Pain Fixes Blog

April 2017 is Lower Back focus! 

Latest Reviews

    Categorized Under: Lower Back

  • Lower Back: The Simplest Psoas Stretch for Sitting Stress
    Lower Back: The Simplest Psoas Stretch for Sitting Stress
    4.5 Reviewer
    Potential Relief3
    Universality4
    Ease5
    Low cost5
    Low time investment5
    Comfort5
    Summary
    Watch the video in this review: Stand with one foot in front of the other, front knee bent and back leg straight. Keep your back tall and vertical. Move your hip forward, and tilt the bowl of your hip backward, to feel a stretch through the front of your hip and lower abdomen. This stretch can relieve chronic tension in the psoas muscles along with other front of hip muscles, typically from chronic sitting, which contributes to a LOT of lower back pain.
    • Potential relief: 3 – For those who sit, it often can relieve many aches and pains when done consistently. The more pain you have, the more you may need to combine this stretch with self-massage techniques.
    • Universality: 4 - Most people who sit a lot will benefit greatly from this simple correction.
    • Ease: 5 – It takes a couple of minutes to figure out. This video gives clear directions, however, making it easy to get right. You can use a wall or object for balance.
    • Low cost: 5 – Utterly free.
    • Low time investment: 5 – Most people benefit from just a quick 20-second stretch on each side when they stand up from sitting, or get out of the car. More benefit comes from longer 30-60 second stretches as you can tolerate.
    • Comfort: 5 – Should feel totally comfortable and painless.

    From chronic sitting, most people have a pair of chronically shortened psoas muscles. These deep hip flexor muscles connect your inner thigh to the front of the lumbar spine, and can pull your thigh and belly together.

    Often, the opposite lower back muscles tighten to keep the spine upright.  When both the front and back of the spine tighten, you get compression!  The compression and tensions can all cause pain.

     

    Excellent, Clear Video of Standing Psoas Stretch

    I’ve found this video that demonstrates where the psoas muscle is, shows the anatomical drawing, and accurately demonstrates the most practical psoas stretch I’ve found.  As described in this review’s summary, you just need to stand!  Watch:

     

    Many psoas stretches you’ll find require another person to help, or inconvenient scenario like lying on the edge of a table.  Most of you don’t need this!  Stand, and use a wall or surface to help with balance if you need it.

    I’ve taught this to people as something to do right after they get out of the car, or up from their office chair.  It simply works and helps.

  • Lower Back: An Elastic Wrap can Soothe and Stabilize
    Lower Back: An Elastic Wrap can Soothe and Stabilize
    4 Reviewer
    Potential Relief3
    Universality3
    Ease5
    Low cost4
    Low time investment5
    Comfort4
    Summary
    Wearing an elastic wrap around your lower back does several things:
    1. It keeps your lower back warm, increasing circulation and comfort for most individuals.
    2. It provides light to moderate support without inhibiting too much movement.
    3. It reminds you to be cautious of your back, avoiding excessive strain or reaching.
    4. It can help you keep the core ab muscles engaged, encouraging better lifting, sitting, and bending habits.
    5. If able, placing it partly lower around the hips seems to help with hip instability that can contribute to lower back pain. (There are “sacroiliac belts” that do this specifically.)
    • Potential relief: 3 – For people who benefit, they can often relieve about half of symptoms while wearing them over time.
    • Universality: 3 – This may help roughly half of people with lower back pain. It may not be convenient enough for everyone, or it may not be acceptable in your work to have a wrap outline showing through your clothes.
    • Ease to learn: 5 – Wrap at a comfortable but firm tightness. For some people, it helps to wrap lower to include the hips, which can be done if your hips are narrower.
    • Low cost: 4 – Options range from $10-40.
    • Low time investment: 5 – Takes a few seconds to apply.
    • Comfort: 4 - Elastic wraps are mostly comfortable, especially with lower back pain. They might get a little irritating, for some people.

