Relieve That Nagging Lower Back Pain

The combination of poor posture and a sedentary lifestyle has greatly increased our generation’s experience of body aches. Spending long hours at our desk is commonplace in today’s working environment. Even with ergonomic office chairs, we are still potential victims of this modern-day epidemic if we don’t offset poor posture with corrective exercises.

Humans are designed to move and be physically active, but instead we train ourselves to sit for long periods of the day. According to the World Health Organisation, we should clock in at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise.

Sitting for long periods not only predisposes us to habitual laziness, it also changes our physiology and posture. Our hip flexors shorten and tighten up and we lose functionality in the muscles we sit on as they become weak and inhibited. By the time we reach 20, we typically have spent more than 30,000 hours sitting and have developed our own unique sitting posture that loads our spines in a very specific way.

When you sit on a chair, you’re at a position of roughly 90 degrees of knee flexion and 90 degrees of hip flexion. This makes the tendons of the quadriceps shortened at the hip and long at the knee, and the tendons of the hamstrings are lengthened at the hip and shortened at the knee.

Physiologically this tends to pull the pelvis forwards into anterior rotation when you stand, and the knees into a slight flexion that often leads to lower back and knee pain. This is a posture termed: Lower Crossed Syndrome by Dr Vladimir Janda, who is a Czech neurologist and physiatrist who has done extensive clinical research on the pathogenesis and treatment of chronic musculoskeletal pain.

And while it isn’t unusual for your lower back to feel a little sore from sitting down, you shouldn’t be experiencing prolonged pain that leaves you incapacitated. Failing to do something about it, can lead to health complications such as rigid mobility, lower back discopathy, and inflamed joints. When physical symptoms like back pain, shoulder stiffness, and poor sleep start to creep up on you out of nowhere, it’s your body signalling to you that it’s time to pay more attention to your physical health.

If you are experiencing such symptoms, you could try some of my recommended stretches listed in Chapter Three for temporary relief, and make the effort to get up from your chair at least every 45 minutes, or see a specialist to realign your spine, which is the main source of most chronic lower back pain.

For now, it’s important to know what’s causing the misalignment so that you can build better habits.

Poor Posture is Like a Slanted Building

As you’re reading this, have a look at your physical posture. Your musculoskeletal posture works much like a building: a slanted building is structurally unstable. And yet, we sit forward, round our shoulders, drop our heads forward for hours every day and it's putting great stress on the stabilising structures.

From a structural engineering perspective, we are holding our body weight against gravity. The straighter we sit, the more direct will the energy be distributed into the chair or the floor where we are standing on. If our posture is slanted, deviated forward, backwards or to the side, muscles on the opposite sides of the body have to tighten up and take that load or stress. This is based on Newton's third law of motion: whatever force you act on a body, there is an equal opposing force.

If your head is leaning forward, the muscles on the back of the neck have to work harder to hold it up. For example, if you hold a cup of water with your arms stretched all the way out, it will start to feel heavy really quickly. This happens as the length of the lever changes, which requires greater force or muscle strength to hold the object still. So if you do get neck pain or lower back pain, you really need to take that stress off your muscles by changing your posture.

Poor Posture Displaces Your Natural Alignment

The pelvis is a floating bone, which floats between the hips and the lumbar spine. When the pelvis is moving naturally, it takes the pressure off the spine. However, if you sit with your legs crossed, it can cause your pelvis to be fixated in one position.

For example, when you cross your right leg over your left leg, the pelvis rotates forward to the right on one side. Suddenly, your body’s alignment system has gone out of place. This places more load onto the muscles that are stabilising the pelvis, and transferring load from the hips and pelvis to the spine and back again. After sitting like this for an extended amount of time, your pelvis gets locked and is no longer neutral: it is rotated forward. And that is how people get lower back pain.

Once your pelvis alignment is skewed to one side, the position of your spine will be affected as well, which results in more stress on your lower back. This means that if you reach down to pick something up, you’ll end up pressing onto your disc space with over-tightened muscles and feel pain in your lower back.

Even when you’re standing, you should adopt a good posture. Leaning on one hip as you stand causes your body load to deviate from your natural plumb line. Once again, you're putting more stress on the muscles that stabilise your unbalanced position. So, if you stand in this position for long hours, your right knee is going to be sore, and the muscles that keep the pelvis neutral are going to tighten up.

