By Kevin Cheng

Pain is your body’s way of telling you that something is wrong. If you’ve experienced lower back pain, you are not alone! With a shocking prevalence of 84% in the adult population (Balague et al., 2012), lower back pain has become one of the most commonly reported musculoskeletal conditions, adversely affecting people in their daily living, not to mention their workout routine.

Lower back pain can be extremely complicated and is likely the combination of multiple factors. Although there has yet to be more research and investigation on the exact mechanisms, managements, and treatments of lower back pain, several guidelines and prevention strategies have been established and have shown clear and positive effects.

To understand how these strategies can alleviate and prevent lower back pain, it is important to have an appreciation for the anatomy and function of your lower back. Your back muscles are a critical component of your posterior chain, often working together with your core muscles, gluteus muscles, and hamstrings to facilitate movement and produce force. Think of them as being in a team; when one member in the team is not pulling his weight, others have to pick up the slack and have a chance of being overworked. Likewise, when our core leg muscles are weak or tight, the back’s function and wellbeing are also being compromised, which can lead to lower back pain.

So, is doing crunches the answer to lower back pain? Well, not exactly. In order to most effectively alleviate lower back pain, the deep core muscles must be properly trained,

not just the “six packs” that we are all obsessed with. A study by Franca et al. (2010) revealed that segmental training (i.e. transverse abdomens muscle and lumbar multifidus muscles) was better than training the superficial core strengthening (i.e. rectus abdomens, abdomens obliques internees and externes, and erector spinae). Although both treatment groups were effective in alleviating lower back pain and reducing disability, the segmental training group also improved transverse abdominis activation capacity. The segmental training group eventually led to an improvement of 99% in pain perception whereas the superficial strengthening group elicited up to 61% of relative gain in similar measures.

Crunches aren’t bad, and you should keep doing them! However, try to incorporate some twisting exercises (e.g. Russian twist) and transverse abdominis activation exercises (e.g. heel slides) in your exercise routine in addition to crunches. Make sure that you also take the following precautions into account to maximize your effort to diminish back pain:

Proper weightlifting form goes a long way to prevent the exacerbation of back pain and other injuries. Rounding the back when deadlifting, hyperextending the back when squatting, and dysfunction in the sacroiliac joint when jogging are all underlying reasons for lower back pain. If you are unsure, ask a professional to take a look at your form and provide feedback.

Finally, controlling your body weight can also help to mitigate back pain. Having a big belly shifts your center of gravity (i.e. where most of your body weight is distributed) anteriorly, putting additional stress on our back. Obesity can also interact with low back pain in other surprising aspects. This includes increasing the risk of mood disorders (Chou et al., 2016) and accelerating the rate of osteoarthritic changes in the spine (Igarashi et al., 2007), both of which further contribute to the intensity and onset of lower back pain. By controlling your diet, managing your weight, and exercising frequently, you are already taking big steps to prevent back pain.

References:

Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-91.

Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. J Phys Ther Sci. 2015;27(3):619-22.

Chou L, Brady SR, Urquhart DM, et al. The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men. Medicine (Baltimore). 2016;95(15): e3367.

França FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study. Clinics (Sao Paulo). 2010;65(10):1013-7.

Igarashi A, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders. J Orthop Sci. 2007;12(2):154-60.

Kevin Cheng is a rehabilitation specialist, personal fitness trainer, biomechanics researcher, and physician-in-training. He specializes in sports and car accident injury rehabilitation, physique and figure training, and powerlifting. He is currently running a volunteer service, “Access Fitness”, to provide by-donation fitness consultation services and program design for the general public in the hopes of gathering funds for fitness equipment for children in rural areas. For more information, please visit accessfitness.org or contact him at info.accessfitness@gmail.com.