What to do when your lower back hurts

[El Exorcisto]

I need to preface this thread stating that I am not a PT or an MD. I have zero qualifications in the field os S&C, kinesiology, or sports medicine. I am a meathead repiratory therapist that works in an inpatient rehab hospital with a lot of resources in PT. I've also lived most of my adult life wih the back of a 90 year old osteoporotic woman, or so I thought. I've done a lot of work on myself getting myself stronger and bulletproofing my back has been priority number one. Here is a compilation of mobility and flexibility drills that have gotten myself, some of my family, and several of the members here walking, lifting, and living better and pain free.

 

If you have diagnosed spinal pathology, ie herniated discs, hardware, scoliosis, etc then this post is not for you. No degree of mobility work will change what your bones are doing and you should consult a qualified physician or PT.

 

"My low back hurts after deadlifting and squatting," or "My low back hurts when I've sat for a while and stand up."

 

This pain most likely comes from a tight iliopsoas. The psoas inserts at the lumber vertebrae and the greater trochanter of the femur, while the iliacus inserts in the anterior face of the iliac crest and descends to join the psoas, becoming the iliopsoas. It becomes hypertonic and contracted from frequent sitting. This also causes the glutes to become inactive, thus losing the ability to counteract the hip flexion of the ilipsoas, potentially drawing you into anterior pelvic tilt. When the iliopsoas gets strained and even more contracted it compresses the lumber spine causing a generalized lower back pain.

 

The drills to help alleviated a tight iliopsoas:

 

Lie on a bed, couch, or table with one leg hanging down to the floor.

Pull the hanging foot back and anchor your toes to the floor putting a stretch on your quad.

Palpate your iliac crest and move just medial of it.

Press your fingers into your abdomen and palpate the muscle. Can't find it?

Press really, really hard. If this doesn't make you want to vomit then move a little more medially and inferiorly.

Press and work your fingers superior-inferior until you feel the muscle hurt a little less.

Press and hold static pressure on the muscle, feel for the muscle to "release." This may take several sessions.

Continue down from your iliac crest to somewhere jsut above your junk.

Flip around and repeat on the other side.

 

After releasing both sides, do the warrior stretch for 30 seconds on each side.

 

Get into a lunge position and lean forward, putting a stretch on your trailing quad.

Put your hands up and keep your thorax vertical. Do not overarch your back.

Rotate your thorax towards your raises knee, feeling for a stretch in your quad and hip.

 

Along with a really tight psoas sometimes come really tight IT bands. I'm not sure what the correlation is, but I am asuming the anterior pelvic tilt gets so deep that it stretches them more than they should be. If your back is still sore after releasing and stretching then foam roll your IT bands. This involves lying on your side on the roll and rolling back and forth along the lateral aspect of the thigh. Working your IT bands without addressing your psoas could allow your psoas to contract even tighter after the inhibition on your IT bands from foam rolling. Rolling just my IT bands led to more lower back pain than doing nothing at all.

[El Exorcisto]

"I have pins and needles going down my leg after I sit too long or squat."

 

Excluding herniated discs, this is likely an issue of the piriformis muscle. The piriformis is a dick muscle deep in the glutes nested against or pierced by the sciatic nerve.

 

The release:

Sit on a tennis or lacrosse ball. Rolling back, forth, side to side try to find the spot that makes you want to vomit it hurts so bad. Work the ball into it until it lets go and doesn't hurt quite so bad.

 

The stretch progression:

First step:

Sit on the floor with both legs extended in front of you. Bring one leg over the other an bend at the knee, bringing it to your chest. Hug your knee and feel for a stretch n your glutes.

 

Second step:

Imagine going into a split, but with one leg bent at the knee and medially rotated. Your trailing leg will be nearly straight and your forward leg will bend medially at the knee, crossing midline. From above you'll look kind of like a question mark. The lower you can get the more stretch you will have. Try to keep your thorax up but don't overarch. If you feel this at all in your erectors then let your thorax fall forward. This is a tough stretch to describe and I can't find any pics online easily.

