Lower back and buttock pain - Sports Injury

4 steps to selecting the best exercises for lower…

by Pete Colagiuri - Sports Physiotherapist

Lower back pain is one of the most prevalent medical conditions. It affecting around 80% of the population.

The best way to fix lower back pain remains elusive. We know a number of options that are effective for most people.

However the best option is different for different people. There is still some trial and error in figuring out the most effective treatment option for your lower back pain.

Medication and exercise for lower back pain

Two of the most effective options – medication and exercise – work at different times in the lower back pain episode.

Medication, like simple paracetemol, can help ease the initial pain in the first few weeks. This is known as the acute phase of lower back pain.

The medicine helps by affecting the way you feel pain. That’s enough to get you moving again but it’s not a cure and it’s not a long term option.

Other medications work with more severe pain or muscle spasm but they’re rarely required.

After you’ve got moving again, usually with ongoing back soreness, it’s time to get back to normal.

That’s when exercises for lower back pain comes in.

Effective exercises for lower back pain

The best exercises for lower back pain fit specific criteria:

You feel better after doing the exercise
You can do the exercise with a smooth, well-controlled movement
The exercise targets range of motion or strength that is functional for the back
The exercise doesn’t generate too much muscle fatigue

You should feel better after doing the exercise/s.

If you’re effective in restoring normal functioning of the lower back, the back is comfortable and able to move with more confidence afterwards.

If the exercise is overloading the back for its current capacity, it’ll become sore and begin to guard against movement, This will delay your recovery and reinforce bad movement patterns.

The exercise should involve a smooth well-controlled movement.

If you find the movement painful, jerky or it just doesn’t look normal, there’s a good chance that it’s not helpful.

The brain learns quickly and it adjusts your movement based on recent experience.

So it the exercise movement doesn’t allow smooth movement, the brain will replay that same movement pattern for your daily tasks.

This will slow your progress and generate some unhelpful barriers to recovery.

For the back to function normally, it needs to move functionally

“Functional movement” as a term has been overused and abused in many gyms. It’s nothing fancy and doesn’t have superpowers.

It literally means any movement that mimics the actually job of the lower back.

The back needs to bend and twist while remaining supported by muscles.

So a functional exercise should do the same.

On the other hand, a plank exercise might be good for strength but it’s not mimicking a normal movement pattern.

This doesn’t provide confidence for the brain to return to normal movements so it’s of limited benefit.

Don’t overcook your strength work

Some fatigue is necessary for strength gains. But if you try to get stronger too quickly, it leads to increased muscle fatigue and soreness.

The fatigue prevents the back from moving and functioning normally for a period of time afterwards.

So while you’re fatigued, you’re more likely to irritate the underlying lower back pain. And excessive fatigue can also trigger muscle spasms, which further delays recovery.

Why I don’t prescribe core exercises

by Pete Colagiuri - Sports Physiotherapist

As a Sports Physiotherapist, I design plenty of exercise programs for patients. They have specific goals that usually link to the cause of the current injury and/or a desired performance goal.

Either way it’s not just a recipe of push vs pull or quads, hammies, glutes.

Typically the most common bit of feedback I get is “but what about core exercises?” or “can you also give me core exercises?”

For me, this thinking shows the common misconception of the function of the core as well as how it should be trained.

Common core exercises

We all know the classic core exercises: planks, sit-ups and crunches.

They referred to as “core” exercises because you can feel your abs on fire. And that’s got to be good, right?

But you need to wonder why we’re training the core…

Is it just for rippling abs (although this will be achieved better through diet and body fat reduction than any crunches)? Is it for improved abdominal strength without a specific goal? Or is it improved core function?

I’d suggest it should be the third option – improving what the core can do rather than its aesthetic or shear strength (although Instagram seems to reinforce option #1 *eye roll*).

To understand the function of the core, you need to look at the way humans move.

Core muscles and how we move

Why do runners swing their arms? Why does a baseball pitcher lead with their leg?

These movements are all designed to either store energy or to counteract movements.

The core’s job is essentially to transfer energy from one end of the body to the other.

A runner’s core needs to function with the arm swing to counter leg drive and maintain trunk alignment. To ensure the leg pushing backwards doesn’t rotate the body, we instinctively throw the opposite arm forwards to offset that twist.

A golfer uses their core to store energy as the hips rotate forwards while the shoulders continue to rotate backwards.

When lifting weights or moving through a walking lunge, your core is involved in stabilizing the trunk to maintain its position against the force of the weight or balance challenges.

Negative effects of focusing on core

With an increased amount of instability, there is greater activation of the core as it works harder to maintain balance. But this is traded off with reduced activation of the arm or leg muscles.

