Why Do We Have Back Pain?
The idea of doing exercises for back pain may send a shiver down your spine if you’re currently hurting. Maybe it’s not just that you hurt, but you also have come to believe that your pain can’t be alleviated.
If you have or have ever had back pain, you may have been told by a health care provider something to the effect of, “Well, you’re getting older…” as a way to justify the fact that your back is currently hurting.
The truth is back pain is not a normal part of aging!
Sure, there are conditions that are more common in older adults, but many of these conditions are the results of our life’s work.
Think about the truck driver who spent his career sitting with less-than-ideal posture for hours at a time, or the mechanic who was bent over fixing engines, or the mothers and fathers who were bending over to pick up their kids repeatedly.
Over the years, our bodies adapt to the stressors we place on them, so that we can continue to function. Of course, we are grateful that our bodies do this, however, sometimes the ways in which our bodies adapt in the present can lead to pain in the future.
How Can Our Past Actions Cause Us Pain Now?
Let’s think about the mechanic who was bent over fixing engines for years. Over time, it’s likely the muscles in the front of their body (abdominals) shortened as they were hunched over. Meanwhile, the muscles of their back were lengthening to allow for them to lean without straining.
Over time, maintaining this position, without using exercises to stretch and strengthen the abdominal and back muscles, will create a posture that becomes the mechanic’s new norm. They no longer stand straight and tall but are more rounded forward.
Our bodies are intended to have a certain alignment. While each person’s alignment is slightly different, the spine works the best when the vertebrae are properly stacked and the muscles surrounding them are strong.
Weakness, which can lead to postural changes, can also force the bones and joints to take on more load than necessary, which can contribute to things like arthritis (which is called “spondylosis” in the spine).1
What Causes Back Pain?
Let me start out with a brief tangent about pain. In a future article, I will discuss pain more in depth, but for now let me say that pain is a very complex thing.
While most of us think of pain as “bad,” pain is designed to protect us. There are people who literally don’t feel pain, but you probably don’t know many. Why is that? Sadly, they don’t live long, because the warning sign that is pain doesn’t alert them to things like scalding water or the cut foot that gets infected.
Additionally, most of us would describe the location of our pain as “in my back,” or “on the bottom of my foot.” The truth is, pain doesn’t come from our tissues, it comes from our brains.
While pain has many definitions, I like this one: “pain is a multiple system output, activated by the brain, based on perceived threat.”2
Basically, what that means is that the brain is interpreting whatever is happening in the body and informing you that you’re in pain. This can happen whether the tissues in your body are actually damaged or not.
So is pain just a figment of the imagination?
Absolutely not!
Pain is real! All pain is real- whether there’s tissue damage or not.
My point here is that the pain may be present without tissue damage, because pain is a brain output, not a body output. The reverse is also true.
Have you ever woken up in the morning and noticed a new bruise on your hand? Does it hurt? No. Is your tissue damaged? Clearly your blood vessels have been damaged in some way, yet you’re not in pain. Why is that?
Your brain didn’t perceive that damage as a “threat.” Maybe you were busy gardening, or playing with your grandkids, or you were lifting weights at the gym, and your brain didn’t register that bruise-causing event as a threat to you, so it wasn’t interpreted as pain, and therefore you didn’t feel the pain and might not feel it now.
In the next section I will discuss common diagnoses that are usually associated with pain. However, just having one of these diagnoses does not mean you must have pain!
Remember! Living in pain is not a natural part of aging!
What Are Some Common Diagnoses Associated with Back Pain?
While pain is not a normal part of aging, there are changes that occur within our musculoskeletal systems that can lead to an increased risk of certain conditions, which can be painful.
These include:
1. Spinal Stenosis- Narrowing of the spinal canal (where the spinal cord lives). Over time, compression can occur, which can impact the nerve roots and/or spinal cord.
2. Spondylosis- Arthritis of the vertebrae.
3. Spondylolisthesis- Slippage of the vertebrae over each other. Most commonly, the L5 vertebrae slips forward on the S1 vertebrae.
4. Scoliosis- Improper lateral curvature of the spine. Although many people think this is a condition that only children (particularly female children) have, some scoliosis is actually a result of muscle imbalance and can be reversed with proper strengthening. So, you can develop scoliosis over time.
5. Osteoporosis- Loss of bone mass and quality. The spine is a very common site for fracture for those who have osteoporosis.1
If I have one of those conditions, will I always have back pain?
The short answer: No.
Once again, you don’t have to live in pain- even if you have damage to your bones!
One of the most effective ways to do that is to correct the muscle imbalances that likely have resulted over time.
Proper strengthening and stretching will enable your muscles to lessen the stress on the joints, help improve your posture, and improve your bone density. All of these things will help decrease pain!
Doing crunches to “Work on my core” is good, right?
Short answer: Please stop with the crunches (unless of course you’re just trying to look cool in the park like this guy- just kidding!)