    Here’s one 4.7-star example via Amazon by iDofit:

    Ignore the marketing:  A lot of the elastic wraps I’m talking about are marketed as “fat burning”, which I believe is incorrect.  If you’re physically active in them, you’ll sweat more around your midsection and lose more water weight.  Personally, I’ve worn a neoprene stretchy wrap during multiple hours of giving massage (manual labor), and it didn’t bother me or smell.

    Lower back support “braces” are typically more stiff, but you might want that instead.  I don’t like how they limit movement so much, as research and experience suggest that some movement helps most lower backs recover.

  • Catching the Earliest Pain Warning Signs

    As I announced to my email list last week, my first series of reviews focuses on pain fixes for the lower back.

    Lower back, neck, and shoulders are by far the most common complaints both for normal aches and disabling pains…  Over 50% of adults (NIH) have had pain in the last 3 months!

    One of my earlier emails shared how I jumped back to full functioning after I threw my back out again.  Since then, it’s doing pretty well.  I’m aware of the earliest signs of stiffness and aches, so I try to head off worse pain within a few days…

    Some of the earliest, subtlest warning signs of the lower back needing hands-on attention include:

    • Getting tiny twinges of pain, then it’s fine
    • When sitting, I have to move my hips more to pick things up
    • It’s harder to reach and tie my shoes
    • When standing, feeling like I have to squeeze the lower back muscle to stay upright
    • At night, catching myself slump-walking, which is walking and standing with knees deeply bent
    • It’s tiring to stay bent over in the kitchen
    • It hurts more than usual to press my fists into the lower back
    • I find myself shying away from fun physical activities like dancing or racing the dog
    • At the gym, I feel overly cautious about picking up heavier weights off the ground
    • Having a nagging instinct that I just want to lie down or even hang from a ledge or bar!

    Think about what your own earliest warning signs are for your recurring aches and pains.

    Sometimes they’re observations you’ve learned to notice, like shoe-tying getting harder.  Other times, they’re often instincts, hunches, and even hesitations — your body is trying to warn you!

    Catching stiffness or weakness early before it becomes full-blown pain is a life skill!  The area is often just tense from stress, stagnation, or overuse and needs some circulation or relaxation to recover.  Without recovery, it might worsen.  Early detection can save you from preventable strains + injuries, improve work productivity, and keep you more active without worrying.

    Many of you feel warning signs like this all the time, which means it’s worth taking care of!  Of course, you can get a massage or chiropractic adjustment if you have the means.  If you suspect a medical condition, see a physician or physical therapist to instruct on care and self-care.

    Most of you can empower yourself, though, by using foam rollers, massage balls, stretching (learn which types!), or those exercises you got from “that physical therapist…” once upon a time 😉

    An elastic wrap or sleeve may be a good idea, too.  Light compression reminds you not to suddenly over-exert the at-risk body part, and provides gentle stabilization if there’s a joint involved.

    Go forth and enjoy your lives as able, but don’t forget to catch the earliest warning signs.  Earliest is easiest!  The sooner you restore healthy structure and function, the happier you’ll be.

     

