5 Minute Facts - Low Back

This is episode 263 of the Empowered Team podcast, a rebroadcast of episode 138. Welcome to the Empowered Team Podcast, where we explore how to optimize your performance in career, sport and life. And now your host, vitality and peak performance coach, Kari Schneider.

Okay, we are on. We are on for five minute facts. And this month's topic is lower back. So if you are one of the majority of the people in the world, you have had lower back issues. Lower back issues are not fun. And at the same time, almost everybody goes through a lower back issue at some point in their life. And why is this? Why would most people experience this? Because the culprits tend to be weak abdominal wall and they tend to be long hours sitting, heavy labor, also poor posture, but then as well, the unexpected, the acute injuries that come along. So five minute facts for lower back. We're going to go a little further into lower back than we would ordinarily for these five minute facts because this affects everybody. So number one is that most people will see an issue with low back in their lifetime. If you haven't, if you're one of the lucky ones, and I know there's a couple of people on here who have, but if you haven't experienced a low back issue, you likely will because almost everyone, I hesitate to say everyone and talk in absolutes, but let's just say everyone will experience something in their lower back at some point or another. Why is this? Because of our posture, our upright stance, also long periods of sitting, as well as weaker abdominal walls, also postural issues. When I say postural issues, it can be a subtle thing and that can cause the lower back issue. And lastly, most often it's a heavy labor type of scenario, so a heavy lifting kind of scenario will do it as well. The second thing, number two for our five facts, it's going to be that the most common types of injuries are muscle strains. There are also going to be disc wear and bulging and acute injuries as well. So those would typically be the muscle strain and nerve pain. So if you've got something going on, it's probably going to fall into those things, but not for everyone. But that is the most common injuries, disc wear and bulging, muscle strains and nerve pain of some sort of thing. So what are the risk factors? This is number three. Our risk factors end up being sedentary behavior, overweight, heavy lifting on the job, and those are the main ones. Now, some of you in here aren't experiencing those particular risk factors and still have Low back pain. And that happens for a lot of people. We'll go into that a little bit as well. The fourth thing is diagnosis and treatment. If you've had a lower back thing, you've probably found that you've gone for a really long time to try and unravel what the problem is. Because diagnosis can be very challenging without an mri, a CT scan or an X ray. So sometimes it's a simple thing. There's a muscle strain and you can feel it, it's right there. The massage therapist or the chiropractor or the physician can feel exactly where it is. And sometimes that can be easily diagnosed. Other times you've got this back pain, you might have shooting pain, you don't know why it came about. It's been a long term thing and that often requires a CT scan or an MRI to figure out what's going on. The problem with diagnosis and treatment, the problem with this is they may find something in there, but it may not be the thing that's causing your pain. It's a very, very challenging thing to distinguish what can be causing the pain, unless it's very obvious, because most of us who are over 30 years old, that's all it takes, just wee little bit of 30 years. And that's typically enough wear and tear to cause pain. And you may not be able to tell where exactly it's coming from, because most people, by the time they're 30 years old, they're going to show something in their discs. There might be some compression, there might be some disc bulging, there might be some damage of some sort, even some cartilage damage. So sometime after, or in that 30 year old realm, usually most people will show that there's been some sort of wear and tear. And the reason that makes diagnosis so challenging is because then when you go to try and pinpoint what the cause was, there's already wear and tear there for almost everybody. So it may not be the actual problem that's showing up on the screen or on the diagnosis, that may not be the actual problem. That's why people who are back pain specialists, therapists, surgeons, that's why they hesitate to recommend surgery. And that's why the process of treatment ends up being really listening to the body. So that's number four. Number five is going to be pain relief. I'm going to say this for almost any back pain scenario that you can try any of these things. So something like a heating pad, a bath, a muscle rub, we use some really great natural muscle rub, we use deep blue an inversion table. If you have an inversion table, that works wonders for many people. It's been amazing for me as well. And last but not least for what I would recommend for dealing with the pain, and this is going to be