A chiropractor can realign your spine, but it is poor posture and muscle tension that pull the spine out of alignment. Even after realigning your spine, the alignment can shift again if you continue to sit cross-legged. Also, sitting with your legs crossed adds even more dysfunction to the hips and pelvis, increasing pressure on the lumbar discs and causing lower back pain.

So, after you see a chiropractor, the goal is to do some exercises to stabilise the spine. You can do this by changing your posture from the way you walk to the way you sit, and to stop putting that pressure back on the same weak link (wherever you feel the pain) in the kinetic chain of your spine.

Chain Reaction from the Bottom to the Top

Usually, dysfunction starts from the foundation and works its way to the top. For example, the most common cause of lower body tension is due to the way people land on their feet. The way we walk and articulate the ankle joints and toes, have a direct relevance to knee pain, hip pain and lower back pain. So quite often, correcting the way people land on their feet has a huge impact on reducing stress in the joints higher up the leg such as their one knee and hip.

Most people stand with their legs and feet rotated outwards. They are disrupting their neutrality through the pelvis without even knowing it. When they walk, instead of the weight being neutrally balanced on the feet, their weight rolls to the outside of their feet.

Shuffling is another common mistake when walking. In fact, 90% of people coming into the clinic with lower back pain shuffle when they walk. Shufflers walk without articulating their ankles and they don't bounce. They're tightening up their leg muscles through the repetition of short-range motion until the hip flexors become so tight that they tug on the spine and compress the disc space.

Practice makes perfect and this applies to the way you walk as well. Find a long stretch of walkway where you can just open up your hips, articulate every joint, and release all the tension from the hips, pelvis, and legs.

The dynamic of getting better at what you practice isn’t unique to movement and posture, but in the study of biomechanics it is known as the SAID principle which stands for Specific Adaptation to Imposed Demand. It falls into the same category as Fitness but unlike improving skill and stamina, repetitive movement and stationary postures can change the way we move and impair the natural flow of energy through our body.

Nine out of ten people who come into the clinic with lower back pain tell us that the doctor diagnosed them with a slipped disc as the explanation for their back pain. However, a slipped disc is just an umbrella term for a multitude of lower back conditions. The doctor might have taken an X-ray that shows you have degeneration in the lumbar vertebrae but it’s more likely to be your over-tightened muscular system that is causing you pain.

The Slip Disc Misconception

In spinal specialist terms, there's no such thing as a slipped disc. Discs may be herniated or even prolapsed, which is when a disc has been crushed and the fluid inside the disc is seeping out. If you often carry a bag on one shoulder or even sit tilted with crossed legs and pressure on only one butt cheek, then it’s common to have a lateral disc bulge which can also cause pain in movements such as bending forward or rotating.

When people with lower back pain have an X-ray, it will often show some deterioration in the spine, especially in office workers over the age of 40. But we are more interested in understanding the root cause of the pain that they are feeling, how it got there and how to ensure it heals properly. More times than not, it's neuromuscular pain, which we've been treating for years just by releasing tension in the hip and restoring natural movement of the pelvis.

Orthopaedic surgeons don't usually perform manual tests on patients to determine how the pain was caused. They tend to lay you down, take a local X-ray and then look at the image. They can see the results, but don’t examine the full mechanics of the patient to determine the reason why the back is holding stress. This is the role of the physiotherapist or osteopath.

We've been successful at relieving lower back pain because we treat the whole patient rather than the injury and have seen patients with back pain from a wide variety of different causes. Some postural, some from poor movement mechanics, some from emotional stress and even some from organ stress in the pelvic region.

Changes in Medical Protocols for Lower Back Pain

In the UK now, unless there’s physical trauma like falling down the stairs, if you go to a hospital for lower back pain, they won't send you for an MRI scan or an X-ray. Instead, they will send you to see a manual therapist like a physio or an osteopath who will perform manual tests.

Surgeons specialise in acute issues like when you've had a car accident or a severe fall. They don’t specialise in chronic conditions. In fact, globally the medical industry is recognising the distinction between the two and are changing their approach towards acute and chronic issues.

Gone are the days where both acute and chronic issues are handled in the same manner. Nowadays medical treatment is much more holistic and all encompassing. For example, if you’re a type 2 diabetic, you’ll be recommended to see a nutritionist to alter your diet and a licensed exercise practitioner to give you a health regimen rather than just a regular supply of insulin. And that's how we've positioned ourselves. We specialise in manual therapies, which are used to remove blockages and restore optimal function of the nervous, muscular and digestive systems.