    Warm regards,

    Alex Gwozda, CMT/LMP

  • Lower Back: Heat Soothes and Releases Painful Tension
    Lower Back: Heat Soothes and Releases Painful Tension
    4.2 Reviewer
    Potential Relief3
    Universality4
    Ease5
    Low cost5
    Low time investment3
    Comfort5
    Summary
    Moderate, steady warmth is ideal. Apply a hot pack, an electric heating pad, or a damp, hot towel to soothe and relax the lower back muscles. Also try a hot bath or homemade dry rice heating bag. (Real heat is very different than topical “warming” creams that will soothe or distract skin nerves from pain, but do not increase the temperature.)
    • Potential relief: 3 - The right level of heat can often relieve roughly half of symptoms.
    • Universality: 4 - Generally, use heat for tension that is NOT inflamed. Most lower back pain is not caused by inflammation or injury, but by over-contracted muscles. Of course, get a diagnosis if unsure. Heat may help relieve most cramps, especially if ice does not help it. Typically, heat relieves achy tension from poor posture. Heat is often far better than ice for “knots” and trigger points, when there’s no other fresh injury or inflammatory condition.
    • Ease: 5 – Easy! Microwave a wet towel or hot pack, or find a heating pad (or bathtub). Apply heat. Don’t burn yourself, especially if you have a condition that reduces nerve sensation around the lower back.
    • Low cost: 5 – It’s essentially free to wet a hand towel, wring out excess water, then microwave it for about a minute. Learn online how to make your own microwaveable hot packs! E.g. use a sock and dry rice, or a moist heat pack that conveys heat better, or even purchase bulk instant hot packs that are large enough. Or, buy a medium to large reusable heating (/cooling) pack. Plus, for sustained heat I really like heating pads.
    • Low time investment: 3 – It takes a few minutes for increased blood flow, warmth, and relaxation. Heating pads can be left on for much longer, like 20 minutes or longer if only set to a low or moderate temperature.
    • Comfort: 5 – Moderate heat feels great.
  • Lower Back: Icing Takes the Pain Away – or Makes it Stay?
    Lower Back: Icing Takes the Pain Away - or Makes it Stay?
    4 Reviewer
    Potential Relief3
    Universality2
    Ease5
    Low cost5
    Low time investment4
    Comfort5
    Summary
    Place bagged ice or a cold gel pack on the lower back for pain. Typically, have a layer of clothing, paper towel, or towel in between to prevent burn. An ice cube can also be rubbed on bare skin in a circular motion, for up to 1-3 minutes.
    • Potential relief: 3 - When it's the right choice, like with new injuries, ice can often relieve roughly half of symptoms. Repeated use is often recommended to continue getting benefit - e.g. at least twice a day for several days.
    • Universality: 3 – The major problem with is that most common lower back pains are caused by painfully contracted knots of muscle, not actual fresh injury. Since ice can increase muscle contraction, it can increase the pain by tight muscles. (While not the same, think of how your muscles seize up when you jump in a freezing pool!) Painscience.com makes a compelling research-based argument for why the lower back is an area least likely to respond well to ice. With that said, if ice feels good and helps you – do it! Ice may be good for a new muscle pull, like if you lifted something too heavy. Otherwise, heat may be better to relax upset muscles.
    • Ease: 5 – Put it on and don’t burn yourself. The hardest part is having ice or a gel pack when you need it! There are some one-time use packs available that you carry at room temperature, and then squeeze to create an internal reaction that turns it cold. (Here are Amazon’s bestselling instant cold packs that are big enough for the lower back.)
    • Low cost: 5 – Ice is basically free! Make your own ice packs with instructions online (e.g. mix rubbing alcohol and water 1:2). Otherwise, get a reusable cold pack for <$10, or instant cold packs in bulk for $1 each.
    • Low time investment: 4 – Ice/gel packs begin to numb within 1-3 minutes, and can be applied up to 20 minutes. Direct ice cubes (applied in constant circular motion) work in 1-3 minutes before they should be removed.
    • Comfort: 5 – If it burns, then it’s too cold. Typically, you’ll want a thin layer between the ice pack and your skin, like your shirt or a paper towel or two. Some very cold ice packs require a towel between the pack and skin.
  • Lower Back: Sit Comfortably for Days (Pelvic Tilt)
    Lower Back: Sit Comfortably for Days (Pelvic Tilt)
    4.2 Reviewer
    Potential Relief3
    Universality4
    Ease4
    Low cost4
    Low time investment5
    Comfort5
    Summary
    Learn to sit with a slight anterior pelvic tilt. This can relieve pain by engaging the ideal spinal curve, which gives a better foundation for relaxed upright posture if you also engage the abs slightly.
    • Potential relief: 3 - It often can relieve roughly half of symptoms. Direct self-massage, stretching, exercises, and/or other ergonomics are usually necessary in conjunction with (and to reinforce) this posture reset.
    • Universality: 4 - Helps most people, who slump with a flattened lower back.  Do NOT do if there may be a herniated disc.
    • Ease: 4 - No complicated contraptions required, but it can be tricky to get used to. You may want a towel to lift your rear, or to adjust your seat height or tilt if able.
    • Low cost: 4 - Free if you get it from online videos; otherwise, about $20 for Gokhale's book to learn completely.
    • Low time investment: 5 - Takes seconds to adjust.
    • Comfort: 5 - For most people who slump, this will instantly feel better.  If you get tired quickly or collapse into a slump, you need a more complete posture overhaul.