a key one, is blood flow. What the old school way of dealing with this was to have bed rest or inactivity. And we now know that that is not going to be the best solution. Some sort of blood flow or activity that doesn't exacerbate the current situation. And that would be your best way to go. So that is going to be the pain relief thing there. All right, so Those are your 5 minute facts on low back, but we're going to dive a little deeper into that because I know this affects so many people and there's going to be some specific questions on it. Now, I know that we're going to address a question about the big three and Stu McGill and spondylolisthesis. Before we dive into that, I want you to have a sense that not only do I have nerve damage coming from two crushed discs, I've also worked in a chronic pain clinic. I also have my Master's of Science degree in lumbar spine kinematics. So there's going to be a whole slew of information I can throw at you about lower back, but sometimes too much information can be confusing. So we want to narrow things down. So to address a question on spondylolisthesis and Stu McGill, I'm going to narrow this down a little bit. Stu McGill is a fantastic researcher who has dedicated his entire life to researching the lower back and lower back pain. This is a guy who I've seen all kinds of the research for over 20 years. This guy actually captured a disc explosion, almost burst disc on an MRI while he was testing somebody in research. He's also a guy who is very physical and has lived it as well. And he's narrowed down three exercises because this is one of the things that people really want to understand and really want to know. The three exercises are the bird dog, the side plank and the curl up. Those are the three exercises that he nailed down. Now, when I say that the bird dog is like a quadruped, basically a hands and knees position and you're raising an arm and typically the opposite leg is going in extension. So those are typically what is happening in those three exercises. Now, those big three are critical for not only stabilization, but also for making sure that you're activating the muscles that need to be there in the supporting role. However, and this May be where the frustration comes in. However, somebody can be doing these exercises and find they make the biggest difference in the world, or they could be doing those exercises and nothing's happening. There are solid reasons as to why he gives the side plank. What that does is it co contracts on both sides on your stomach and your lower back. There's solid reasons why he gives the curl up because you start the activation from the transverse abdominis the way he has it done, instead of just the rectus abdominis. There's solid reasons why to do the bird dog, and that is because of this oblique angle of extension contraction, engaging the glutes at the same time while extending from the upper and lower body. There's really solid neurological and muscular reasons to give those three exercises, but. But it doesn't always mean it's going to work. So let's put these in context to the spondylolisthesis, which the question was about. Question was, if I have spondylolisthesis, this is typically a fracture bilaterally. Spondylolysis is a fracture on one side, and spondylolisthesis is typically a fracture on both sides of this artic, the area of the vertebrae that can be a little bit weaker versus the kind of thicker part of the vertebrae. But if there's a fracture on both sides, there is at risk for this vertebrae moving. And it can put pressure on the nerves and can be extremely painful. Here's the question. I'm doing the exercises, but I still have pain. So what I would do, and this is where even though those exercises are great and Even though Stu McGill has a ton of knowledge, this is a scenario where what I would do is look and see. Okay, how are the exercises being done? If the exercise is being done are the spine is relatively neutral. There's really solid engagement. The sequencing of movement is really high quality and going in the direction it showed. What I mean by that is, are they trying to do some of the curl up, but they're not engaging the supportive transverse abdominis down below? Or are they going to do the bird dog and is their back arching too much and they're not getting the extension that they need in that position? Or are they doing that side plank, but do they have a real sway back and they're not their hip flexors are taking over? So those are some of the questions I would look in terms of the how are those exercises being done then? If they were being done really well, then the question I would ask is, how frequently are you doing those three exercises? Is it in the morning and the evening? Is it three times throughout the day? Is it once every three days? What are those types of things? So the frequency makes a difference too, because if what caused the injury is postural, for instance, if the person was a hockey player and the pelvis was rotated forward and the lower back was getting a whole bunch of extension for a long period of time, and that posture never got corrected, then those three