Navigating Lower Back Pain: Expert Insights for a Healthy Spine

Understanding Lower Back Pain

Our last blog entries have suggested reasonable considerations for aging adults with respect to common injuries. This discussion cannot be complete without addressing the lower back. Unfortunately, statistically, most adults will experience a bout of acute lower back pain in their lifetime. Thankfully, most are relatively short-lived and don’t have to be life-changing. Ask anyone who has experienced a severe episode of lower back pain with sciatic irritation, and they would likely agree that any effort to limit the severity or even perhaps avoid the experience is worth it. Unfortunately, there is no simple answer. Lower back pain is very complicated, and there is a lot that we still don’t know. There is no silver bullet for recovery or prevention. It’s impossible to summarize lower back pain in a blog entry, but this post will address a few common items that come up in the clinic and are perhaps different from what many patients think. As always, this is not specific advice for any one person. Consult with an appropriate professional to get individualized recommendations for your diagnosis and your health.

Gentle Movement is Key

Recommendations for lower back pain can hinge on whether a person is in pain or not. For example, stretching can be an appropriate recommendation for someone who is trying to improve their available range of spinal movement, but it’s not always appropriate when someone is in pain. Typically, when a patient attends our clinic with acute lower back pain, we often recommend that they keep moving and try some gentle movement exercises, but we don’t usually recommend vigorous stretching while the spine is irritated. The cat-cow is one of my favourite recommendations for when someone is in pain. In many instances, regular rotational stretching might serve to perpetuate the irritation, whereas a cat-cow is usually more helpful. Think of it like scratching a mosquito bite. Vigorous rotational stretching may be satisfying for a moment, but from my experience, it tends to perpetuate symptoms. The cat-cow helps to prevent the spine from getting too stiff, and it usually doesn’t irritate the area. In short, I usually recommend very gentle stretching (if any stretching at all) when someone is in acute pain, but they are advised to keep moving as best they can and try the cat-cow.

The Role of Stretching for a Pain-Free Spine

When not in pain, stretching is a great way to maintain or improve mobility and make you more confident in doing day-to-day chores or exercises. For a pain-free spine, I encourage patients to stretch as often as they wish and in any way they feel comfortable. At the same time, if someone doesn’t want to stretch, I don’t push the issue. In my opinion, a person only needs to feel as mobile as they need for their life. I don’t stretch a lot myself, and knock on wood, I don’t experience lower back pain. I have good hip mobility, and I’m able to move my lower back through all the required ranges that I need for my life.

Strengthening – The Unsung Hero for Lower Back Health

I place a much greater emphasis on strengthening both for my patients and for myself. Unless something has changed, science would support strengthening over stretching for most musculoskeletal conditions, and the lower back isn’t much different. We don’t have to choose between the two, though! A routine of stretching and strengthening is usually a great way to keep the lower back healthy, but most people are under the impression that stretching is more important than strengthening, which isn’t what I’ve observed in my career.

Rethinking Core Strengthening (Beyond “The BIG 3”)

At one time, the literature was a little rigid when discussing core strengthening. “The BIG 3” were recommended as the core exercises that everyone needed, and in many practitioners’ opinions, that’s all that was needed. Curl-ups, planks, and bird-dogs were viewed as the best prevention for lower back pain, which we’ve now realized isn’t true. They are still very good exercises for most people, and I still recommend them as a starting point for those people who haven’t done a lot of core strength work, but there isn’t one way to strengthen someone’s lower back area. A program should be graded and appropriate for that person, challenging them in different directions so that their spine becomes more tolerant of life’s demands.

The Often-Missed Element – Rotational Strengthening

My observation is that most people don’t strengthen in rotation. Russian twists, Paloff presses, and wood-choppers are examples of rotational strength, and it’s rare that I hear of people doing these exercises. If you’ve never strengthened in rotation, it’s reasonable to expect that your lower back might be susceptible when doing rotational movements like shovelling, raking, or golfing. Although rotational exercises are an excellent way to challenge your spine and prepare it for strenuous rotational activities, they may be too advanced for a lot of people. Building up more experience and tolerance to strengthen the lower back is the first step, and with time, perhaps with the guidance of a professional, rotational strengthening is a great way to help protect your lower back from injury.

Final Thoughts

Again, summarizing lower back pain is impossible in a blog entry. From my experience, when someone is in pain, I typically recommend that they keep moving, try some gentle movement exercises like the cat-cow, and seek treatment for their condition. When not in pain, the emphasis is usually on strengthening around the lower back and core area, but stretching is also a good way to help get your spine more athletic. In general, spines like to move. Don’t sit all day at work and try to change your position frequently. Be aware of what factors aggravate your lower back because all cases are unique. Perhaps you need to re-think your footwear or your sleep position. Perhaps an activity that you like to do (such as golf) is irritating your lower back too much, and you need to space out your games. In the gym, I’ve found that deadlifts and burpees are common lower back exacerbators. This does not mean you shouldn’t do them or that they are bad for you. In fact, it may be the opposite; they are a great way to build up the lower back to tolerate the demands of life. It’s just that we often see people in the clinic with exacerbations of their lower back pain that occurred after deadlifts or burpees. If your priority is to not get injured when exercising, it may be wise to speak with a professional about how to reduce the risk and find an appropriate “dosage” of these more advanced exercises. No exercises are inherently “bad” for you; the question is whether you’re adequately prepared for that particular exercise or the way you’re doing it.

Again, this blog has touched on a few areas of common lower back pain misconceptions or questions we encounter in the clinic. Every case is unique. If you’re experiencing lower back pain and want a strategy specific to your case, please contact our clinic.