Eighty percent of people report having low back pain in their lifetime, and the phenomenon has been worsening. According to the National Institute of Health, in the 1990s, it was the sixth most "burdensome condition" affecting Americans. By 2010, it had jumped to the third highest.
Lower back pain seems hard to treat because it can come from a variety of factors. The back is the nexus of a complex system with interconnected muscles, tendons, fascia, discs, and bones. Lower back pain can come from your posture, from walking improperly, poor pelvic alignment, glutes, abs, or lats not working, no movement in your lumbar spine, and muscle imbalance from repetitive motion — to name a few causes. The good news is, whatever the case, it can most often be fixed.
The positions you put your body in will dictate your posture, which in turn dictates your ability to function. Slouching is a perfect example: When you slouch, you are not using your muscles to hold your body up. Instead you are instead hanging on your fascia and musculotendinous junctions (where the muscles and tendons meet). You round your upper back, which causes your shoulder blades to elevate and rotate out of position. When you stand, your scapula gets stuck in this position because the muscles are too stretched out to contract properly, while they should be supporting you. Then your lat muscle becomes inefficient and you rely on the low-back fascia-musculotendinous junction to hold you up. Lower-back pain will follow.
You can see the cascading effect that one postural deficit will have on your lower back, but similar chain reactions occur from walking incorrectly, if your pelvis is out of alignment, or if your head is too far forward.
We've shown you how to fix a slouch, so let's focus on the next huge cause of lower-back pain, your pelvis. Over 33 sets of muscles connect to the pelvis, and the body is built upward and downward from there. We need to create proper alignment here first to create balance elsewhere in the body. Ideally, at rest, your pelvis should be in pelvic neutral. As you move, the pelvis should alternate between posterior and anterior rotation. However, clinically I see the pelvis get stuck in an anterior rotation (tilted forward). Once that happens, your hip flexors get tight and limit the ability for your abdominal muscles and glutes to work properly. When that happens, the work gets dumped on the lower back, causing an unequal pulling on the low-back fascia, which further pulls your bones out of alignment. And since muscles cross joints, those joints have increased friction and won't move properly.
Try these exercises, in this order, to get the pelvis back into place and create more motion, alleviating the pressure on the low back.
Hip Flexor Release
- For this release, use two lacrosse balls taped together.
- Lay on your stomach and place the double lacrosse ball just below your hip bone.
- Lean a tolerable amount of weight onto the lacrosse balls.
- Bend the knee on the side of the release back to a 90-degree angle. Swing that leg side to side in a tolerable range of motion.
- Perform for 30 seconds on each side three times.
Hip Mobilization With Foam Roller
- Lay on one end of a foam roller so that the tip of foam roller is flush against the base of your spine (sacrum).
- Arms may be at the side in order to maintain balance.
- Raise both legs up while keeping knees straight. Make sure the sacrum is flush against the foam roller throughout the activity.
- Perform two sets of 30 reps.
Hip Rotation Mobilizations
- Lie on your side with your knees and hips slightly bent.
- With your top hand, locate the bony prominence (the ilium) on the back of your top hip. With your fingers on top of the ilium, apply constant pressure.
- While maintaining the pressure, draw your top knee toward your chest and extend it back to your feet.
- Repeat three sets of 20 reps on each side.
King Cobra Stretch
- Lay on your stomach with hands palm-side down and turned out. Arms should be slightly wider than shoulder-width apart.
- Slide one knee up to the side with the foot turned out, keeping the other leg straight and turned in.
- Push shoulders off the floor until arms are straight (like a cobra pose). Keep your shoulder blades down and back. Hips should stay down on the floor with elbows close to your sides. Squeeze your glutes.
- Look up and twist to the side of your bent leg.
- Hold for 30 seconds and perform three times on each side.
Hip Flexor Stretch
- Begin in split kneeling position (back knee down, front knee up) with the back knee on a soft pad.
- Forward knee should be directly above ankle with a 90-degree bend in knee.
- To begin stretch, shift weight forward into a lunge while keeping your torso tall and pelvis tucked under. The stretch should come from your pelvis and you should feel it in the front of the hip. Don't lean forward with your torso.
- To get a deeper stretch, bring the arm on the same side as your back leg up over your head, then side bend and twist your torso away from the leg being stretched.
- Hold for 30 second and perform three times on each side.
Single-Leg Hip Thrusts
- Holding a dumbbell on your hips, lie with your upper back flat on a bench or table with your legs and low back off the edge. Plant one foot on the ground with your knee bent, and extend your other leg out.
- Dip your glutes down and then thrust back up with your bent leg, squeezing your glutes through the movement.
- Repeat for three sets of 15 on each leg.