It’s Not About the Muscles.
90-95% of back pain is non-specific and mechanical in nature. It has many names: lumbar pain, sciatica, lumbago, disc problems, etc., but it is rarely dangerous. However, it's a serious cause for health and wellness problems because the pain usually flares up at night, just when we are trying to fall asleep.
Often an acute, or new episode of pain, is initially caused by lumbar muscle sprains. These are basically micro tears in the muscles surrounding our spine due to everyday life.
The good news is that our body tissues typically heal themselves within 4-6 weeks.
While back pain can be caused by serious problems, it is rare. The scary reasons for back pain are usually easy to diagnose without an MRI, according to the Clinical Practice Guidelines of the Journal of Orthopedic Sports Physical Therapy.
Top 4 Stretches for Back Pain
1. Piriformis Stretch
Begin by lying on your back on a mat or bed with your head on a pillow. Bend both of your knees with your feet on the mat. Cross your right ankle over the top of your left thigh, making a figure 4 shape with your legs. Do a tiny abdominal crunch to reach behind your left thigh and interlace your fingers to hold your left leg. Gently settle back down to rest your head on the pillow and continue to pull on your left leg until you feel a gentle stretch on your right hip, buttocks, and lower back region.
Hold 5-10 breaths, then repeat other side up to 3-5 repetitions.
“It’s all in the hips.”
This is the go-to stretch for lower back pain, SI, and pelvic related pain as it stimulates most of the muscles crossing the interconnected hips and lower back region.
Alternatives to the piriformis stretch that may be more accessible for those with mobility problems or late pregnancy is the pigeon yoga stretch or a chair version.
To perform the chair version, sit at the edge of your seat with the ankle crossed over the knee, keeping the back straight, hinge forward at the hips until a stretch in the back of the hip and lower back region is felt.
2. Knees To Chest
Starting from the position of lying on your back with your knees bent and feet on the mat, gentle interlace your fingers behind your left thigh and pull your knee towards your chest. Hold 5-10 deep breaths, then switch legs. Then if it’s accessible, try holding both knees towards your chest. Only pull to where it’s comfortable and visualize your spine moving effortlessly.
“Motion is lotion.”
At the very onset of back pain, your best instinct should be to gently and comfortably begin to move the injured body parts. Movement is one of natures’ best pain killers. Lying on your back is a safe position without much fear of falling, so it’s a great place to start. By moving your legs and hips, you actually non-threateningly begin to move not only your lower back spine joints (which likely has become sensitive to movement) but also your back muscles.
This stretch can be modified to sidelying or sitting if one has mobility problems that prevent getting up and down off the bed/floor or in late term pregnancy.
3. Cat-Cow Mobility
Starting on hands and knees with your hands under your shoulders, and your knees under your hips, slowly inhale and begin moving your entire spine. Stick your tailbone up towards the ceiling, then sag and arch your lower back, then lift your chest and head and eventually look up towards the ceiling (cow). On your exhale reverse the direction by looking down towards the floor, tuck your tailbone under and round your entire spine into a C-shape (cat). Move back and forth between the two positions with your breath 10 times.
“If you don’t move it, you lose it.”
What is special about the quadruped (hands and knees) position is it’s possibility to articulate each joint in your entire spinal column safely in all directions. Other positions make this difficult.
Physical movement promotes blood flow, increased body awareness, and stretches almost every muscle in your back to ensure you don’t lose mobility in the future through pain and disuse.
Cat-cow can be modified to a seated position for those whose knees do not tolerate kneeling or are ordered by their doctor to be non-weight bearing on a leg after a surgery. For most it is an extremely safe and effective stretch to mobilize your entire spine and is very comfortably to do on a bed or the floor.
4. Transferring between Sitting and Standing Frequently
Most physical therapists hear from their back pain patients.
1. “Sitting too long aggravates my back.”
2. “Standing too long aggravates my back.”
One would guess that something like jumping out of airplanes, pushing humvees, crossfit, or situps would be on the top of the list for things that aggravate back pain, or a bad desk chair.
However, ergonomic chairs and desks make no difference in reports of pain according to this 2018 spine pain study, and people rarely complain about peak physical activities as pain generating experiences.
The best posture is your next posture.
It’s actually about the “next” posture that makes a difference. Create your environment so that you continuously move between a sitting or standing posture throughout the day. At night use pillows, leg pillows, and a mattress that enourages you to move between sidelying and lying on your back. If you must sleep on your tummy, try to place a pillow under your hips.
Try setting a timer to remind yourself to move, drink a lot of water to have to get up and use the bathroom, or buy a sit-to-stand desk and change postures frequently before your back sensitivity reminds you to take advantage of natures’ most easily accessible pain killer, movement.
This stretch of your entire lower body and trunk is helpful for anyone with the capacity to stand and not medically required to be in bedrest or sitting in a wheelchair.
Curious About What is Going Wrong?
Troublingly, United States spends about 100 billion dollars per year on diagnosis, treatment, and lost productivity related to back pain per year. It is also the second leading cause for people to seek medical care, according to the journal Spine.
For some people, back pain doesn’t from being acute (adaptive) to chronic (maladaptive). Acute pain is a signal to rest and heal, but chronic pain is persistent and lasts longer than the time needed to heal the body’s tissues, often leading to suffering and disability because of a fear of movement and lack of physical activity.
Issues in the Tissues?
The past 20 years of research have shown that the usual suspects as such as bad posture, core “weakness”, bulging disks or other MRI age-related findings are not the source of pain.
The biomedical hypothesis doesn’t account for why our society is suffering pain at unprecedented rates and causing an opioid epidemic. Basically, it’s not the “structures” around the spine that are causing the suffering according to systematic reviews.
What are the Real Culprits?
Whatever we are doing in the medical system for back pain, it isn’t working. A 2012 Spine journal article reports the costs of medical treatment for people with chronic spine pain more than doubled between 1998 and 2008, without making people’s lives any better.
What seems to be related to whether back pain gets better or not is modifiable lifestyle factors such as: physical activity, sleep quality and duration, stress management, and social connection, according to a British Medical Journal study of 973 patients with acute back pain.
A Holistic View of Back Pain
If we are going to turn the tide on back pain, we have to stop medicalizing stress and pain. We should pay more attention to the social determinates of health, educate and support people to be physically active, and foster social connection and meaningful work and hobbies.
The good news is that 70% of people with back pain gets better on their own without medical intervention. All they need is time and to return to normal physical activity as soon as possible.
This is where stretching can play a major role as one of the best conservative approaches to back pain. It is non-addictive, cheap, and empowering to people who want to avoid dangerous medicines, injections, or invasive surgeries. It is an approach that allows people in pain to take care of themselves.
Stretching sends adaptive signals to your brain to reduce feelings of discomfort, allows more freedom of movement, improves physical function to play with your kids or do your job, and reminds our subconscious not to be afraid of movement.
For a Fit and Healthy Back
Even though most back pain starts with a muscle strain, it’s not about the muscles. Rather, it’s about how we decide to think about our amazing ability to heal from within, our strategies to actively manage stress, and staying physically active and involved in meaningful social activities.
The result: a fit and heathy back without pain.
Forge Your Outdoor Freedom.
Mountains & Sea, Please.
💖Beyond Exercises By Morgan Fielder from BeyondExercises.com.
Author profile: Morgan Fielder is an evangelist for play and DOD civilian physical therapist living near Ramstein AFB raising two gorgeous girls, wife of a rebel, serial expat, and is actively involved in the German community through several organizations. Visit her community project at cornholeuropa.com to learn more.