So if you've been in a car crash, and you've got back pain, don't come and see us, go to the hospital. But if you've been sitting at a desk and you've got lower back pain from reaching down to tie your shoes or sneezing, then come and see us.

Active Isolated Stretching

If you want to remedy your back pain, you’ll have to change the way you sit, sleep, and stand. Doing any one of them erroneously changes your physiology so much that it affects the way you’re able to do the other two. For example, your poor posture from sitting causes tightness in your hip flexors and as a result, you shuffle when you walk. Over time the tension becomes so ingrained that the only way to sleep is in the foetal position with your knees up towards your chest while you hug a pillow. This vicious cycle continues and worsens over time until you stretch out all that tight, hypertonic tissue.

To correct your physiology, we use Active Isolated Stretching (AIS) to “whitewash” all of the muscle memory so that you can start from a fresh slate. With AIS, we can open up your joints, increase blood flow and increase your range of motion. It also helps to reduce muscle pain and inflammation. Ultimately, AIS restores the natural rhythms of your neuromuscular system to create a balance of flexibility and strength across a joint. We’ve laid out the various AIS stretches in the next chapter.

First of all, let us explore the benefits of general movement. Movement is required to maintain the optimum health and function of the many systems that make up mammalian biology. Regular daily exercise improves the neuromuscular & musculoskeletal systems, the circulatory & cardiovascular systems, and the digestive system.

Repetitive, partial range movements will cause you to lose function in the range that you’re not utilising, affecting your mobility and flexibility. This means that if you suddenly try a full-range action like a squat, you might injure yourself. This applies to training at the gym as well. Most people at the gym perform a series of two-dimensional movements with an external load such as a bench press, which isn’t natural to the way we are designed to move.

When you see animals in nature, they don't do repetitive partial range movements, they are always using their complete range of motion with multiple planes and angles. Watch how a cheetah chases a gazelle – unrestricted, agile movements that only our top athletes can aspire to achieve.

This is why one of our mottos is Move Better! Train for better movement rather than train to improve a few limited movements.

In truth, we are born just as supple and mobile as other primates but our early stage conditioning starts to erode our natural athleticism, leading to restricted movements.

From a young age we are drawn away from playing and natural movement and trained to sit still for long periods of time. This is when our physiology starts to change and our myofascial system starts to tighten up, leading to poor flexibility and paving the way for pain and stiffness down the road. This unnatural state is always met by great resistance from children who on some level instinctively know the long-term perils of learning to sit still.

Diversify Your Movements

So first of all, work in isolation to unlock every joint and improve full range of motion by strengthening muscles in their specific roles. Ultimately, we want to be able to do full three-dimensional movements. If your movements are stiff, you might not be able to add load to a joint system that isn't strong and stable without having an injury.

We are advocates of a slower kind of gymnastic style movement, such as animal flow where there is a full range of movement in their exercises. Each set of movements is always different, always unique, and you're not repeating the same thing over and over because it's easy.

Even if you practise Yoga, which is a great way to open up the joints of the body, make sure you rotate your asanas and challenge the brain and nervous system into opening up new pathways. Don’t get into the habit of repeating the same 20 poses just because it's easy.

If You Don’t Use It, You’ll Lose It

When it comes to lower back pain, the muscles that need strengthening would be the hamstrings, glutes, and lower back as they get long and weak over time from sitting. When they are weak, they are unable to perform their roles as movers or stabilisers and when that happens, we open the door to compensation, overload and injury.

With that in mind, when you next head to the gym, don't think about how to build your ‘show’ muscles like the biceps or chest. Think about the muscles that perform functional stability. As you've probably been trained to sit for long periods of time, focus on strengthening the glutes and hamstrings.

The glutes provide hip extension, lateral rotation of the hip, and hip abduction, which also means that you need to do all three of those movements to train for proper function. The squat doesn’t do any of those three efficiently or to full range so you’ll need to add some extra exercises to your routine such as hip thrusters, clams or fire hydrants.

As for the hamstrings, you have five functions. Three of them are movement orientated: knee flexion, knee rotation, and hip extension. Two of the roles are as stabilisers: keeping your pelvis from rotating forwards and knee from hyper-extending. The deadlift only trains one stabilising movement and really poorly at that so, add some hamstring curls or the scorpion pose if you like Yoga.

Hamstring Strength Test

To test if your hamstrings are weak or quadriceps are tight, stand up and place your hands on a wall. Get a partner to assist you in pulling one of your ankles up towards your buttocks.