As the force generated by the arms or legs is not on a stable platform, the brain reduces the output of anything outside the centre of balance as it would only add to the instability. That leads to reduced lifting capacity.

So adding a bosu ball to every exercise may seem more challenging but you’re probably reducing the potential benefit of that exercise.

Take home message on core exercises

When I get asked about why I haven’t included core exercises, I explained that every exercise performed well includes core strengthening as well as improvements in core function, simply by focusing on good technique.

This will have a greater correlation to the movement patterns of sport and the performance improvements from the program.

How can I fix my posture?

by Pete Colagiuri - Sports Physiotherapist

It’s one of the most common observations from well-meaning friends, work colleagues and parents: “your posture is terrible” or “you need to sit up straight“.

This usually leads to the inevitable Google search “how can I fix my posture?“, which in turns brings you here…

But before we cover “fixing” posture, you need to understand what normal posture looks like and the three main reasons why posture can be out.

Normal posture in standing and sitting

If you’d asked what normal posture looked like in 2009, we’d show you this beautiful picture of an upright human being.

But the thing is, it’s rare to see anyone stand or sit like that. And even the people that do aren’t like that all the time!

Posture is a combination of bony structure, muscle fatigue and joint movement.

So your normal posture is different from someone else’s posture. It’s even different for you from morning to evening, based on what you did that day.

So here are the 3 reasons why posture might look different from normal.

1. Bony structure

The body is essentially a bunch of muscle slapped around a rigid bony frame. So the shape of that frame dictates the shape of your body, even with muscles pulling it into different positions.

If your spine has bony changes, it may not be able to straighten completely. So your slumped posture isn’t going to change, no matter how much Mum reminds you to sit up straight.

2. Muscle fatigue

For anyone who needs to sit or stand all day, you know how tiring this can be.

And the brain has figured this out. So the easiest solution is to give different muscles a rest throughout the day.

It means you might stand on one leg, then the other. Or arch your back for a while, then round it the other way.

None of these positions are “perfect posture” but it’s a way of resting muscles in sequence.

3. Joint movement

It’s been said long ago that humans weren’t built for sitting down all day long. Or standing still for hours on end.

Our joints require regular movement to stay healthy and mobile.

So if you need to sit or stand all day, the brain occasionally shifts you around to keep things moving. It’s that restless feeling you get after a while.

But constantly changing position will take you away from being like the perfect posture model. And that’s ok. It’s the way we adjust for prolonged sitting or standing.

So how can I fix my posture?

Remembering that there is no perfect posture, what we need is better habits. Getting stronger alone won’t keep you upright all day long!

Focus on variability

Standing desks became popular in recent years but it turns out that sitting or standing all day isn’t great. You need variability.

A desk that you can sit for a bit then stand for a bit is the best option. It’s a sit/stand desk designed for easy transitions between positions.

Regular breaks

Taking a break from the position you’re in every 30min is great. It can be a toilet break, a trip to the printer or just wandering the corridors. Just get up and get moving.

Daily exercise

Research tells us you need 1 hour of exercise for every 8 hours of desk time. It can be a long walk home from the station or a gym visit, just make it a routine. Otherwise the effects of prolonged sitting or standing can accumulate from one day to the next.

Joint health

A balanced exercise session needs to improve your joint health as well as your muscles.

This may be mobility-based training like yoga or repetitive impact loading like running. It keeps your joints healthy and reduces that restless feeling from prolonged immobility.

Hip osteoarthritis – exercises for pain relief

by Pete Colagiuri - Sports Physiotherapist

Hip OA can be present from 30 years of age, although it doesn’t tend to be symptomatic until age 40-50 years
Early symptoms include stiffness (eg. difficulty in reaching shoe laces) and pain after rest (eg. on waking in morning or long car drives)
Risk factors for early hip OA include heavier body types and reduced leg strength

TIPS

Leg strength is King! Getting stronger improves control of the hip and reduces the adverse loading patterns that are irritating the joint cartilage
A short course of anti inflammatory meds can help you overcome the symptoms to get started on a strength program
Reducing body weight makes a huge difference. With up to 8x your body weight impacting your joint during some activities, every 1kg takes 8kg of pressure off the joint

MYTHS

You can’t reverse the internal structural changes but you can reverse the symptoms and get back to pain-free exercise
Running doesn’t wear away your joints quicker. In fact your joint quality is better with running if you’ve always been a runner (those who start later in life don’t get the same benefits) and your running load is consistent (ie. no long breaks and sudden increases in volume)
You’ll often hear the line from doctors that “you’ll eventually need a hip replacement”. Technically we all will need one if we live to 200, but this doom and gloom phrase doesn’t take into account all the effective strategies that can manage hip OA and avoid the need for replacement (until long after you’re gone)