment can be done by qualified strength and conditioning coaches, personal trainers and physiotherapists.

Debunking the flexibility and yoga style myth to lower back management

You can walk onto any high street in the uk and see huge postural deficiencies but are they all in pain? Probably not. Postural training is only as good as the next posture you’re in (Ian brown 2015) management is the key.

While certain stretching can feel good initially it tends to be improvements in structural balance that will help people progress. Excessive flexion rotation and flexing overload can aggravate the spinal issue. (Frederick 2002) noted yoga style stretching made the myofacia in the muscle hypotonic, which causes tendon reflexes and loss of muscle tone when stretching for too long.

The only way to make it work together was to incorporate a strengthening resistance programme which put emphasis on trunk stabilisation and mobility at the hips. stretching exercises should only be used when addressing muscular imbalances and combined with resistance training.

Influence of exercise

Guidelines now state a quick return to movement with regards to lower back is the key to management and pain prevention, (chartered society of physiotherapists 2006). Too many people when dealing with lower back pain are afraid of movement and generally make things worse by being sedentary and over protecting their injury or pain. When managing lower back pain, you need to try and reactivate a lot of the muscles that have become dormant through an inactive lifestyle. With the appropriate coaching cues and mind-to-muscle connection the correct muscles will start to engage and allow for better postural control; with pain management, if you rely purely on coping strategies, you’re only masking the problem further.

GPs are becoming increasingly encouraging of back pain patients to be more active and thus decrease the pain and discomfort, especially in long term back pain suffers. (Hayden 2006) If you experience persistent back pain for 3 consecutive months, an exercise programme should be employed, which can then lead to less pain felt and allow better movement around and during normal activities.

With this mounting evidence, we now look at the type of exercise you need to do to help manage the situation.

Recommended Exercise

Basic aerobic and strengthening can be useful, but it is not ideal because peoples’ symptoms are usually quite specific to themselves. With the appropriate movement screening from a Fitness professional, the correct exercises and programme format can be applied to ensure the correct muscles are becoming stronger and movement is improving.

Human bodies are designed to move in 3 movement planes:

– Sagittal

– Transverse

– Frontal

We tend to stick to a very linear plane and our day-to-day lives tend to be very static. Movements we must introduce to progress our functional movement are Squat, Push, Rotate, Lift, Pull, Carry/Move and Gait/Locomotion. Applying all of these movements regularly will allow us to move more freely and with greater function in day-to-day life and in sport.

Programmes, when dealing with back management, need to focus on single arm pulls and single arm cable work that focuses on pulling, so you work your diagonal muscle slings.

Lower limb movement and muscular endurance are key with a big emphasis on rotational lunge variants and single leg movements.

The core should incorporate movement and different movement planes, and should not be static as humans aren’t designed to just move in narrow lines. We should be putting big emphasis on the transverse abdominus and muscle activation to allow the correct stabilisation of the spine.

Here are a few examples of how you can do just that:

– Plank and Rotate

– Wood Chop Patterns

– Hip and Lower Back Activation

A client suffering from a bad back is nearly always fearful of exercise in case it means more pain. People are out of condition generally and a return or introduction to fitness will start to move things forward with the correct monitoring and progressive coaching.

A progressive and incremental approach is key so the individual is in full control of their pain management.

Training guidelines should focus around frequency. We should be training around 2-3 times weekly, with a 1-4 sets focus on as many different muscles as possible. Where conditioning isn’t appropriate, longer rest periods can be allowed but generally 20-30 seconds after a set is sufficient before progressing onto the next.

Aerobic activity can be useful, but not essential. What it can provide though is increased blood circulation and joint mobilisation which will make symptoms more manageable.

Conclusion and progression

As you develop, a more active approach toward the pain and greater levels of functional stability will be achieved .

Day-to-day movements will become easier and we can add in more specific loading parameters which can help you with your lifestyle.

With the correct coaching and observation, the risk of injury and trauma are greatly reduced because exercise practitioners can correctly monitor perceived exertion and pain scale.

Often clients will think that a particular movement or exercise is unachievable; this should be challenged as most can perform any given exercise to some degree with a specific coaching adaption.

The more you start to move and feel better, the more empowered you will become, allowing you to overcome as many obstacles as possible.

Playing with the children will start to become easier, participation in a variety of activities will flow naturally and general daily life will improve.

Once you take part in regular exercise, you will begin to recognise that exercise is not going to produce intolerable pain or result in further damage.

This confidence will increase your ability to workout will lead onto greater results and better management of activity cycling. Bad days will become manageable, you will know when to slow down and recover, and you can decrease the overall symptoms of lower back pain.

At RAW, we can use advanced techniques and training to form solid structure in your back which will condition you for more intense exercise that will achieve great results. To look into our Specialist Training and see how we can help you free up your back pain, form strength in the muscles that support it and bring you into a more active quality of life, fill in this form and we’ll explain exactly how it all works.

If you would like any additional advice or have any questions you would like to ask Jake, click on his name below and you can message him dirctly on Facebook. Or alternatively, you can send him an Email

Jake Cooper-Guinness Justforyoufitness

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