Transcription:
Exercises for Lower Back Pain

Joey Wahler: It's a common physical ailment, but there are ways to address it. So we're discussing exercises for lower back pain. Welcome to the Live Greater podcast series, Information for a Healthier You from the University of Maryland Medical System. Thanks for listening. I'm Joey Waller, our guest, Dr. Peter Bowman. He's Director of Therapy Services for the University of Maryland Orthopedic Associate. Site therapy director for University of Maryland Orthopedic School of Medicine at Camden Yards, and also assistant professor at the University of Maryland School of Medicine Dr. Bowman, thanks for joining us.

Dr. Peter Bowman: Oh, thanks for having me.

Joey Wahler: So first in a nutshell, just how common is lower back pain and are there certain people, for whatever reason that it seems to affect most?

Dr. Peter Bowman: Sure. Lower back pain is a very common condition that can affect over 80% of the adult population. Most of us are gonna have bouts of lower back pain on and off throughout our lives. Current literature doesn't really support any definitive causes for an initial episode of lower back pain. The clinical course for lower back pain can be described as either acute, sub acute, recurrent or it's chronic. And given the high prevalence of recurrent and chronic lower back pain, there are a number of associated [inaudible] with that.

And a lot of times clinicians should try to work toward, recurrences and helping the patient through episodes of chronic lower back pain. It tends to affect all of us. And once you get it, once you may get it again. You may not get it again, but there really isn't one or another factor that really points us toward is always getting lower back pain.

Joey Wahler: So what seems to be the most common cause? Is it just wear and tear over time, or is there more to it than that?

Dr. Peter Bowman: It can be wear and tear over time. It can be certain jobs may predispose people to getting lower back pain. I've worked in a number of different outpatient settings and worked with patients who do a lot of heavy lifting, and some of those patients have lower back pain. And I've worked with people who have very sedentary jobs and they have lower back pain. It's just kind of one of those things that I think over time, as we all get a little bit older, there is a lot of wear and tear and certainly the harder your job is, the more that may affect your different muscles throughout your body, which can lead to lower back pain.

Not only does it affect, men and women pretty much equally it can even affect antipartum postpartum women, whether or not they have lower back pain. And, sometimes people who have back pain at certain times in their lives and other times it may go away. One thing I find interesting is that, a lot of patients. It doesn't matter if they're obese or they're skinny, they can also have lower back pain. So it's kind of an interesting thing that there isn't one specific driver for it. And I've worked with patients in the past who have been morbidly obese and lost a hundred pounds and didn't have lower back pain.

And as soon as they lost the weight, they had intense lower back pain. So it's just one of those things of working with, your healthcare provider and trying to figure out what may it be the best thing for you and trying to help you with your back.

Joey Wahler: Wow. So very hard to pinpoint often it sounds like. What everyday things can we do to prevent lower back pain, and what should we do to avoid causing or worsening it?

Dr. Peter Bowman: I think one of the easiest things to do for all of us in the working profession. Try to get up and move every hour. You can even have the best ergonomics set up with a $2,000 chair and a $5,000 desk set up and still have lower back pain. One of the easiest things to do is to either set an alarm and get up and walk around every hour. An easy thing that I tell patients to do is to try to drink more water. If you drink more water, you finish your cup, you go where you refill it or maybe you have to get up and go to the bathroom.

And so really changing positions and modifying that you do every hour is really kind of one of the best things for you. For me personally, if I were to sit all day, my back and my whole body may ache because I'm so used to up and moving around. But I think a simple trick honestly, is just drinking more water and fluids throughout your day.

joey: So speaking of sitting and being at work, sitting, whether it be home or at the office, how about posture? Why is that so important to back support and what can we do there?

Dr. Peter Bowman: Honestly, I think this question comes up a lot, is there an optimal posture for sitting, standing, and laying down, there really isn't. I think if you're really trying to get yourself a good setup and when you're sitting constantly through your day, is really start with your feet, making sure your feet are flat, either on the ground or on some type of surface. Not all chairs are easily adjustable, depending on how tall we are. So another trick I've, taught patients in the past is to either get a trash can and, turn it sideways.

