This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2024. For the original video go to https://www.youtube.com/watch?v=2b3QUNI0zTI
Mike: Are you frustrated with back pain and not sure what's helping and what's hurting?
Brad: Well, join us today as we reveal seven of the worst mistakes people make that actually make their back pain worse. Now, these are things that we've found out over the years working with patients and clinical experience. We're going to share them with you. And ready to go, Mike.
Mike: Yes.
Brad: First of all, we're going to cover what you can do with a pillow. People are not using proper support or additional support for their back during a back pain flare-up.
Mike: So if you have a couch that is either worn out or very low in areas, oftentimes just using a little throw pillow in the worn out area can really help support that back. It keeps your pelvis and your lower back in a better optimal position so you're not experiencing as much back pain.
Mike: Now, if you're having back pain in a standard chair, a small pillow might not be enough. You can take a long pillow, place it vertically, and then you have support throughout your whole back. So give that a try. Pick which works best for you, and it can help relieve some of the back pain you're experiencing.
Brad: That's right, and don't forget your vehicle. I have had extremely good success with using support on the back of your vehicle, particularly if you drive more than 20 minutes to and from work or wherever. Alright, the next one is doing the wrong stretch for the specific condition your back has. We're going to give two common examples. The first one is if you have a disc problem and a very common stretch that should not be done. The second one is going to be stenosis or spondylolisthesis, which I personally have both of those conditions. So Mike is going to show the first one I mentioned.
Mike: It's typically when you flex your spine forward. If you have a herniated disc, this can make your problems be worse. You can do this in a long sitting position, or a standing position. Am I stretching my hamstrings and my lower back to a point? Yes, however, if you have a bulging disc, this is probably going to feel worse.
Mike: So a good clue if a stretch is not right for you, is you start doing the stretch or exercise and your back pain starts getting worse, do not do it.
Brad: That's right. The long seated stretch does the same thing to the disc.
Brad: So that's a problem. If we look at spondylolisthesis or stenosis, which with spondylolisthesis, stenosis often accompanies each other, the stretches that you want to avoid are low back lumbar extension. This is one way to extend or arch your back, which is not tolerated, and typically makes it worse. On the other hand, this could be good for a disc problem. So they're almost the opposite. Actually, they have the opposite range of motion in regard to the lower back. So doing this, or stretching backward if you have spondylolisthesis or stenosis is going to be a problem and get you worse.
Mike: So if you are unsure what your back pain diagnosis is, because maybe it's new back pain to you, experiment. If you notice flexing bending over makes it worse, avoid those. If you notice extending makes it better, then go into that. Again, vice versa. Do what range of motion feels good for you.
Brad: That's right. One thing that makes it a little bit tricky is you also want to note how the pain feels while you're doing the stretch, we should get positive improvements. As well as after the stretch. How does it feel five or 10 minutes after you do the stretch? We want to have positive results in that regard as well. Alright, the next thing you really need to be aware of is centralization or how pain feels regarding the location. Now, if Mike has back pain, and it feels like it's covering his whole back. He does the exercise, but the pain, instead of feeling like the size of a volleyball, shrinks down to the size of a baseball and it's more in one spot. That's called centralization, that is a good sign. Even if the pain gets a little worse, but it gets much smaller and more towards the center of the spine, that's good. That's one thing to be aware of, and it is critical. Another thing is if you're feeling pain out and it actually radiates, or refers we call that, down the leg, maybe pass the knee into the foot. It can be any length in that area. If you do the exercise and all of a sudden the pain, it could be numbness or tingling in a disc problem, actually dissipates and goes away distal or further down the leg, and it actually seems to be moving up towards the buttock, or towards the center or back. That again is centralizing, the pain is centralizing. The center, where the back is. Anything that centralizes or brings that pain up in that direction is a good sign, so you want to continue doing exercises that centralize the pain. Mike, do you want to add to that?
Mike: No, I think we can go on to the next subject, Brad.
Brad: Yeah, I really babbled on though with that.
Mike: You did.
Brad: Sorry about that. These next two approaches to resolving your back pain we found recently by an expert physical therapist. He's written books on this. His name is Rick Olderman, and he's really shed some light on our treatment of people as well as ourselves. Do you want to go through them, Mike?