If you look at the list of conditions that often cause back pain again, you will see that spondylolisthesis is when the vertebrae slip off of each other. Typically, this “slip” happens in the forward (AKA “anterior”) direction.1
When we do traditional crunches, we are putting our spine in what is called “flexion” or a “flexed position.” Flexion is movement in the anterior direction also, so that will not help the vertebrae that has already moved forward. In fact, it could make it worse.
Even if you don’t have that condition, flexion exercises are not preferred. It can lead to osteoporotic vertebral fractures.
Also, think about our posture. Most of us are already too “hunched” over. In order to combat that, we need to strengthen the muscles that allow us to be more upright, which are our “extensor” muscles.
Working “the core” actually involves working the muscles on the front and back of the body, essentially from shoulders to knees. So crunches not only could be causing more issues in our bodies, but are not targeting enough muscles.
When should I do exercises for back pain?
Now! There’s a real misconception that you need to be out of pain to exercise.
You’ll often hear physical therapists use phrases like “Motion is lotion,” or “Movement is medicine.” We don’t say these things just because they’re cute. We say them because they’re true!
The body truly has a design. Our bodies are intended to be aligned, so that the muscles can move the bones with the greatest amount of efficiency. Although this is how our bodies were intended to exist, as we know, they can get “out of whack,” at times.
When we sit around for an excessive amount of time when we’re hurting, we perpetuate the weakness and misalignment that caused our bodies to be in that position to begin with.
Exercise is the key to not only decreasing pain but maintain a more pain-free life!
6 Exercises to Help Decrease Back Pain
Click Here for a video of Dr. Katie doing these exercises
If you’ve seen my other articles, you’ll notice that I often prescribe 3 sets of 10-15 repetitions. With these exercises, I recommend starting with 3-4 repetitions, as I really want you to focus on achieving proper form. If we don’t consistently work our abdominal muscles, it’s likely that they will fatigue pretty quickly, which will lead to poor form in the subsequent exercises.
Start with a low number of repetitions, improving your form. Once your form remains intact for all six exercises, increase your repetitions gradually.
Also, because we are trying to strengthen bones and muscles, if you can do these exercises on the floor (you can put a yoga mat or something with some cushion down) that is preferred, as it is requires more weightbearing from the body.
If you can’t get down to and up from the floor, it’s perfectly fine to use a bed or a couch.
1. Neutral Spine
It may sound kind of odd that we have to practice achieving “neutral” spine, but over time, as our bodies adapt to the demands placed on them, “neutral” becomes less natural.
Achieving neutral spine is important, because even though you’ve functioned for years without it, it’s truly the best place for your spine to be- properly aligned, so your muscles can contract effeciently to support you (see photo above for natural curves in the spine).
Everyone’s body is unique, so everyone’s neutral will be unique, but generally, we want to align our spine so there’s a natural forward curve in our low back (lumbar spine).
Usually, our spinal extensors will need to turn on to find neutral, and once we find that alignment, we use our abdominal muscles to maintain it.
1. Lay on your back with knees bent so feet are flat on the floor/bed.
2. Press your low back down into the floor/bed.
3. Arch your low back away from the floor/bed.
4. Relax. Place your hands under your low back- there should be a little space between your back and the floor/bed.
5. Pull your belly button in towards your spine to engage your abdominals and maintain that position.
6. Breathe 3 times.
7. Relax.
8. Repeat steps 2-3 for 3 repetitions.
2. Bridges
Working the core includes the back side of the body as well. This exercise increases our strength in our glutes and hamstrings, which help stablize our pelvis and spine.
1. Lay on your back with knees bent so feet are flat on the floor/bed.
2. Find neutral spine alignment and engage abdominals.
3. Press into your heels to lift your buttocks off of the floor/bed.
4. Take two breaths at the top, keeping abs engaged (don’t allow hips to drop).
5. Slowly lower your buttocks straight back down to the floor/bed.
6. Repeat steps 2-5 for 3-5 repetitions.
7. Rest for 1-3 minutes.
8. Perform 3 sets total.
3. Toe Taps
This seemingly simple exercise takes a lot of abdominal engagement/strength, as we are now having to maintain neutral spine with our feet off of the floor.
Transverse abdominis, obliques, and rectus abdominis are all being worked in this exercise, which all help to support our back.
It’s very important to keep your hips stable during this exercise. If you are currently unable to do that, please perform the modified version below.
**Note: Even with the modified version, you’re still workiing the same muscles and will get huge benefits! Then you can safely progress to the non-modified version in time!**
1. Lay on your back with knees bent so feet are flat on the floor/bed.
2. Find neutral spine alignment and engage abdominals.
3. Keeping neutral spine, lift one leg up, then the other (so your legs are in a table top position).
4. Lower one leg down, tapping your toe to the floor/bed.
5. Bring that leg back up to the starting position.
6. Lower the other leg down, tapping your toe to the floor/bed.
7. Bring that leg back up to the starting position.
8. Perform 2-3 repetitions on each leg.
9. Rest for 1-3 minutes.
10. Perform 3 sets total.
Modified Toe Taps
1. Lay on your back in front of a couch/bed/table (any surface you can put your legs up on, so your hips are about at 90 degrees).