[LessJos]

Great posts El Exorcisto! Thank you!

[stevembk]

I have this issue. Anterior pelvic tilt and all. My lower back has been bad for years and my hip flexors have started bothering me pretty bad this summer, both from running too much and squatting with bad form.

 

A video or image of the first exercise might help. Maybe ill try rereading the steps tonight and see if I can work it out.

 

Ive tried feeling for trigger points in my psoas but cant seem to find any. I do however have major tightness and trigger points in my hips, gluteus maximus, and  especially the gluteus medius. I can get at these with a lax ball and feel relief for a short period.

[El Exorcisto]

steve, just think of lying in bed with one leg hanging out to the floor. Now just pull your foot back so you put a stretch on your quad and start working down along the medial edge of your iliac crest. Also after you release your glute trigger points do you do any stretching? Try the piriformis stretches I put up after you work out your trigger points and see if the relief stays longer.

 

Are you doing any direct glute work ie barbell bridges or barbell hip thrusts? Strengthening my glutes directly helped keep my posture better for days at a time vs acutely pre-workout or when my lower back ached. Squats and deadlifts are good, but hip thrusts get about 5x more glute max activitation.

[stevembk]

Ive been focusing on correct form with my squats (pushing from my heels) and have been adding bulgarian split squats with dumbbells. Yesterday, I did that crab walk exercise with the stretch band and It killed my glute medius. They were spasming at work towards the end of the day.

 

Ive only been going into warrior stretch after the foam roller/lax ball release. I try the stretch where I lay face down w one leg crossing under my torso but my hip flexor prevents me from getting the full stretch. It might be easier to cross my leg in the sitting position and reach for my other ankle.

[LessJos]

Since it hasn't come up in this thread yet, I want to mention that I learned and fixed a lot following KStar's method on mobilityWOD.com

He also has a book now with I think is one of the best books, if not THE best, I ever invested money in.

[stevembk]

Since it hasn't come up in this thread yet, I want to mention that I learned and fixed a lot following KStar's method on mobilityWOD.com

He also has a book now with I think is one of the best books, if not THE best, I ever invested money in.

 

Is it the Supple Leopard book? Ive had it for a bit but have not gotten around to reading it.

[LessJos]

Yes. That's the one. Amazing how well his stuff works. You just need to keep it up. Every day, no rest day. Though only 10-15 minutes.

I just discovered that I neglected my psoas for a couple of weeks. Started last night again and it was very painful. But I know that just working on it for 3-4 days will fix that.

 

His videos are great to learn and fun to watch too. Check it out.

[I-Jo]

I do foam roller work because of that- and I do one of KStarr's hip opening mobility wods.

 

I love it- feeeeeels sooooooooooo good.

 

need to do more

[Mad Hatter]

Press really, really hard. If this doesn't make you want to vomit then move a little more medially and inferiorly.

 

Why is it that the psoas releases cause nausea? I've never experienced that with any other muscle...

[El Exorcisto]

Not so much nausea as searing, unending pain that can induce it. The iliopsoas is one of those muscles that never gets any love while it's antagonists get worked on daily. This leads to a very angry muscle filled with ridiculous trigger points.

 

It may make you have to pee though. Releasing the psoas itself which requires palpating near your lumber spine through your abdomen will most certainly cause a need to pee after a release.

[Mad Hatter]

No actually I just feel queasy... My psoai (pl?) are in relatively good shape so it doesn't hurt, but I do find releases deeply unpleasant and I feel a bit sick. Maybe it's just because it's close to so many sensitive areas...

[stevembk]

I cant find my psoas anywhere from between my hip and my belly button, down to my junk. No tenderness anywhere. Ive been pushing down around and under my abs while doing that stretch but still cannot feel any "sausage" like muscle that relieves my hip flexor tightness.

 

The only trigger points I can get to are in my glute meds and It insertion are.