exercises never have a chance. Because what they're competing with are they're competing with a movement pattern and a posture that is doing hours and hours and hours of disservice to the back. And those three exercises never have a chance. It's just too little for too big of a cause, if you will. So there's that kind of thing. The next thing. And I would have, I know the person who's asked this is on. So you can pop some in the chat, pop some comments and clarifications. If there's a couple things that are coming up as I'm saying this. The other thing about spondylolisthesis, and this is why I'm making some reaches when it comes to hockey hips or things like that, is that spondylolisthesis typically happens in people who have a little more of a lordosis or they've been carrying a lot of loads, or they've been a gymnast, a hockey player, track athlete, someone who has this repetitive load on their back. It could be someone who's carrying big packs a lot, or those are often the, the issues. If those scenarios aren't present, then I would also start to look at why did that fracture occur? Was there a specific car accident? Was there a specific event? And then the other question I would ask is nutrition. Because if those, if even if there wasn't a specific event and not massive overload for a healthy human being, they shouldn't have a fracture occur unless there was a major overload happening all the time. The extension postures are usually the spondylolisthesis situation. What that would mean is that the pelvis, if it's hyperextended, extended, or it's got this anterior tilt, it's almost like a bucket that's been tilted forward, then you try and tuck it under a little bit. And what that's going to mean, the emphasis on those three exercises that were given by Stu McGill would be the curl up portion of it. The problem is, is that if there's so much instability, because when you have a fracture on both sides of that vertebrae, that instability creates pain. Anytime you move that pelvis too much in flexion or too much in extension. So what you're going to do is you're going to start to slowly but surely make that plumb line from the top of your skull straight on up and try and get that pelvis so that it's somewhat tilted in not too much of this, but somewhat the up and down with this nice little lordotic curve, but not excessive lordotic curve and not tucked too much either. So you want that neutral position in order to start to train the musculature around it to be able to hold that position. You hold that neutral position for 5 minutes, 10 minutes, 30 minutes, and it's going to feel exhausting because the muscles don't know how to hold that. The other factor that's often ignored, that is ignored in those three main exercises from Stu McGill, is that those hip flexors are going to be so freaking tight that that is going to pull you back into that lordotic position, that extended position all the time. So what's not being addressed in those big three exercises is that some, you know, they'll often say in the bird dog, make sure you don't sway your back too much. Well, someone who has really tight hip flexors can't not sway their back. They go to do that movement and the back sways automatically. And that will happen in skaters, hockey players, think of volleyball players. So for Paul, same exact thing, he can't not do that unless he's really, really opened the hip flexors. So step one, instead of just a cat, cow, or rounding and arching of the back, step one has to be be warm enough, whether it was from biking or walking or a hot tub. Passive warmth, A shower. A hot shower. Be warm enough that you're sweaty enough that you can open the hip flexors first. Those hip flexors are going to be really tight and really challenging to open. And when you open them, you have to be hanging on with the stomach. Otherwise you're risking pulling on that spondylolisthesis with a strong, strong hip flexor. Because the iliopsoas, one of your hip flexors, is attached to this side of your spine. So you start yanking on that hip flexor, and every time you do, it's going to pull on your spine. So when you stretch, when you lengthen the hip flexors, you have to make sure your stomach is really on to support the spine so you don't yank on it and cause pain. Pain is your biggest clue. Pain will be the thing that says, hey, you've gone too far. Or you're not engaging, or you reach too far or any of those movements, pain is going to be your biggest, biggest clue. This red flag, this alarm bell that says, okay, this is going to guide how you do your exercises. And that hip flexor opening is going to be critical for you to be able to maintain the strengthening that's developed from some of those side planks, from some of those curl movements is lengthening through that hip flexor. Now you, you may go to stretch and you're like, this sucker won't move. Or you may go to stretch and you may go, okay, I have immediate back pain. As soon as I'm trying to stretch my hip flexor because it's pulling one of them, the iliopsoas will pull on your lower back. So in that case, try to create pliability and length with rolling. This is where you would