2. Find neutral spine alignment and engage abdominals.
3. Keeping neutral spine, lift one leg on to your surface, then the other.
4. Slide one heel away from you, keeping your hips stable.
5. Slide that heel back to the starting position.
6. Slide the other heel away from you, keeping your hips stable.
7. Slide that heel back to the starting position.
8. Perform 2-3 repetitions on each leg.
9. Rest for 1-3 minutes.
10. Perform 3 sets total.
4. Dead Bugs
This is another wonderful exercise that has a great modification so you can perform it safely and effectively!
Once again, if you can’t maintain neutral spine with hips stable, please do the modified version to get the most benefit!
In this exercise, we are working obliques, rectus abdominis, and obliques again- yes! They’re that important for our back health!
1. Lay on your back with knees bent so feet are flat on the floor/bed.
2. Find neutral spine alignment and engage abdominals.
3. Keeping neutral spine, lift one leg up, then the other (so your legs are in a table top position).
4. Bring your arms up to just in front of your shoulders, so your fingers are pointing towards the ceiling (you should be able to see your fingertips at all times).
5. Keeping abdominals engaged and spine neutral, bring your right hand back (towards your head) while your left leg extends forward (as you bring your arm back, down bring it all the way down to the floor, keep your fingers in sight).
6. Return right hand and left leg to starting position.
7. Repeat with left hand and right leg.
8. Perform 2-3 repetitions on each leg.
9. Rest for 1-3 minutes.
10. Perform 3 sets total.
Modified Dead Bugs
1. Lay on your back with knees bent so feet are flat on the floor/bed.
2. Find neutral spine alignment and engage abdominals.
3. Keeping neutral spine, lift one leg up, then the other (so your legs are in a table top position).
4. Bring your arms up to just in front of your shoulders, so your fingers are pointing towards the ceiling (you should be able to see your fingertips at all times).
5. Keeping abdominals engaged and spine neutral, bring your right hand to your left knee (don’t twist your spine or hips) and provide a gentle press into the left knee.
6. Return right hand to starting position.
7. Repeat with left hand on the right knee.
8. Perform 2-3 repetitions on each leg.
9. Rest for 1-3 minutes.
10. Perform 3 sets total.
5. Heel Squeezes
I love this exercise! It provides such great muscle contraction of the glutes, hamstrings, rectus abdominis, and pelvic floor!
Our pelvic floor muscles also tend to be quite neglected, but they not only help support our back, but our bowel and bladder!
1. Lay on your stomach with legs apart.
2. Engage abdominals (pretend there’s an ice cube under your belly button and you don’t want to touch it).
3. Keeping abdominals engaged, bend your knees so your heels come together.
4. Squeeze your heels together (still breathe!) for a count of 3-5 seconds.
5. Relax and rest for 1-3 minutes.
6. Repeat 3-5 times.
6. High Hip Planks
Okay, so I know this word scares some people, but hear me out! This plank is a high hip plank, so it’s not only a little easier on the shoulders, but more effective for our back.
This is a great exercise for the transverse abdominis and rectus abdominis.
As always, feel free to do the modified version on the knees, but just make sure you have enough padding under your knees when doing so.
I challeng you to work your way up to a full plank!
1. Lay on your stomach with legs hip distance apart (or a little wider to make it easier).
2. Place your elbows directly under your shoulders.
3. Engage abdominals (pretend there’s an ice cube under your belly button and you don’t want to touch it).
4. Keeping abdominals engaged, lift your hips up towards the ceiling, using your abdominals to lift as you push into your elbows.
5. Hold for 3 seconds, breathing (eventually you want to be able to hold for 10-30 seconds, so practice this one!) .
5. Slowly lower yourself back down.
6. Rest for 1-3 minutes.
7. Repeat 2-3 times.
Modified High Hip Planks
1. Lay on your stomach with legs hip distance apart (or a little wider to make it easier).
2. Place your elbows directly under your shoulders.
3. Engage abdominals (pretend there’s an ice cube under your belly button and you don’t want to touch it).
4. Keeping abdominals engaged, lift your hips up towards the ceiling, using your abdominals, and pushing into your elbows, keeping your knees on the bed.
5. Hold for 5 seconds, breathing (eventually you want to be able to hold for 10-30 seconds, so practice this one!) .
5. Slowly lower yourself back down.
6. Rest for 1-3 minutes.
7. Repeat 2-3 times.
Have the Strength to Live Life to the Fullest!
Sources:
- Abdominal and Core for the Aging Spine. . (2010).[Video/DVD] Healthy Learning. https://video.alexanderstreet.com/watch/abdominal-and-core-for-the-aging-spine
- Louw, A. Teaching People About Pain | MedBridge. Retrieved 30 January 2021, from https://www.medbridgeeducation.com/courses/details/teaching-people-about-pain
- All pcitures from canva.com
