The past few years have not been kind to my lower back. Between
the physical tolls of pregnancy, parenting and working from home, I have a
constant stiff, achy feeling in my lower spine. I am not alone: It’s estimated
that up to 80% of Americans will develop lower back pain during their lifetime,
with 15%-20% of adults reporting it in an average year.
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Could exercise prevent some of this pain? The short answer is
maybe. A consistent mixture of cardio and dedicated core work can help.
Exercise alone, however, is not a guarantee of pain relief, as there are a
number of mistakes that many of us, even experienced athletes, may make.
The spine is susceptible to pain when core muscles are weak.
“The lower back is the center point of our whole body,” said Dr.
Krishna Shah, an interventional pain specialist at Baylor College of Medicine.
The spine has to be mobile, able to bend and twist in multiple directions,
while also bearing the weight of our body.
Surrounding the spine are the core muscles. Although we tend to
think of our core as the abdominals, it also includes the deep back muscles, as
well as the hip muscles, quadriceps and hamstrings, which support our spine and
pelvis.
Core muscles work similarly to a back brace, keeping the
midsection stable and upright. That’s why wearing a brace provides short-term
pain relief for patients with lower back pain, but relying on one too much can
weaken their core muscles. Instead, the goal should be to strengthen those
muscles enough to do the brace’s job.
“If you can develop your own internal brace, that is more
effective,” said Dr. Sean Barber, a neurosurgeon and spine specialist at
Houston Methodist Hospital.
Acute back pain is often the result of pulling or straining a
muscle while trying a movement that requires a muscle that has become weak or
stiff. If this muscle can’t provide the needed force, then the pressure shifts
to the spine in a way that leads to pain.
Developing core strength, flexibility and muscular control can
help you avoid these pulled or strained muscles.
Exercise strengthens the spine.
The simplest way to strengthen your spine is to move regularly
throughout the day, in whatever capacity works for you. This might mean
increasing your daily steps, taking short walks during the workday or
prioritizing a slightly longer walk in the morning or evening.
People who are physically active tend to have lower rates of
back pain, and a recent meta-analysis of 25 studies found that the most
effective way to prevent lower back pain from recurring was regular exercise,
preferably combined with some form of physical education.
“Exercise doesn’t cure everybody, but on average, it’s an
effective intervention,” said Mark Hancock, a professor of physiotherapy at
Macquarie University and one of the authors of the study. There is no single
type of exercise that has been shown to be effective, he said. “If you are
doing a variety of exercises, then you are likely getting all the things you
need,” he said, adding, “It’s just like your diet.”
Physical activity also strengthens the bones and cartilage of
the spine, protecting against age-related degeneration, and increases blood
flow to cartilage discs in the spine that don’t receive a lot of blood supply,
Shah said.
If you have time, try some fast walking or jogging. A number of
studies suggest that runners have thicker, healthier cartilage discs in their
spine than people who aren’t active.
Work the neglected deep core muscles.
Working the core is crucial to avoiding future back pain, but
that doesn’t mean shredding your abs to look like Chris Hemsworth. Popular core-strengthening
exercises, such as crunches or situps, primarily work the larger, exterior
muscles, while neglecting the deeper muscles.
For instance, the transverse abdominis is a delicate sheetlike
deep muscle that wraps the midsection like a corset. There is also the
multifidus, a muscle that lines the spine, with a number of extensions that
wrap each individual vertebra, similar to the way a bicycle chain wraps the
sprocket.
“It doesn’t take that much effort to activate these deep
muscles, but they are neglected because you can’t see them” when you are at the
beach, said Femi Betiku, a physical therapist at the New Jersey Center of
Physical Therapy who specializes in treating lower back pain. People with
six-packs can still have lower back pain, he added, if they are working only
the stronger, outer muscles.
The deeper muscles get engaged during movements requiring more
control than raw power. One way to activate your deep core muscles is by doing
planks, whether it’s a regular plank, a side plank or some of the many other
variations.
If holding a regular plank is uncomfortable, start with your
knees on the ground, then progress to balancing on your toes.
Shah also suggested squats, pushups and bridges. To build and
maintain core strength, he recommends two to three sessions of dedicated core
work a week. “This is a lifestyle change,” he said.
There are also sports and physical activities that require light
contraction of the core, such as kayaking, cycling, dancing, barre classes,
boxing, rock climbing and swimming. Any activity that requires a certain level
of control over the midsection will help activate and engage those deeper
muscles.
Work on controlling the spine.
In addition to strengthening exercises, emerging research
suggests it’s important to develop muscular coordination and spine control.
This is just as true for athletes, who focus on performance and sometimes
neglect exercises aimed at controlling the spine and pelvis.
In a 2018 study, researchers compared elite athletes to a
population of moderately active people. Half of each group had lower back pain.
To the researchers’ surprise, both elite athletes and regular
people with lower back pain had a similar stiffness in and lack of control over
their spine, which is indicative of a similar pattern of weakness in their back
muscles.
“The key factor is how able you are to control your muscles,”
said Mariá Moreno Catalá, a researcher at the Humboldt University of Berlin and
the lead author of the study.
To combat this, Betiku recommends Pilates because, in addition
to strengthening the deeper core muscles, the exercises promote muscular
control. For a number of the exercises, the spine either remains stable or
moves very slowly, which develops muscle control along the spine when it is in
different positions.
Incorporating Pilates into your fitness routine can be as simple
as doing short workout videos, many of which require little to no equipment,
two to three times a week.
Incorporate an element of instability into your workout.
The slow, controlled movements in exercises like Pilates teach
your muscles to move the spine efficiently. The next step is to start
exercising in a more variable environment, which develops even more
coordination and control.
In another study, Moreno Catalá and her collaborators found that
adding instability to exercises — like balancing on an uneven surface or even
working out in a noisy environment — was effective at relieving lower back
pain.
Moreno Catalá said it is less about the amount of muscular strength
and more about the ability to finely control the activation and deactivation of
all the muscles that stabilize the spine.
“We think the size of the muscle is the most important quality,
but it’s also the quality of activation that is important,” she said.
Choosing sports that include an element of reactivity, whether
it is hiking on a rocky surface or reacting to a sudden tennis volley, can
result in a similar level of muscular development and control. Body weight
exercises, such as pushups, pullups, burpees and squats, also help, since they
require full-body coordination, rather than the isolated movement of lifting
weights.
Like many, I am guilty of working the outer core muscles while
neglecting the deeper ones. But for the past few weeks, I’ve started doing some
short Pilates videos, 10 to 20 minutes each, focusing on slow, controlled
movements. Two weeks in, the stiff feeling in my back started to fade,
disappearing for hours at a time. As it turned out, all my lower back really
needed was to develop a little more coordination and control.
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