Back Pain

Causes, treatment and exercises

by Phil Mack

Consultant Sports Physiotherapist

back pain, neck pain,

Back pain is something most of us will experience at some stage during our lives. However, the good news is, in most cases the cause of pain is not serious in nature and is treatable.

What causes back pain?

Poor postural is by far the most common cause of back pain, especially in the lower back (lumbar spine). Pain generally stems from sitting, standing, running or cycling whilst adopting a static poor postural position, putting the complex soft tissue structures that surround the spine (muscles and ligaments) under excessive strain, which, if not corrected, will eventually cause pain.

Poor posture is normally the result of weak core muscles which help maintain the spine in the correct position – like guidelines of a tent. When these muscles are weak it is very difficult to keep your spine in the correct or neutral position which in turn will overload other soft tissue structures around the spine. If you then maintain this poor postural position in a static position for lengthy periods when sitting, standing or in sports like running and cycling, then eventually the surrounding soft tissue will start complaining, initially manifesting as a dull ache across your lower back.

What is common with sitting, standing and sports like running and cycling is very little movement occurs in the lower back. Therefore, if you have poor posture, the overloading of surrounding structures is often constant with little relief, so it no wonder pain eventually develops.

Other muscles may also contribute to developing poor posture. For example, if your posterior thigh muscles (hamstrings) are tight, when you sit they will pull the pelvis out of position and increase tension of the lower back muscles. Tight anterior thigh muscles (quadriceps) are also a common cause of back pain, especially during running, again by pulling the pelvis out of a neutral position. The cause of pain whilst road cycling and mountain biking is slightly different. This is generally caused from prolonged periods in a static flexed (forward lean) position combined weak core muscles. (also see article “Back pain and Mountain Biking”).

When you first start to develop postural back pain it manifests itself as a low grade ache which tends to be relieved with light exercise or by avoiding the cause, like long periods of sitting for example. But if the symptoms are ignored, pain becomes more apparent and tends to be there most of the time, to varying degrees.

It should also be noted that a small percentage of back pain is caused by more serious conditions like a prolapsed disc, fracture, nerve root or joint impingement. Symptoms that suggest a more serious back problem are leg pains, pins and needles or weakness in your leg or foot. These symptoms need to be properly assessed by an experienced Physiotherapist.

How to avoid or reduce back pain from poor posture

  1. As mentioned earlier, lack of movement in the lower back region is common to when adopting a poor postural position is pivotal to developing pain. Therefore, introducing regular movement to break the constant static position is a key factor in relieving back pain, for example, when sitting, getting up and moving around every 20 minutes or so and moving around. Introduce simple pelvic and lower back exercises (see below).
  2. Maintaining a good postural position when working at a desk for long periods is essential if back and neck pain is to be avoided. Here is an excellent article on how to sit correctly with good posture.
  3. Add a daily routine of dynamic exercises (see below) and stretching any tight thigh muscles (quadriceps), posterior thigh (hamstring), and buttock (gluteal) muscles. This will help to prevent overloading your lower back muscles when sitting.
  4. Apply heat to the lower back muscles. A shower, massage or hot water bottle works best. These will help to relax the muscles.
  5. Release and relax back muscles through massage, use of a tennis ball or foam roller for 5 to 10 minutes twice daily – purchase a foam roller from www.physiosupplies.com/exercise/foam-rollers Here is a video of foam rolling on YouTube
  6. Apply movement to the lower back muscles using the suggested exercises below. About a minute of each 3 or 4 times a day will help to recover the overloaded lower back muscles.

Four good pieces of advice

  • Try not to wait until your back pain or discomfort gets really bad. Get into a regular routine following steps 1-3 above and the exercises below. If you are prone to lower back pain, and your workload is about to increase, start the following routine as soon as you can.
  • If you are already experiencing postural back pain, start the routine  and exercises below. It will take time to make a difference, but you CAN get rid of your constant back pain.
  • Make sure you are maintaining the correct postural position
  • If your back pain is long standing you may need initial help from an experienced Physiotherapist who specialises in back pain.

For further advice email your questions to info@physioinsport.com or use the contact page on our website www.thephysiotherapyclinics.com or call us on 07738 304238

Back Pain Exercises

The following exercises will help mobilise your back, strengthen your core and reduce pain caused by poor posture.

trunk rotation, back pain

Trunk rotation

This is a useful exercise and easy to do at work to help mobilise and loosen the lower back, especially if you sit for long periods

Stand with your feet slightly apart and your back straight. Balance your weight equally on both feet. Turn your shoulders and your head toward the right to look behind you. Then turn toward the left. Keep your feet on the ground and your back straight at all times.

Continue for 1 minute

back pain, back pain exercises, log roll

Log Rolling

This is a great warm-up exercise and a good way to mobilise and loosen the lower back.

Start by lying on your back with your feet on the ground and knees bent. Slowly move your knees side to side going as far as you can without causing pain

Continue for 1 minute

Pelvic Tilt

Lie on your back with your knees bent.
Activate your lower abdominals (transversus abdomini) by bringing your belly button inward and by activating your pelvic floor muscles 20 to 30% of maximal contraction.
Maintain a steady abdominal breathing while tilting your pelvis and flattening your back to the ground.
Return to neutral and repeat.

Back Pian exercise, single knee to chest

Single knee to chest

Isolated stretch for the lower back

Lie on your back and bring one knee up to your chest.
– Hold for 2-3 seconds
-Return to the starting position.
– Slowly lower back down and repeat all the above steps as prescribed to add your own Lie on your back and bring one knee up to your chest.

Cat

Cat / Cow

Start on all fours with the hands under your shoulders and knees under your hips, with a neutral spine.
Exhale, then slowly round your back to the sky, starting from the tailbone.
Inhale, then extend the spine starting from the tailbone and lifting the crown of head last.
Repeat as needed, flowing with your breath.
Return to neutral spine position at the end.
If you have wrist discomfort or injuries, use “fist for wrist” with palms facing each other. For sensitive knees or other knee concerns, use a knee pad for comfort.

Plank exercise, lower back pain, core exercise

Forearm plank

This is one on the fundamental exercises to help strengthen your core muscles.
Place the elbows directly under the shoulders and prop yourself on the elbows. keep a neutral back and head aligned with the spine.
Draw in your lower stomach to engage your core muscles. Hold the position for 5-10 seconds, then lower to the ground. Repeat 6-10 times.

shoulder bridge, lower back exercise, back pain

Shoulder Bridge

Core strengthening exercise

Lying on your back with your knees bent, as pictured
– Flatten your back by squeezing your tummy muscles
– Squeeze your glute/buttocks
– Slowly lift up off the ground (do not arch your back)
– Hold for 2-3 seconds
– Slowly lower back down and repeat all the above steps as prescribed to add your own text

Phil Mack

Phil has over 17 years of experience working with professional and international athletes and teams throughout UK, Australia and South Africa, including the South African Springboks, Leicester Tigers and Ulster Rugby as well as the South African Triathlon Team.

Phil Mack
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