take a softball, a tennis ball, even a foam roller. And you would try and roll on the areas that are on the front of your hip. So you're going to roll rectus femoris, that's going to be right here. So one of your quadriceps comes across your hip and you would roll all the way along here. The next area you would want to roll is that iliopsoas spot that I was talking about. And if you landmark your belly button, so belly button here, and you landmark the top of your pelvis, which is your asis, there's going to be a spot right in the middle of those two points. So that's going to be right here and that landmark, belly button and asis, and then right in the middle of the two. That spot, if you roll a tennis ball or a lacrosse ball, would be probably pretty painful for most people. But that spot is underneath your abdominal wall and that's where your iliopsoas is. If you can roll that spot on your stomach with a softball, with a tennis ball and tolerate it and notice the difference between sides, that can help create pliability in that area on your own without external help. If you can get external help, a really good massage therapist can get into that spot and help release the that iliopsoas. A really good chiropractor who does art or acupuncture, they will be able to release that spot as well. But it's not going to be a one time go. It's going to be the kind of thing that area has a tendency to be tight because of sitting, because of postural position. So the arched back. So that spot is going to Continue to be tight. What you want to do is daily roll that area daily, make sure that that's happening, especially pre and post, the times that you know it's exacerbated. So if you know you are on a shift that you are standing a long period of time, you know you're sitting a long period of time. If you've been sitting longer than 45 minutes, then that's the time to open up those hip flexors. Because as soon as you're in that seated position, your back is susceptible and the hip flexors become tighter from being in the seated position. So as soon as you've been sitting for more than 45 minutes, go into a staggered stance, tuck the pelvis, open the hips, reach away and really open it up all the way through where you're in that position and you're opening away with the glute on, with the stomach on. And those two things will allow you to get to the hip flexor without having the stomach arch and the glute not be on. And then you won't get to the hip flexor. You'll be right into the lower back where the problem already is. And that's where it's a hard area to get. Because when people go to stretch the hip flexor, they often end up in the back where the pain already is. So you don't want. How it's done is so vital. That is why when you do it, it's going to be this little tuck of the pelvis, little tuck here, your split stance, tuck on, on, and then sink. And then you can see if you can get away from that hip flexor. Those little things will make a big, big difference in being able to open up that hip flexor. I would roll. I would roll twice a day. I would stretch as often as needed throughout the day and. And I would be doing those exercises for sure morning and night. And one of the reasons the morning and night are so key is that when you wake up in the morning and you've been sleeping, a lot of people, if they've mastered their bed comfort so they've got enough softness but firmness in their bed, and they sleep with their pillow between their knees, and they come wake up in the morning and their back isn't screaming at them, then that is, their back has had some rest from what, what aggravates it during the day, then first thing in the morning is the time to activate. So after you have slept, that is the time to activate the transverse abdominis, this lower transverse supportive postural muscle that's underneath the abdominal wall. So that's the time to activate there. And then the other time you want to be activating those glute meds, you want to be activating the co contracting the entire abdominal wall with the lower back. So when you can co contract and activate first thing in the morning, you have a better chance neurologically to have those muscles continue to engage later in the day. If you just get up out of bed and just kind of like a blob in bed all night and then start your day, you go immediately right into the postures that are probably causing the problem. So if you get out of bed and for not even 10 minutes, I'm talking like two to eight minutes, you do some of those exercises that activation from your brain to your body tells those areas to still fire to support. And that can help you hold your posture longer throughout the day through some of the troubling times. Then you might have to reengage it. If you've been sitting long period, standing long period, holding heavy things, you may have to reengage those postures and then again later in the day. Because what happens, the back pain comes back inevitably when you have been. When you are fatigued, when you have been trying to hold positions or you've been out of the optimal positions for longer periods of time. And then as you're fatigued, you