The Cure for Lower Back Pain
The Most Common Painful Region In The World
Lower back pain is one of the leading conditions among the United States population. This commonly leads to people becoming more inactive, or leading people to believe they need to completely stop exercising altogether in order to let it heal. Instead of using lower back pain as an excuse to do absolutely nothing, the better alternative is to proactively work around the pain, or to exercise in an intelligent way to alleviate the symptoms.
There could be an infinite number of reasons why the lower back is causing pain, but one of the biggest common factors is that people are not moving as often as they should, and/or moving incorrectly. Inactivity is at an all-time high in western society. Technology has us constantly seated, as well as forcing us into poor postural positions. Compound that over time, along with hours of desk work, scrolling through social media feeds over and over, not consistently exercising, and bam! Your lower back is chronically aching. Instead of trying to approach it from a training perspective, the common practice is to go see a physician who prescribes some medication to get rid of, or at least minimalize, the pain. Although the pain may be acutely relieved, there needs to be a long-term solution to reduce the level of pain, or to remove it all together.
The first areas that needs to be addressed to help determine the cause of lower back pain is orthopedic history and lifestyle habits (hours at work seated, activity level, type of work, etc.). Most people are left in the dark in regards to what caused the pain in the first place. Identifying the negative behaviors and taking immediate action to offset them can have a substantial effect on their symptoms.
Walk To Cure Lower Back Pain
High levels of sedentary living leads to muscle atrophy, poor posture, and decreased spine stability which precedes chronic lower back pain. One of the best approaches we can have to help relieve lower back pain is to just simply walk! As basic as this sounds, it is one of the most ideal activities we can do. More often than not, regressing back to the very basics of human movement will set us up for the most success in what we are trying to accomplish. There is no need to get super fancy with everything we do. Getting the body to functionally move the way it was designed to is so important to daily living, pain alleviation, and performance.
Walking ensures proper spine stability because the entire pillar complex, including the rectus abdominis, abdominal wall, quadratus lumborum, latissimus dorsi, gluteal group, and back extensors, are engaging at low to moderate levels to support the body and actively walk (2).
Common areas of dysfunction due to excessive inactivity are the gluteal group and the quadratus lumborum. These areas get tight and shortened from lack of activity and poor postural positions. Confronting the gluteal group and the QL with changing postural patterns and increasing reciprocal movement by walking is a must for curing lower back pain (2). By doing this, muscular tonicity will be reduced and the muscles will be strengthened, allowing them to work the way that they were designed to, thus resulting in a decreased pain response.
The body is intended to work and function in a reciprocal fashion. Meaning, the body works all together to perform every movement. So if there is a weak link, such as muscular or joint dysfunction, it will negatively impact the rest of the body. Therefore, if we can incorporate the most essential component of basic human movement (which is walking), more often into daily living, we can reap the benefits of a healthy lower back and increased functional capacity.
Daily Walking Progressions
As easy as walking seems to be, one of the most overlooked aspects is proper walking form. Maintaining good form is crucial for you to be able to yield the benefits and to protect the back and reduce risk of injury.
Proper Walking Technique:
- Keep the head up and centered between the shoulders with your eyes focused straight ahead. Your shoulders are straight and inline over your hips. Avoid slouching forward.
- Actively engage the core musculature to support the spine and pillar complex.
- Begin walking with a comfortable stride length. Contact the ground with the heels first, rolling smoothing towards the front of the foot, pushing off with the toes.
- The arms should stay close to the body swinging front to back with the stride of the opposite leg.
Walking is low risk and easy to start. The American College of Sports Medicine recommends light to moderate intensity walking for 30 minutes, 5 days a week, for a total weekly volume of 150 minutes (1). This starting point is effective for building a cardiovascular foundation, as well as working the major muscle groups responsible for maintaining a strong lower back. If you are completely inactive now, begin with short distances and short time periods of about 10-15 minutes at a time. Remember, start slowly and gradually increase the intensity by increasing your time or distance in order to avoid overuse injuries and high fatigue.
Once you have met the prerequisite stated above, you can further add progressive overload to your walking program by incorporating 20 minutes or more of vigorous activity, 3 days a week, to add a greater challenge to your cardiovascular system and core musculature. This can include walking at a faster pace, walking hills or an inclined treadmill, power walking, and the like.
Walking is the cure to relieving lower back pain. But, just walking every day isn’t enough to instill longevity. Once you have earned the right to walk, it then needs to be loaded like any other foundational movement pattern to further strengthen and protect the lower back.
The Loaded Carry
Coined as “the most functional exercise” by Gray Cook and Dr. Stuart McGill, the loaded carry is one of the best movements to help eliminate pain, improve strength, and boost performance.
Loaded carries are the superior method of core training, and they make you better at everything else too. In the course of a loaded carry, every muscle is engaged within the entire kinetic chain resulting in total body strength training and high effort dynamic stability. Since this movement has such tremendous benefit paired with a low risk of injury, every person should be performing it.
Focusing directly on the lower back, loaded carries are a game changer for rebuilding strength and stability. The core, hips, and spinal musculature play an enormous role in day to day functionality and movement. Therefore, placing certain loads on these structures are necessary, and in fact are part of maintaining a healthy back (3). Keeping these structures strong and stable will minimize dysfunction and lower back pain.
Evidence shows that back pain is almost always intensified by a particular incorrect motion or faulty posture. A plan that is designed to eliminate those pain triggers and encourage better function will leave you with the most success (3). Practicing the perfect execution of loaded carries teaches proper bracing during locomotion, which is vital to correct spinal alignment, joint centration, and the activation of the core musculature. Once again, strengthening and improving the coordination between the abdominals and back muscles will improve overall core stability, which is needed to minimize lower back pain.
