Back Pain – Everyone has back issues. Unfortunately, it’s life and it’s the norm. Our back is under constant tension, uneven loading, and stuck in weird positions, all of the time. This can cause chronic and/or acute conditions in the back or neck. Some of these issues can be structural or soft tissue based. Stuff that tends to come on out of the blue (acute) is normally a soft tissue problem that will go away with rest, rehab and a short time duration. Things that we take with us from major injuries or accidents and are persistent (chronic) will usually be structural and take a lot more to fix and get through so you can function in some semblance of normalcy. Structural screw ups can be rehabbed, but may always linger in the background waiting for a perfect time to strike again. In looking at back issues, here are a few of the more common things that come up with people.
Degenerative disc disease is a common chronic issue. Over time, our discs compress and become dried out. This is referred to as “degenerative disc disease” and everyone gets it due to gravity and time. Unless you’re a fruit bat, hanging upside down for 12 hours a day, you have it. So quit running around acting like it’s something you inherited or you are the only person doomed to such a fate. The now smaller discs can cause discomfort when nerves now get compressed around it and/or the facet joints of the spine make contact with one another. This is most common in the lower back (lumbar spine). Another structural issue that crops up is the bulging disc or even a herniation. Occasionally we get bulging discs from either a bad movement under load and extreme action, or the effects of time. For many people, a constantly over extended back position can put just enough constant pressure on the discs to cause them to bulge a certain way just slightly. This can be from work, anatomical issues, etc. Sometimes you can wander around for an eternity without feeling anything while other people are unlucky enough to have that disc bulge out just enough to hit a nerve running past it and causing pain. People may be undiagnosed and have them just due to life in general, but being smart in your training will help you avoid and/or repair discs. A few things that help: 1- Get a proper MRI based diagnosis if you think there’s a structural issue (not your massage therapist or drinking buddy’s opinion, and certainly don’t use WebMD or the internet or you will be convinced you will die of a host of things you had no idea plagued you). 2-Strengthening the musculature around the spine to handle and distribute the loading. 3-Proper form, ROM and movement. 4-Using appropriate weights for your current condition. 5- staying off the affected area for a while, no matter how bad you want to do the workout and then taking time to let it heal and easing back into workouts. 6-Working with different positions and/or exercises to avoid problem areas. 7-Using ancillary strengthening movements to rehab the area and add stability to it. 8-Adding traction (stretching the spine out) to your daily routine by either hanging or by creating a position of spinal flexion (lying hunch back over a bosu ball or similar – think Halloween cat on a fence). All of the above issues apply to a myriad of injuries or tweaks, but truth be told, if you are doing things right and have never been diagnosed with a structural defect, the biggest culprit for back pain lies in the musculature (soft tissue).
Muscle based issues may in fact contribute to structural failure issues (like those above), such as overly tight hip flexors and/or quads which pull the pelvis forward, thereby overextending the spine and placing compression on the discs causing a bulge. This can also be the case in lateral muscles, such as the Quadratus Lomborum, glute medius, TFL, etc. Of those muscles, the biggest culprits will often be the psoas (deep hip flexor) and the QL (the Xmas tree muscle in lower back).
The Psoas is a tough one to work and it needs constant hammering, but there are ways to do it. The psoas gets smoked through squats, constant lengthening/shortening and then being put away without being stretched out. As the muscle “cools off” it stays rock hard and shortens. This is worsened due to the fact most of our downtime is spent sitting down immediately after working out. Due to it’s attachment on the lower spine, when the Psoas tightens up, it pulls the spine forward, thereby increasing the curvature of the lumbar spine and placing stress on the discs and nerves. The Psoas can be manipulated and manually released through by applying pressure to the muscle through the front of the abdominal cavity, just along the sides of your rippling six pack and above the pelvic crest. However, this hurts like hell and usually takes a trained person to locate and manipulate.
There are several stretches that work, but they are hard and require some hardcore stretching, either with a band or a partner to get at them. The goal is to get the top of the femur to rotate forward, thereby pulling on the psoas. Picture lying on your stomach and creating pull on the leg by pulling the leg behind you (up in the air). This will get the necessary stretch into the psoas. Now you just have to Google some stretches or mess around with things until you can find it.
The QL is another jerk off of a muscle that causes major grief and lends itself to pelvic misalignment and then sacroiliac joint misery. The QL gets a ton of work due to it’s role of keeping pelvis leveled off when the opposing leg is working or when we are trying to maintain midline stability. When your left legs is working and under tension, the right QL in the lower back activates to stabilize the pelvis. So, when we are working both legs or applying major force to the midline, the QL is working overtime. Along with the spinal erectors, abs, serratus, and obliques, it’s preventing us from being tacoed when deadlifting, squatting, doing KB swings, etc. As you can imagine, it gets beat up and like many of us, we probably don’t take real good care of it pre/post workout. As the QL tightens up, it causes pain in the hips, which may manifest itself as radiating pain just below the belt line in the glute medius muscles. This radiating pain is often across both sides. That in turn often triggers pain in and down the TFL and IT band on each leg. That’s a lot of suck going on at once…
When muscles like the QL and psoas get hammered that much and not stretched out regularly, they are going to become rock hard, shortened and inflexible. That means they are now pulling on all their connection points and moving things out of alignment. Additionally, we tend to see these two muscles start to compete insofar as working against each other due to the muscular imbalances being created by each other and we get locked in a cycle of psoas spasm/QL spasm, etc. This would be bad.
Fortunately we can reverse a lot of these effects, however, it may take some time and a lot of work on a very consistent basis. You can do a lot of the work on your own using PVC rollers and a lacrosse ball, and if you are in major need of help, finding a good massage practitioner or ART therapist. Keep in mind that although there may not be a structural issue going on initially, it can come on due to unchecked soft tissue issues. In other words, allowing the Psoas, hamstrings, QL and other tight muscles in the trunk to be left to their own devices, they will continue to place stress on the spine and discs due to the misalignment they are causing. At some point that area affected will fail and now you have a structural defect to work around and heal.
Lastly, do some research and find out where things hurt and what you can do to alleviate the pain on your own. Just remember, it’s up to you to make sure the issue gets handled or it will never get better. Take 10 minutes a couple times a day, especially post workout, to get into those muscle groups and get them worked out. If things are feeling really bad, stay out of the workout routine for a few days, stretch, roll and let the muscles relax before they get trapped in a spasm you can’t fight through. Then ease back into your routine and take care of the problem areas along the way. Get some!