So you can have your feet on a flat surface, or even get different books throughout your house, and you can have your feet at least on something. So if you start with your feet flat on a surface, that will actually change the angle of. Hips are positioned in your chair. As your hips are sitting differently in your chair, it's gonna affect your pelvis. As your pelvis is in a different position than it affects your lumbar spine. As your lumbar spine's in a different position. It affects your thoracic spine and then that affects your neck and your shoulder girdle.

So I really think the easiest thing to do is to start with your feet and kind of work your way up and that kind of gives you a good sense of how you're sitting in your chair. If you're sitting with your feet dangling on the ground, all day that's gonna have a different effect on your lumbar spine, and they may have you increase your lumbar extension, which may cause pain. So one of those things, like I said, is start with your feet flat. And another thing I always like to tell people is when they're sitting in their chair, they sometimes will tell me they have the best optimal posture that they can have while they sit.

And so my question to them is, does it hurt? They say, Well, yeah. I say, Why Don't you change a different position for how you're sitting? Well, because I need to sit optimally with my back straight and upright. And I'm like, Well, maybe if you change that slight positioning, maybe if you flex a little, does your pain get better? And so a lot of times it's gonna depend on the patients posture, how they are standing, how they are always in a normal resting position, and then you can vary it from there. But like I said, I think having your feet flat on the ground is probably the easiest thing to start with.

Joey Wahler: So that's a great place to start. Let's get into some exercises, please. First, what muscles are we typically looking to strengthen when we do lower back exercises?

Dr. Peter Bowman: Sure. So you have your core, mid core stabilizing muscles and we've heard a lot about core Throughout the world, everyone's always working their quote unquote core. So there's actually two different sites of core muscles and the core muscles that actually really give your trunk stability are made up of five muscles. And those muscles of your are your malus, which are very small muscles that go. Every other vertebrae in your lumbar spine and all the way up to your cervical spine, your transverse abdominus, which is a very flat, thin muscle that wraps from front to back.

And that also interweaves with your internal obliques also working your diaphragm and your pelvic floor muscle. These five muscles kind of work as almost like a soda can around your mid trunk, which helps to stabilize your lumbar spine and to help stabilize your body.

Joey Wahler: And so in order to work those as advantageous as possible, give us a few exercises, please, that we can do on a regular basis?

Dr. Peter Bowman: Sure. One of the exercises I love to give patients is in a quadraped position where someone is on their hands and knees. And a lot of times people will see people at the gym in this position doing a bird dog exercise, and most of the patients at the gym actually do it. Not patients, but patrons at the gym do it incorrectly because they actually hyper extend their lumbar spine. And so if you're actually in a position in a crawling position and raise your arm about three quarters the way up. So if you actually raise your arm, not quite to your shoulder height, but a little bit less than that, that'll actually help to activate your ous muscle.

And when patients or patrons do this, they tend to be doing them very fast and doing them very frequently. But if you are actually hold the position and get the muscle to engage a little bit more, you actually feel more of a tightening in your lower back and maybe from your thoracic spine down. And what you're looking for is you're not looking for a very massive muscle contraction. You're looking for a very subtle tightness and a contraction into your back. And you can progress from an arm raise to a leg raise, and then into an arm and leg raise, doing the opposite sides.

And one thing that's easy to make this exercise even harder is to throw in a kegel exercise. And I think the easiest way to have. Do a kegel exercise is to pretend that they're trying to not pass gas. And what that'll do is pre-fire their molticidous muscle, their transverse adominance muscle, and their pelvic floor. So if they pre firing these muscles and then they incorporate this arm raise, they'll actually get more of the molticidou firing, to occur. And as the molticidous fires more. That actually helps with the patient's lower back pain. So this muscle is key because it's one of the main muscles that shuts off when a patient injures their back.

And a lot of us don't tend to actually work our malus muscles very well. So I think this is a key exercise that people do in yoga class and are doing at the gyms. They're just doing it maybe not as effectively as they could be and just reimagining how high they're actually moving their joints and their limbs and their extremities will help them to fire that muscle better. Another really good muscle that we all tend to underutilize, which isn't part of the core muscle that you're speaking about, but is actually your, gluteus maximus muscles and your gluteus meatus muscles.

