There comes a point in the recovery process of each patient with low back pain where we have to address the stabilizer muscles of the low back. Address is a gentle way of saying we have to work those muscles and make them stronger. Most of the time it was weakness or imbalance in these muscles that allowed the low back to get injured in the first place. Yes, we can remember something we did that we can blame our low back pain on, but that something was only the opportunity for the low back to “go out.” The problem was already there just waiting for the chance to jump out and bite you.
The low back has about a dozen joints in it and every one of those joints has about a dozen muscles attaching to each one. So we are talking about a whole lot of muscle coordination that has to go on for your low back to hold you up. They not only hold you up, but they also keep your center solid and acting as a counter-balance every time you move your arm, leg, or head. If one or two or a half dozen of those muscles forgets to do its job perfectly, your low back joints get pinched and damaged.
There are lots of “Core Muscle” exercise programs out there in the world, and most of them are bogus. They are bogus because trainers that are used to working with the movement muscles of the body design them. That, plus they have to make a program that looks good and makes you feel like you are really getting your money’s worth from them. Unfortunately, strengthening the real stabilizers of the spine is boring and looks like you are doing next to nothing. Plus, once you are done you don’t really have a way of knowing whether you have really achieved anything. Stabilizer muscles are silent and in the background. You don’t see them doing their work. But you really feel the consequences if they don’t do their job properly.
In earlier times our low back stabilizer muscles got all the workout they needed just during the course of a normal day. We walked, lifted, pushed, pulled, reached and moved in every direction all day long. For so many of us these days our primary activity is no activity at all. Productivity seems to be centered on sitting at a desk. Manual labor is a thing of the past. But it was the manual labor that strengthened our low backs. So now we have to manually work these muscles regularly.
There are some basic principals in exercising stabilizer muscles that have to be understood. Most importantly, these muscles are for holding you steady – that means no movement. If the area you are working is moving, you are not working the stabilizer muscles; you are working the movement muscles. So when we are working the low back stabilizer muscles, the low back should not be moving at all. A lot of research has been done on these muscles and the current consensus is that maximum rehabilitative gain is accomplished in the first 8 seconds of the contraction. Unlike movement muscles, there is no benefit to working these muscles to exhaustion. They are made of slow twitch muscle fibers that are designed to be able to work all day long. This is good because it means that working these muscles will not give the post workout soreness that most gym workouts produce.
We want to assume postures that stimulate contraction of the muscles we want to work and we want to hold that contraction for 8 seconds. Generally I have folks repeat the contraction 3 or 4 times. Now here is the tricky part – we can hold the exact same contraction in the low back but have arms or legs in different positions or even moving around and this will produce a different exercise for the low back.
The primary low back stabilizer muscle is the Multifidi muscle. It is a long tubular muscle right up next to both sides of the spine that extends from the sacrum right up to the base of the skull. In a healthy person it is about as big around as a garden hose. No, sorry, your abs are not primary spine stabilizers for your core. Well toned abs may look good, but they do not contribute much to the stability of your back. In fact sit ups and crunches are actually bad for your back. That movement actually stretches out the stabilizing ligaments of the spine leaving you more prone to back injury.
The same problem exists with most yoga routines. Traditional yoga routines focus on flexion and stretching out your spine. This is a bad idea even though it may feel good at the time. The back actually needs to be tight and strong, not flexible and limber. We are not cats with suspended spines. We are upright and constantly fighting gravity. As such a lose flexible spine means that when we stand and sit we will let our spine slump into a posture that relies on the ligaments to hold us up and not the strength of the muscles. This will stretch out the ligaments in time and destabilize the spine. There are Yin yoga postures that emphasize extension of the spine and holding postures that are much better for the spine. But again, the long two-minute holds are not necessary for spinal stabilization.
So what are some of these simple, boring exercises I am prattling on about? How about simply rolling over on to your stomach in the morning before you get out of bed and simply lifting up your head and shoulders an inch and holding that posture for 8 seconds. Try this three times. As you work up to getting fancy, you can play with moving your hands into different positions – at your side, out to the sides, above your head, or even behind your head. Initially you might need to let the weight of your arms rest on the bed, but eventually you want your arms to be off the bed.
Another good one is to use when you brush your teeth. In front of the sink, bend you knees slightly and stick your butt out and let your low back sag toward the floor while you brush your teeth over the sink. The move is all about holding steady in this position. As before, you only need to hold for 8 seconds at a time, but repeat the posture 3 or 4 times. A variation of this move can be done in the evening as you approach the bed. Bend your knees so your feet are still on the floor but your knees are supporting you on the edge of the bed. Let your butt center over your feet and drop your low back down and hold the partially kneeling position for 8 seconds. How do you know if you are doing these stabilizer exercises right? You will feel the contraction in the muscles right smack up against the spine and not the big muscles coming off the crest of your hip bones.
The last one I want to mention for this article is to simply stop half way down every time you sit down and hold that position for 6 to 8 seconds. Be sure that your head and chest are upright and your eyes are looking straight forward. Do this every time you go to sit down and you will build a stronger low back.
As you can see, these are not exciting. The are simply crucial. Years ago I used to train people to exercise the spine by lying over an exercise ball and lifting up into a superman position. I still enjoy this exercise. But I found over time that people just found reasons for their exercise ball to disappear. The cat clawing the ball was a favorite excuse for a while. Or they deflated the ball to get it out of the way for company coming over and just never got it re-inflated. Basically I think a big ball in the living room just didn’t fit most peoples sense of household style. I had two and they were always in the way.
What we have here is a little simple posture training activity that needs to become a normal part of your lifestyle. You always need to exercise your spine stabilizers – forever. They are your primary defense against spinal injury during daily activities. Even in nasty situations like auto accidents, the better shape your stabilizers are in at the time of the injury, the better shape you will be in during the recovery process. I have seen many folks that had de-conditioned weak spinal muscles and then got into accidents. They took forever to recover, and many never did recover completely.
I agree, it is annoying to have to deal with the reality that our bodies require some simple maintenance… but they do. You have to feed it the right foods and avoid the bad foods, give it enough sleep, and you have to give it the exercise it needs. That is just the way it is. Skip on these necessities and the body lets us know the only way it can – pain. Personally I am not fond of pain. And as much as I am not fond of maintenance, I do it. I am important to myself.
Take care,
David