As with many Americans, your clients can experience debilitating back pain on a regular basis, which can drastically limit their ability to enjoy their favorite pastimes. It is important for health trainers and exercise professionals to know which exercises can help and which ones can be counterproductive. This article examines some of the most common causes of back pain and provides an overview of the exercises that research has found to be most beneficial for treating back pain.
If your client has acute back pain that is affecting their quality of life, it is important that they seek advice from a qualified doctor who can help determine the cause of the pain as well as a specific course of treatment. However, if your client is like many people who have occasional discomfort, however, they may be able to improve their back health with an exercise program that improves flexibility and strength in their hips while improving the ability of your deep core muscles to stabilize the spine.
Causes of back pain
From a small amount of muscle strain to a disc rupture affecting the surrounding nerves, there are many different injury mechanisms that can lead to back pain. Dr. Stuart McGill, Professor Emeritus at Waterloo University in Canada, spent his career studying the mechanics of the spine. He has identified several types of back pain, including injuries to the soft tissues such as ligaments, tendons, or muscles, damage to the bone structures of the vertebrae, or the fibrous discs that form the cushion between each vertebra. In his book Lower back disorders, Dr. McGill explains that it is virtually impossible to devise a specific training plan without first performing an assessment to identify the mechanism of the injury.
Various causes of back pain include muscle imbalances that limit joint movement, repetitive movements or prolonged postures, including hours of sitting in a seated position, that overuse the muscle, or a poorly designed exercise program with movements that actually aggravate the pain in return for relief. Also, some people just don̵
Exercises to Avoid
Before we identify the exercises that can help optimize back health, it is important to first look at some exercises that Dr. McGill’s research could actually make back pain worse. This list includes traditional sit-ups that activate the large psoas muscles that are responsible for flexing the hips. Leg raises that also use the psoas and compress the intervertebral discs; and the Lying Superman, in which the arms and legs are raised at the same time, creating excessive compressive forces on the lumbar spine.
Exercises to optimize back health
Here are two stretches and five muscle fitness exercises that you can incorporate into your clients’ programs to help develop a healthy back and potentially reduce back pain. These exercises focus on improving the movement of the hips by targeting the gluteus maximus. If you bend forward by rounding the spine, pressure forces can be exerted on the intervertebral discs, which can lead to injuries. However, the ability to maintain a relatively straight, neutral spine as it bends forward from the hips allows the strong glutes to be used for movement, which can greatly reduce the forces exerted on the spine. Not only can these exercises help improve your back muscle fitness, but they can also help your glutes work more efficiently. This is the key to avoiding future episodes of back pain.
Kneeling hip flexor stretch
The largest hip flexor muscle is the psoas, which is attached by the lumbar spine to the lesser trochanter of the femur to flex the hip and rotate it outward. In a sitting position, the hips are bent and the psoas brought into a shortened position. If the psoas sits too long, it can become stuck, which is why moving back to a standing position can cause back pain. If the psoas is too tight, it can reduce the gluteus maximus’ ability to effectively create a hip extension. This stretch helps lengthen the psoas, which can improve hip movement as well as gluteal function.
This classic yoga movement stretches the psoas from a standing position. The knee position used in the previous exercise emphasizes a “bottom-up” approach to stretching the psoas. Raising your arms above your head while maintaining a high, straight spine can help elongate and stretch the muscle from top to bottom. To increase the effectiveness of the stretch, instruct the client to press their back heel into the ground as they shift their weight forward.
Lying on your back (face up) is the safest position for the spine, as the floor supports it and there are no pressure forces caused by gravity. This is the starting point for activating the gluteus muscles, which are responsible for stretching the hips. An additional benefit is that the hips move up, creating an active stretch of the psoas. This means that the hip extensors are activated while the hip flexors are being stretched. Once your client is able to do two to three sets of 15 to 20 reps, you can add resistance and progress to the reps Hip thrust. Loading weight on the hips can be an effective way of strengthening the glutes while reducing excessive forces on the spine. Strong buttocks muscles are the basis for optimal back health. (Learn more about the many benefits of hip thrust in this article.)
Four-legged hip extension
This exercise recruits the deep muscles of the core that stabilize the spine while targeting the glutes. To increase the activation of the hip extensors, ask your client to press their left knee down into the floor as they lift their right hip in the air. This action creates a so-called “cross extensor” reflex, which can help to increase overall muscle activation. Another option is to place a mini-band around your thighs, just above your knees. This added resistance can help strengthen your glutes.
Standing hip joint
Once your client has established a foundation for muscle fitness through floor-based exercises, it is time to move into a standing position that allows multiple muscles to be recruited to increase overall strength. When teaching the hip joint, hold a light dowel rod along your client’s spine, as shown, to remind them to move away from their hips rather than rounding off their spine. The dowel rod should stay in contact with the head, thoracic spine and pelvis throughout the hinge movement. Once the client can do 15-20 reps, increase strength by adding external resistance and moving to a Romanian barbell deadlift. (Note: Kettlebells, dumbbells, or a medicine ball can also be used for cargo.)
The deadlift can also improve the fitness of the hip extensors and back muscles. During the lift, the back muscles are activated isometrically to stabilize the spine, while the glutes contract to straighten the hips. This movement can also be done with a kettlebell, which allows the weight to be placed directly under the center of gravity.
This is the ultimate back exercise, but should be saved until your client has no back problems. Holding the hip joint while performing the row requires tremendous strength from the deep core muscles. To increase activation, ask the client to put their feet into the ground and squeeze the bar firmly while pulling on the elbows to activate the large latissimus dorsi muscle. Start with a light weight for optimal shape. As the client’s strength improves, gradually increase the resistance.