To achieve the best results from loaded carries, we need to set the body up for ideal joint centration. This will allow for optimal muscle function and injury prevention throughout the entire movement.
How To Perform Loaded Carries:
- Pick up the weight.
- Brace the pillar to properly keep the shoulders stacked over the hips. This will prevent any unwanted flexion, while also keeping proper spinal alignment.
- Squeeze the weight for more stabilization.
- Begin walking by taking small steps. By moving with a smaller stride, you will keep the body in alignment as well as minimize compensatory patterns throughout the exercise.
- Complete the programmed distance or time for the workout.
Do not try and complete your carries as fast as possible. Emphasize a slow, focused pace, concentrating on full pillar engagement. By doing so it will cause the key stabilizers including the transverse abdominis, rectus abdominis, oblique’s, QL, lats, and erector spinae to present maximal effort building a strong and resilient core.
Loaded Carry Variations
While there are countless ways to perform and program loaded carries, listed below are some of the most common variations to incorporate into your training to strengthen your lower back.
Double Dumbbell Carry
- Coaching Notes: This carry variation tests your dynamic stability and stabilization under even compressional forces on the body. This is also a tough challenge for grip strength since we have to further stabilize the dumbbells from tipping back and forth. Place your hands in the middle of the dumbbells, and pick up the weight. Your shoulders and hips should be stacked directly over each other to allow for optimal joint alignment. Begin walking with a normal stride keeping the dumbbells close to your sides. Keeping the pillar complex fully engaged, walk smoothly from heel to toe with even weight distributed between both feet.
Single Dumbbell Carry
- Coaching Notes: Since we are carrying weight on only one side of the body, it presents a much larger challenge in anti-lateral flexion. This places a larger emphasis on the oblique’s, quadratus lumborum, and abductors while walking. Set up will be similar to the double dumbbell carry variation, grabbing the dumbbell in the middle, and getting into a good starting postural position with the joints stacked over top of each other. During this movement make sure to keep a tall posture and resist lateral flexion on both sides of the body. Make sure to not disengage the “non-working” side of the body. We still want to act as if we are carrying weight in both hands, actively engaging all of the necessary musculature to correctly perform this exercise.
Trap Bar Carry
- Coaching Notes: These are very similar to the double dumbbell carries in how they act upon the body. However, the advantage here is that greater load can be applied to this movement since it can be loaded with weight plates. Place your hands in the middle of the handles on the trap bar, and pick up the weight. Your shoulders and hips should be stacked directly over each other to allow for optimal joint alignment. Begin walking with a normal stride keeping the trap bar steady at your sides. Squeeze the bar hard to keep it from tipping front or back. Keeping the pillar complex fully engaged, walk smoothly, from heel to toe, with weight distributed evenly between both feet. This variation is for stronger clients and athletes who need to further challenge their strength capacity.
Progressive Overload With Loaded Carries
Once the prerequisite of walking is mastered, there is a hierarchy of progressive overload that should be followed:
Phase 1: During the beginning stages of strength training, or rehabilitation process of acute or chronic lower back pain, the recommendations are as follows:
- Using loads varying from 20-50% of your bodyweight, carry for 2-3 sets of up to 30 seconds.
- The goal of phase 1 is to carry 50% of your bodyweight for a total of 30 seconds.
Phase 2: When the goal of the first phase is met, you can now progress to working your way up to carrying 100% of your bodyweight.
- Starting from 50% of your bodyweight, gradually add 15-20% bi-weekly until you can successfully carry 100% of your bodyweight in one 30 second attempt.
Phase 3: For maximal athletic performance, the goal of the final stage is to carry 2 times your bodyweight for 30 seconds.
- Using the same progression protocol listed in phase 2, start with 100% of your bodyweight, and gradually add 15-20% bi-weekly until you can successfully carry 200% of your bodyweight in one 30 second attempt.
Note: These metrics are based off of the “farmer carry” variation.
Taking care of your back is a lifelong process. For people that experience chronic back pain, simply implementing a walking routine will enhance one’s capability to do normal everyday activities. However, intelligent strength training with loaded carries should also be encouraged to reduce pain, promote longevity, and enrich quality of life.
About The Author
Tim Danchak, BS, ACSM-CPT, FTS
Tim is a strength coach, wellness instructor, and functional training specialist in North Carolina. His primary focus is working with general and special populations to regain proper movement mechanics and improving total body strength. Tim’s passion is focused on enhancing overall quality of life and pain free performance for his clients.
- American College of Sports Medicine. (2011). Starting a Walking Program. In American College of Sports Medicine. Retrieved from https://www.acsm.org/docs/brochures/starting-a-walking-program.pdf
- McGill, Ph.D., S. (n.d.). Designing Back Exercise: from Rehabilitation to Enhancing In backfitpro. Retrieved from https://www.backfitpro.com/documents/RehabtoEnhancing.pdf
- McGill, Ph.D., S. (2016). Stuart McGill, Ph.D.: Taking Charge Of Back Pain – Empowering Self Advocacy. In otpbooks. Retrieved from https:/www.otpbooks.com/stuart-mcgill-back-pain-self-advocacy/
Treatment of low back pain requires a skilled clinician. Physical therapists who understand how to classify low back pain and follow an evidence based approach to treatment will provide the most bang for the health care buck. 4 essential components needed: 1). Accurate assessment and classification of the problem 2) Reduction of the troublesome symptoms 3) Gradual reintroduction of functional components of life 4) Prophylactic back plan as back pain is extremely episodic. You can strengthen all day long with stabilization, weighted carries, Medex machines -strength may go up ( not likely as pain inhibits muscle function and must be addressed first) but what the client wants is pain relief. Do what’s best for your client and refer them to a COMT, cert MDT or a PT that has a proven track record of excellent outcomes with spine and uses a classification system of symptom presentation.