Are you able to do so? Now try it without any assistance. Are you still able to pull the ankle all the way to your buttocks? If you could stretch all the way with assistance, but are unable to do so actively or by yourself, then it means your hamstrings are weak in the role of knee flexion.

Build a Mobile Lower Back by Stretching

When we talk about stretching, we use the term a little differently from most trainers. With AIS, the goal isn't to passively stretch a muscle into a longer range of movement. Muscles work in pairs across a joint. When one muscle contracts and shortens, it pulls the antagonist muscle into a stretch. Our goal is to strengthen the muscle bond so that range of movement is improved before the antagonist feels a stretch and starts to resist the movement.

Imagine that you're lying on your back and I'm holding your ankle and pushing up towards your head until we get a hamstring stretch, and then you hold it. What's your hamstring doing? Well, it isn’t stretching. Instead, it is contracting and resisting me as an external force. The nervous system has told the muscle to contract and stop opening up (this is called the stretch reflex mechanism and is a protective function against overstretching and tearing the muscle).

To counter this, we're not going to go into a tug of war with your nervous system. We want your nervous system to trust us. So we will come back out of the stretch and repeat the process. The more repetitions you do, the further you’re able to stretch.

With this method, there's no pain and you don't tear the tissue because the mind is working with the nervous system. When you're trying to increase range of motion, always work with the nervous system, not against it; otherwise, you’ll create trauma.

The 5 Most Important Exercises for a Pain Free Back:

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Knee Flexion: strengthens the hamstrings and stretches the quadriceps

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Stand facing a wall and place your hands on a wall at chest level, slowly try to bring each foot as high as you can to your buttocks without any assistance. Hold it for 2 seconds then slowly lower and repeat using the same foot for 8-10 repetitions. Perform 2 sets on both legs.

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Hip Extension: strengthens the glutes while stretching the hip flexors

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Lie face down on a comfortable bench. Slowly raise one leg towards the ceiling as high as you can. Try to keep your legs and back straight throughout. Hold it for 2 seconds and then slowly lower back to the floor. Repeat 8-10 repetitions before moving on to the next foot. Perform 2 sets on both legs.

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Hip Extension with Abduction and External Rotation: strengthens the oblique fibres of the glutes and piriformis while stretching the pectineus

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Lie face down on a comfortable bench. Similar to hip extensions, slowly raise one leg towards the ceiling as high as you can and move it outwards before returning. Try to keep your legs and back straight throughout. Hold it for 2 seconds and slowly lower back to starting position. Repeat 8-10 times before moving on to the next foot. Perform 2 sets on both legs.

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External Hip Rotation: strengthens the deep external rotators of the hip

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Grab a pillow for your head and lie on a comfortable bench to your side with your top leg in front of the bottom leg (scissor-like position). With your bottom leg that is slightly behind you: keep the knee on the bench and lift the foot towards the ceiling. Hold at the top for 2 seconds before slowly lowering. Repeat 8-10 times with the same foot before turning onto your other side and working the other foot. Perform 2 sets on both legs.

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Hip Abduction: strengthens the gluteus medius

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Again, use a pillow for your head and side lie on a comfortable bench with your legs straight. Lift your top leg towards the ceiling, as high as you can. Hold it for 2 seconds and slowly lower to the starting position. Repeat 8-10 times before moving onto the other foot. Perform 2 sets on both legs.

1. Correct Your Posture

Your sitting and standing posture is the foundation of a healthy lower back. Maintain the natural curvature of your spine and ensure your pelvis is in a neutral position. While it’s of great benefit to keep moving gently in this position with small regular adjustments, be aware of your posture if you are required to be still. Remember the plumb line and try to keep as tall as possible. If you are sitting, then pull your chest up high and draw your shoulders back.

2. Get Up From Your Chair

Get up every half an hour and start moving or stretching. Sitting for extended hours puts the knees into a slight flexion that often leads to lower back and knee pain. If you sitting there for eight hours a day, it is also mentally draining and your physical posture will eventually resemble your mental thought process – slouching.

3. Activating the Muscles that are Switched Off

For a healthy lower back, focus on the hamstrings, glutes, and stretching out the short tight muscles that have come into a state of hypertonicity. If you're feeling a little bit of back pain, we will suggest that you first focus on gentle exercises to isolate and strengthen the glutes. Then, stretch those muscles that are short and tight.