can't even engage the stomach, you can't even hold the postural position because you're tired. That's where you would go to either do whatever your back can tolerate with the exercises sometime throughout the day or later in the day, and sometimes later in the day. And this has been. I'm going to give Paul as the example right now, later in the day, at this point for him, because he aggravated his back doing overhead drywall work. And if he's sitting all day or he's standing for long periods of time, by the end of the day, the best thing that works so well for him is just lengthening his back in a supported position, which might be a yoga child's pose. You know, he might just be crouched and holding that supported position to lengthen the area that's super immobile, which is his lower back. He's really what we would call hyperlordotic. And he would be very susceptible to a spondylolisthesis if his, you know, if he, if he pushed it a little more, he may have even had that at some point. Okay, so I'm going to give. There's a couple more minutes left, so Pop a question out there if you have another one on this specific topic. I know I've gone a really long time on this specific topic, and if there's not another question on this specifically, then I've got another couple questions that people have thrown at me that are related to this in terms of injury and because it's hip flexor injury and hip flexor injury will. Will impact this scenario. Okay, so another question that came in has to do with nagging hip flexor or abdominal injury. If you have had a little pull, it can be rib cage, it can be somewhere closer into the abdominal wall. It could be hip flexor, just a little pull. Those types of muscle strains end up lasting way longer than anybody expects. It feels really small at the time, and it can nag on for two to three months. And then people wonder why, and they wonder what's wrong. But part of it is because we're constantly breathing, we're constantly moving around, and it doesn't get the rest it often needs. And they take longer. The hip flexors and the abdominal wall or any intercostal muscles, those typically take a little longer. Anytime you sneeze, anytime you cough, anytime you laugh, those little tweaks take so long to really overcome that little injury. Those are the types of things that, if we're relating this back to the lower back scenario, those little tweaks are the types of things that are usually either a prerequisite for a lower back issue, or they end up becoming a prerequisite for a lower back issue if we don't fully recover and be able to get back to the true mobility. And the reason this happens is because if it becomes a prerequisite, it's because we've changed our movement pattern and we're favoring that side. So we stop rotating the exact same way. We shorten our range of motion. And once we do that for long enough, then we go to swing the golf club, we go to play with a child, we go to swing the tennis racket, and we don't have the same mobility throughout the trunk that we did. And we tweak something, either the same spot again, or we tweak a little muscle strain in the back because it's overcompensating for where we're not moving properly. This is why anything that's this little tweak or little strain that comes, whether it's in the back, the hip flexor, the abdominal wall, the intercostals, it's really worthwhile. Gently, gently moving through those ranges of motion of rotation of side flexion of hyperextension. Because when we go to do it, we wonder why we get either retweaked or we injure something else because we've been favoring that one spot. So as humans, I'm going to leave this as a last final note on this topic of lower back. As humans, we are not meant to be only in this plane. We are not meant to be only upright perfectly. So once you are able with a low back injury or a hip flexor or abdominal injury, once you are able to start to get back into more movements that actually require greater ranges of motion of flexion extension, hyperextension. This is hyperextension side flexion rotation. Once you're able to get back to those movement patterns, you have to start gently integrating them back in. Because if you don't, you literally lose those movement patterns. And when you try to do something that's very human, like play frisbee, play frisbee, throw a football, run around, reach for something, and then you will tweak again if you haven't been slowly getting back those movement patterns that become compromised from a tweak in the back, a tweak in the ab, a tweak in the hip flexor. Okay, I'm going to leave it at that for today. I hope that serves you. If this didn't answer all the questions on this particular topic, please pop one more. Send us another question that is related so we can address it further. And and we will go into it. And remember, by all means, feel free to send the questions. I will. If I don't know the answer, I will gladly research it because this is the stuff that we love. We love to open this up and bring more information for you. Have a beautiful rest of your day and I will see you next time.

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