    Detailed Instructions

    “Sit up straight!”

    We hear that all the time, right?  But HOW do you do that?

    Specifically, how do you do that in a way that feels good on the lower back?

    There are multiple pieces to that puzzle, but the main piece I find that helps the lower back is a slight “anterior pelvic tilt”.  Anterior just means forward.  What does it mean to make the pelvis is tilt forward a bit?

    Imagine a bowl in your hands, and tilt it forward as if to pour water past your toes… Your pelvis is the bowl.  Put another way, it’s going to feel like you’re sticking your butt out slightly when seated, as with this first image.

    Watch this 2-minute video to see clearly the full range of pelvic tilt, and where you should settle:

     

     

    Who Won’t Benefit from Anterior Pelvic Tilt

    You may have heard that anterior pelvic tilt is bad, and you must “fix” it. No!!!  Not when done properly.  Except for a small percentage of people with a very exaggerated forward tilt (second image of boy below), “fixing” anterior pelvic tilt is a total misidentification of where the posture problem is located.*

    There’s a different, real problem with most people who already have anterior pelvic tilt.  Their problem is not the pelvis position, it’s exaggerated spinal curve.  Almost all of them have an exaggerated backward arch in their entire lower and middle back, a type of hyperlordosis (third image of boy below). That reflects disengaged core abs and over-reliance on back muscles, causing the whole back to be overused and upset.  I’ll review those solutions in future posts.

     

    Who This Helps Most

    However, I find that most people flatten their lower backs and round their midbacks in a slump, either slumping forward (toward a desk) or backward (rounded backward into the chair). If so, this posture correction is for you.

    Furthermore, Esther Gokhale’s introductory video below recommends using a wedge, like a towel or a forward-slanting chair, to help with pelvic placement.  This lets your knees be slightly below the height of your hips, easily creating the mild anterior tilt.

    Click for Gokhale’s Sitting Intro Video

    Herniated Disc Warning

    Do NOT do if you have ANY suspicion of a herniated disc in the lower lumbar spine.  Tilting your pelvis this way can pinch off the herniated portion of your disc, according to Esther Gokhale. 

     

    Just One Piece of an Integrated Sitting Strategy

    Sitting with your pelvis bowl tipped slightly forward is one simple piece of a full strategy to sitting comfortably.  For an integrated strategy that will help lock in perfect sitting posture, I STRONGLY recommend learning the multi-part “Stretchsitting” and “Stacksitting” methods from 8 Steps to a Pain Free Back.  It feels really good from head to toe, and takes only a couple seconds to get into once you learn it.  I’ve recommended this book to at least fifty people over the years, because it has changed my posture and life. Combined with exercise and some tennis ball muscle release, I’m now able to sit for hours with practically no back pain and much less fatigue.  So many people need that!

    Like I mentioned above, if you find you already sit with your pelvis like this and you still hurt, it’s likely you have excessive backward arch in the upper lumbar / midback.  You’ll need a solution to correct it. “Stretchsitting” is one solution (official preview video here), along with engaging the abdominals including the transverse abs (some safe core exercises for beginners from Mayo Clinic).

     

    *Controversy Note: “But My Doctor / Physical Therapist Told Me to Get Rid of my Anterior Pelvic Tilt”

    The US medical view for decades has been that anterior pelvic tilt is a bad thing, like Upright Health’s video repeating that argument I don’t agree with.  On the contrary, ancient and modern world societies with pain-free backs universally have an anterior pelvic tilt (as documented by Esther Gokhale and others).  The problem is NOT that forward pelvis!  The problem is when an exaggerated arch backwards continues up through the upper lumbar and middle back, reflecting an imbalance between core abs and the back.

