Low-back pain sucks donkey balls. Roughly 85% of people will experience it at some point in their lives. It may vary in severity but no matter how you look at it, that’s a fuck-ton of people with ouchies in their back.
I am one of those people. I have had low-back pain of various forms many times. I can’t count the number of times where I have been at the point of justifying that I don’t need whatever I just dropped on the floor. For real.
Getting up from the toilet, or any chair for that matter, took unbelievable levels of motivation and contemplation. “I can order take-out directly to the bathroom can’t I”
Considering that firefighters are humans too, it’s safe to assume that 85% of them will experience back pain at some point over their careers. It’s a gross understatement to say this is problematic, given the nature of this profession.
Many people receive a diagnosis of non-specific back pain and a non-effective rehab program of low back stretches and crunches to strengthen their core. Maybe they’ll get told to do a plank if they’re lucky. A poor, cop-out diagnosis met with an ineffective rehab approach. In extreme cases they might be referred for back surgery, which according to Dr. Stu McGill, the back mechanic himself, is the wrong way to go and they would be better served with “virtual surgery”.
After surgery patients are forced to rest but with virtual surgery the scalpel is cut out (pun intended) and patients act as if they did have surgery by resting. This is the first step to recovery. We go on thinking back pain is just part of normal life and fire fighters everywhere develop new standard operating procedures that include pain. This is not normal and pain shouldn’t be the norm.
The low back is designed, or has evolved, to function as a transfer point for force to translate from the legs and hips out to the extremities. The lumbar spine (technical term) is made for stability and stiffness while the hips and thoracic spine (the upper back) are made for mobility.
Common causes for low back pain in firefighters are similar to the rest of the population, stiff upper back, which can also cause shoulder issues, and immobile hips. This, coupled with a lack of stiffness and poor motor patterns is the recipe for constant low back pain, possibly leading to more serious issues.
How do we fix this? According to Dr. McGill we do the following:
- Virtual surgery – Rest the low back, avoid painful positions and movements. Allow the area to “calm down”.. Dr. McGill refers to this as avoiding “picking the scab”. Each time you go through painful movements you prolong the pain and slow down healing.
- Reprogram movement – In addition to avoiding painful movements you will need to find postures and ways of moving around that do not cause pain. Perhaps replacing bending with lunging to reach the floor if possible. This may take some experimenting but is generally avoiding flexion in most movements. This is referred to as practicing good spinal hygiene.
- Increase range of motion in the hips and upper back with targeted stretching and mobility drills that do not exacerbate low back pain. You’ll generally be looking at some glute stretches, hip flexor stretches and perhaps a bench t-spine dip.
- Increase stiffness through core stability program. McGill’s “Daily Big 3” is the most effective way to do this because science. All jokes aside, I have not found a more researched and proven method than McGill’s “Daily Big 3”. His research has shown these three exercises to be the most effective at training and creating the stiffness needed to beat back pain and return to performing.
The Daily Big 3
The side plank will create stability in the lateral line or the frontal plane. Begin lying on your side with your top leg in front of your bottom and your feet in line. Your shoulder should be stacked on top of your elbow. Pull yourself up into a straight line and hold this position. If this is too difficult it can be regressed to bridge from bent knees.
Modified Curl Up
This limited range exercise will strengthen the rectus abdominis (the 6-pack) while sparing the low back. Begin on your back with one hip and knee bent and the other straight. Place your hands flat under your low back for support. Brace your abdominals and lift your elbows off the ground. Finally, lift your head and top of shoulder blades off the ground, maintaining a neutral neck. Hold here and return to the ground.
This will train the low back directly as well as the glutes and develop the ability to resist rotation. It is also one of the most butchered exercises in like, ever. Start on all fours and find a neutral spine position. You can use a dowel touching your head, mid back and tailbone or have a friend assist you. From here reach your left arm forward and your right leg back towards the wall. This should occur with no movement in your low back. At all. Period. Hold this position and return to the start. You’ll want to do the same with the other side. This can be regressed to just moving the arms or just the legs.
With each exercise you’ll want to aim for holding from 8-15 seconds each rep. Every body will be different but generally the goal will be to aim for 6 reps in the first set. Follow a descending rep scheme completing 2 fewer reps with each subsequent set. So, 6 then 4 and finally 2. You may need to start at a lower number to prevent pain. For example, if you can only perform 2 good reps then start here and perform 1 rep on your second set. Try to build up to 3 in time and keep progressing from there.
If you find you are unbalanced right to left on any exercise then make your goal to achieve balance first then work to bring up any lagging exercise. Balance side to side then balance between all three exercises before progressing time. Once you achieve a 6,4,2 rep scheme then work to increase from 8 to 10 seconds and continue to 15 seconds per rep.
When you can perform this rep scheme with 15 second holds each rep then this routine becomes a warm up and you can move on to more difficult core exercises.
Even if you are one of the lucky ones and are currently not experiencing back pain it’s a smart idea to implement the Daily Big 3 into your routine as a prevention measure. Once back pain is under control it is vital to take an inventory of your training program to make sure it’s not the cause of your pain. Eliminating exercsies that don’t fit well with your build or abilities will go a long way in staying pain-free down the road. Personally, I have removed almost all bilateral squatting in favour of single leg training and it has kept me healthy as the months pass. Read more about it here.
Low-back pain is a bitch but it doesn’t have to be a life sentence. Finding a therapist that is up-to-date and familiar with Dr. McGill’s research will make a world of difference. For more information about the causes of low back pain, self-assessment and self-care, check out the book Back Mechanic.
As this is something that affects the daily lives of so many people, and occurs at an alarming rate in firefighters (yes, pun intended again) I’ll be revisiting this topic with more information and progressive exercises. Keep checking back, or just join the mailing list and I’ll let you know when something is published.