And I think most of us all really think that we squat correctly and we do a great job doing squats. But most of us, and this even goes down to, pediatrics and to kids, we actually all tend to squat not as effectively as we could, and the easy way to get a better squat is when you do squat back, is to look down and make sure that you can see your toes when you're squatting back. So your knees should stay behind your toes as you squat back into a chair. The other thing that a lot of people don't actually do is to activate or squeeze that or glute muscles as they stand up.

So a lot of us, as you're squatting, you may just try to. And you don't actually feel your glutes contract, but if you actually make your mind squeeze your glutes as you stand, you'll get a better glute firing. And as your glutes get stronger, it actually takes pressure and pains off of your lower back. Another good thing to work on is hip strength and getting any of your hip muscles and your hip rotator muscles stronger. Because having good local support at your hip will also take some stress off of your lumbar.

Joey Wahler: And then you mentioned the glutes. And before we go, I also want to ask you about hamstrings, because tight hamstrings can contribute to lower back pain if you don't loosen them up too, right?

Dr. Peter Bowman: That's true. I mean, and sometimes with tight hamstrings, it's gonna play with overextending your lumbar spine and stretching your hamstrings can be a good thing to do. What's actually is there's some research on it, stretching, but there hasn't been really good evidence as to how good it really is, which I find interesting because everybody tends to stretch, right? But doing good stretches, doing anything to give you a good warmup before you get going and get your blood flow going is gonna be great. And if you do a hamstring stretch, make sure that you're not having anything other than a muscle pull in the back of your leg if you start feeling something else.

Maybe you're irritating a nerve or something else, maybe getting irritated as you go, but a good stretch, you should hold for at least 30 seconds and do anywhere from three to five different types of repetitions with that.

Joey Wahler: Excellent. And so finally, Doc, in summation here, when should someone with lower back pain seek professional help, whether it be a doctor or maybe a physical therapist? And what's your overall message to those suffering from this?

Dr. Peter Bowman: The main thing I usually tell family, friends, anybody is if you have an injury or have any type of lower back pain. Usually a lot of that is gonna hopefully improve within two weeks, within a two week timeframe, some of that should be getting better. You should be improving. if within after two weeks you're not feeling better, I think it would be a good idea to go have your lower back, looked at. Other things that may be more of a red flag would be somebody experiencing maybe some numbness, tingling, especially if they feel any weakness where now they're not able to do certain things like lift their foot that they were before.

If there's ever any loss or change in their bowel or bladder, those are immediate things where they should go seek their physician. If someone just has lower back pain, that can get better, but I think, two weeks is a good timeframe to kind of see how things go unless you're having one of these, major red flags that are going on. Key takeaways, most of the time. 80, 90% of the time, lower back pain's gonna get better. 95% of lower back pain is gonna improve. It may just take longer in certain instances than in other instances. And then within that 5% there isn't a huge percentage that do need surgical intervention. But the ones who do need surgical intervention do need that.

And if you are suffering. easy things that can really help somebody if they don't have a fear of water is getting into the pool, walking around doing something that can unload their body to keep them active, at least for 30 to 40 minutes a day, maybe an hour. But the pool is a good thing for someone who has lower back pain, especially with nerve pain and radiating symptoms. That'll just keep them active. And keep them going. back pain, disc herniations, all those things can improve. They just take a long time and sometimes it's just how long people can deal with that.

Joey Wahler: And for those listening wondering, Wow, I really wish I could see some of these exercises that the doctor is describing. We hang in for just a sec because we're gonna tell you more about where you can see them in just a moment. Folks, we trust you're now more familiar with exercises for lower back pain. Dr. Peter Bowman, thanks so much.

Dr. Peter Bowman: Well, thank you so much for having me.

Joey Wahler: And you can find more shows just like this one at umms.org/podcast, as well as on the University of Maryland Medical System YouTube channel, where you can find that great video that as mentioned, Dr. Bowman has put together. Where you can get a visual of these exercises in action firsthand. Now, if you found this podcast helpful, please do share it on your social. And thanks again for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, hoping your health is good health. I'm Joey Wahler.