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Treating Lower Back Pain

October 3, 2009
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If you’re like millions of other Americans and humans alive today, you’ve probably had lower-back pain at least once in your life. In this blog post I’ll cover some very basic concepts related to lower-back pain (LBP) and how it relates to getting out of pain and eventually getting better as an Ultimate player!

The latest (Fall 2009) issue of UPA’s USA Ultimate magazine has a great article by Dr. Nuwer (of http://injurytimeout.org/ fame) and June Srisethnil PT/DPT titled “Treating Lower Back Pain”, and as we can’t do justice to the entire field of LBP in a single blog post we’ll just review some of the basics covered in the article and give some other perspectives along the way.

MOMA statue, flickr photo from ketrin1407

MOMA statue, flickr photo from 'ketrin1407'

“Ultimate is a high impact sport that causes significant stress on the spine, particularly the lower back,”  Nuwer and Srisethnil write. “Back pain most commonly arises from overtraining, repeated layouts, and weakness of core muscles.”

[Note: “Treating Lower Back Pain” doesn’t yet seem to be available at Dr. Nuwer’s injurytimeout.org article page at the time of this writing, but let’s hope it becomes available soon!]

They then remind us to see health and/or fitness professionals qualified to perform movement screens / assessments, diagnoses, and/or evaluations, noting that any “numbness, tingling, or isolated weakness” should prompt you to see a medical professional. That said, many people suffer from LBP just from sitting all day with poor form (anterior neck carriage, extreme thoracic flexion and inappropriate pelvic tilt), in class or at work, developing tight hip flexors and inactive glutes (we call this gluteal amnesia in the biz, perhaps a reference to Thomas Hanna’s term “sensory-motor amnesia” (SMA).

Dr. Nuwer’s suggestions are five-fold.

  1. Improve abdominal core strength and endurance
  2. Maintain flexibility in the hamstrings, quadriceps, and hip flexors
  3. Practice balance, core control, and coordination
  4. Maintain proper technique for jumping, landing, and laying out
  5. Address the warning signs

Great! I won’t drill down to each of these in turn for this short post, but just mention that Dr. Nuwer suggests 3 sets of 60s planks, “dying bug” and “gym ball bridges”, “very slow crunches for 3 sets of 60s”, “Superman” and your garden variety hamstring / quads / and hip flexors stretch. For a different perspective, also see the articles: http://bit.ly/stopcrunching as well as http://bit.ly/nyt-abs — NYTimes article titled “Is Your Ab Workout Hurting Your Back?”

That said, let’s go on and walk through the article’s five bullet points.

Bullet point (1) Core Strength-Endurance: As we covered briefly in “Mobility and Stability, part II” you want lower-back mobility in an unloaded position and lower-back stability under compressive load (gravity, barbell squats, Kettlebell snatches, and so on). Planks are a great way to build the most basic stability, just remember to maintain a long spine, without sagging or arching too much either way. Having a friend hit you gently (?) with a disc or foot as you maintain plank position is a great way to bypass SMA–you’ll see Russian Kettlebell instructors do this all the time, hitting the glutes / rectus abdomnis (“abs”) / TFL (tensor fascia latae) / quads whether you’re in a horizontal plank or hitting vertical plank position at the top of your 24kg Kettlebell swing.

Bullet point (2) Flexibility & Mobility: Flexibility is great, but you may want to mix in some dynamic mobility work as well. See this NYTimes article on dynamics, particularly the video which has some great dynamic mobility drills. I personally like the “Spidey crawl” that opens up your hips and teaches you to control your legs under hip flexion and total body movement. To see the hip flexor stretch in motion, check out my friend Marty Covault, SF-based RKC and Kettlebell instructor, teach a hip flexor stretch on YouTube. Another approach is to focus on contralateral shoulder mobility as in Z-Health, doing coordinated mobility drills to hack your nervous system into letting your hip flexors (the ones you are stretching are connecting to the knee on the ground, PS) open up.

Bullet point (3) Balance and Coordination: You spend much if not most of your time on one foot, so if you aren’t doing much single-leg training you may want to think about mixing things up. A double-body weight bilateral barbell deadlift feels pretty damn good but then again so does dropping down from neutral stance into a rock-bottom single leg squat (heel on the ground comrades!), aka the Russian “pistol”. Whether you are cutting, accelerating or decelerating, much of the force exerting is passing through your anterior and posterior chains through your lumbopelvic complex and leg musculature. If you don’t train the ability to absorb and generate force on a single leg, whether through single-leg deadlifts (see Gray Cook on this one) or single-leg squats (Pistols), or bodyweight step-ups for more novice trainees.

(Just don’t forget the SAID principle when it comes to single-leg balance–your vestibular and nervous systems will thank you😉

Bullet point (4) Movement Quality, not Quantity: Proper technique and perfect form? Yes please. For female athletes in particular, check out the ACL prehab PEP protocol mentioned on injurytimeout.org. If you don’t practice jumping & landing, single-leg and double leg, in *all of* the sagittal (front-back), transverse or horizontal plane, and coronal (side-to-side) planes, think about adding this sort of “jump matrix” training to your prehab / dynamics.

No need to get crazy with the plyos just yet comrades, can you simply do little hops & skips forward-back / side-to-side / rotating with perfect form (a) on each leg individually, (b) on both legs simultaneously, (c) in cleats when jumping for a non-stationary disc, (d) in cleats jumping for a moving disc? No worries, just practice a little bit every day, and maybe your proprioception and movement skills will get that much better over time.

Bullet point (5) Address the warning signs. That’s what she said :)–

“Take care of your back as soon as you begin to have symptoms or discomfort. Take at least a week off from Ultimate, running, and lifting… Be mindful of your posture at work and take breaks every 30 minutes to walk around and stretch. Set a time or downloading a desktop stretching reminder.”

Word. I use AntiRSI on OS X and WorkRave elsewhere. If you have chronic lower-back pain and have already seen multiple health / fitness professionals, I highly suggest you buy a copy of Esther Gokhale’s 8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain (Remember When It Didn’t Hurt) as I have found this invaluable in my every day life and have personally trained at the Gokhale center here in Palo Alto. For the clinically minded, Dr. Stuart McGill’s Low Back Disorders is brilliant and I have friends who liked his athlete-targeted Ultimate Back Fitness book.

Awesome, thanks for reading, but remember that if your lower-back is hurting, it may or may not be your lower-back that’s at fault. As they say in the physical therapy world, “he who treats the site of pain is lost,” so don’t get too lost on your journey through and past pain! See y’all on the other side of the neuromatrix rabbit-hole theory of pain =)

Next time on UltiTraining.com, superstiffness, Bruce Lee, and applying core “pulsing” jitsus to fixing your backhand hucks. Ja!

9 Comments leave one →
  1. Vano permalink
    October 5, 2009 8:46 pm

    Is it worth my money subscribing to that UPA magazine?

  2. Leslie Wu permalink
    October 18, 2009 10:15 am

    I think it’s worth being a UPA member, which gives you free UPA magazine subscription =)

  3. October 18, 2009 8:34 pm

    Nice post Leslie.

  4. April 19, 2014 9:39 pm

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  5. September 8, 2014 7:04 pm

    The success of physical therapy can be noticed in the improvement
    of the patient’s daily activities. This bed is different from the rest because this can be transformed to over 1001 comfortable positions that can support your entire body.
    Lower back pain can be triggered by a number of factors and different
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