    In Upright Health’s video, her explanation of “bad anterior pelvic tilt” and the over-reliance on back muscles is actually an example of upper lumbar hyperlordosis!  It’s misidentifying the problem.   If you follow that recommendation to tuck your pelvis (tilt the bowl backward), you will compress your lower spine, flatten the buoyant curve in your lower back, and have no stable foundation to keep your shoulders rolled back.  Her “recommended” tucked posture is frankly ugly, and for good reason.  It’s unnatural.  Slouching is inevitable with a flattened lower back, and more pain is likely.

    Some people do get temporary relief by tucking their pelvis, but that’s because slumping the pelvis backward relaxes the back muscles, which are probably tight and hurting from doing too much work.  That will wear on the spine over time.  With slightly engaged core abs, and weight balanced on the ideally curved spine, you have the stability to not over-rely on your lower back muscles – plus a balanced base that gives long-term relief.

     

  • Lower Back: Simple, Sideways Foam Roller Release
    Lower Back: Simple, Sideways Foam Roller Release
    3.5 Reviewer
    Potential Relief2
    Universality4
    Ease5
    Low cost4
    Low time investment3
    Comfort3
    Summary
    Lay half-sideways on a foam roller wedged between your hips and ribs, and tender pressure will slowly relax part of the lower back. This may relieve lower back pain caused by over-contracted QL muscles.
    • Potential relief: 2 - This is a lower score because it relieves basically one muscle. I recommend it because it's so simple and quick, and it uses a tool I think you should probably have anyway for many uses.
    • Universality: 4 - Check first with your doctor if you have spondylolisthesis, lumbar vertebrae instability, or other major spinal conditions. Almost all of my massage clients with lumbar vertebrae medical conditions report that sideways pressure benefits them, and some have had doctor's clearance confirming that. Almost everyone has the basic level of core strength needed to prop your upper body off the ground, in order to control the amount of pressure. Shoulder injuries or neurological weakness from injuries can sometimes interfere.
    • Ease: 5 - Just take a minute to follow the instruction of where to place the roller, and voila!
    • Low cost: 4 - Foam rollers range from as low as $9 for a very short one from Amazon that will work for this technique, to $50 for a full-length, long-lasting, soft OPTP brand roller that is my go-to for many years.
    • Low time investment: 3 – Usually, relief happens within a few minutes on each side.
    • Comfort: 3 - Like all direct pressure release of tight points, this will be a little uncomfortable or painful if done properly. If you apply stronger pressure, it can be very painful, but that's not necessary for the muscle to begin relaxing after 30-60 seconds.

    Detailed Instructions

    Are the muscles of the lower back killing you?

    Here’s a safe lower back fix that directly releases a commonly tense muscle behind lower back pain.

    Laying at a half-sideways angle on a foam roller uses a broad surface with a lot of control.  Unlike some rehab exercises or stretches, there is minimal risk of accidentally pulling or aggravating the pain.

    One major source of lower back pain are “knots” in a pair of short lower back muscles, the “QL”, or quadratus lumborum.  One QL attaches along each side of the lower back, connecting the side wing of each lumbar vertebra to the lowest ribs and the ridge of your hips.  One side’s QL muscle is in bright red:

    Here is a straightforward 2-minute video of exactly what I’m talking about:

    The first part of the video is a WARNING.  Do NOT lay flat on your lower back like he does in the beginning – if you listen, he is demonstrating what NOT to do.  Again, here’s the proper form.  Lay at an angle, halfway between on your back and on your side:

    Typically, contracted “knots” of muscle take at least 30 seconds to begin releasing.  Apply enough weight for a moderate pressure – tender or somewhat painful, but still tolerable.  You should breathe through it and relax into it. Ease off if it starts to spasm or cramp.  Sometimes pain will radiate down the leg or hip; this is normal as long as it’s not burning or like an electrical zap.  (Those tight points that radiate are called trigger points, and can cause that radiated pain even during your day.)

    This is not a complete solution for lower back pain.  There are many other muscles around the spine and hips that need addressing, but this is an outstanding go-to technique for most people.