Mike: Yeah. So the first one we're going to talk about is walking with your knees locked. So I'm going to stand up here and show what we mean. So a locked knee is a straight knee or even hyper-extended.
Mike: If I'm walking and planting my foot out in front of me with a locked-out leg like this, the jarring force is going from my heel up to my leg, and even into my lower back. So this can make your back pain worse as you're walking. So to combat this, do not walk with a heel strike and extended knee, try to walk with soft bent knees. You can do this by either kind of landing flat on your foot or on your forefoot more when you walk.
Mike: This will take some getting used to. If you just want to try it, just do it in your house. Walk in slippers or barefoot if you feel comfortable. And that will show you, "Hey, when I'm walking like this, I don't have as much back pain compared to when I'm blocking my knees up." So give it a try first and see if it helps.
Brad: One thing I really want to clarify is when you do this, you do not have to pull your pant leg up like Mike.
Mike: You can if you want to show off your legs.
Brad: No, it is nice, we've had people just say, "Wow." It feels so much better immediately when they go to that soft knee. That's what we call, soft knee walking. The next one.
Mike: So mistake number four is not stretching your hip flexors. Now, if you have tight hip flexors, you'll need to stretch them. If you don't, this isn't as much of a problem. What we're talking about are the muscles in front of your hip. They flex your hip up. However, if they are tight, they can actually start to tilt your pelvis. Notice when I tilt my pelvis forward like this, I'm arching my lower back more and this can increase pain.
Brad: Right, can we use a stick to demonstrate?
Mike: We can, just don't hit me with it.
Brad: Okay, get a good position. Normal pelvis position here, we've got a level here. Now demonstrate tight hip flexors, and notice how the whole level of that pelvic region changes because of tight hip flexors.
Brad: Let's show them a nice way to stretch it. And this is how Rick likes to do it. It's the best, not always the easiest, but it works really well.
Mike: Okay, so you're going to sit at the edge of a bed or a table if you can get on one. Make sure the edge is firm though, you do not want to slide off. The further my buttock is to the edge, the more stretch I will feel. So what you're going to do is begin by lying on your back, and you're going to drop one leg down off the edge here. Once I bend it down, I'm going to start flexing my knee. And it's important to bring the opposite leg up towards your chest. You'll notice once I do that, that you can see a little bit of tightness in my hip flexor. I'm going to just relax and breathe, and try to go for 30 seconds. I also want to make sure my leg is straight, do not let it veer out to the side. Once you do one side, reset your back for a few seconds, and do the opposite leg. There are many ways you can stretch your hip flexor. This is just a nice safe way because your back stays in a nice neutral position and often feels good.
Brad: Right, I like it also because you're allowing gravity to do the work of the stretch. In other words, Mike is going to be completely relaxed throughout his leg and pelvic region. He's locking his lower back and pelvis, and just letting gravity stretch. And you can't actually bring your foot under this way to get an additional stretch on that rectus femoris, which is also a hip flexor, oftentimes, neglected with other stretches. Sorry to babble on, Mike.
Mike: So you can do two to three sets on each side. If one side seems tighter, maybe give that side a little extra stretch.
Brad: Yeah, there you go.
Mike: Okay, tip number five is not bracing your core correctly when doing activities involving your lower back. So this can mean picking something up off the floor or getting in and out of bed. Or in Bob's case when he had some back pain, shoveling snow. If you're from the Midwest, you know what that's about. So what we want to do is engage your core with these activities. This is kind of like a superficial back brace of muscle holding your spine in place so it won't get it to move and cause pain. What you wanna do to begin is, oftentimes I will just put my fingers in the, not right on my belly button, but kind of out to the side, not way out to the side. I would say a 45-degree angle. And what you want to do is push out into it. I am engaging my core this way. Now my core is engaged, helping my back. If your back pain is more up and maybe not low, you can also try engaging the lats. So meaning I'm going to pull down and tighten the shoulder blades. This is locked in, my pecs are engaged, my low back, and you can gauge your core. So essentially you're doing a muscle contraction using your core to save your spine.
Brad: That's right, so it's really important. It's kind of like using your back belt, but you're using your back belt built in. Just do it properly. A lot of people don't think about that. So when Bob was doing his shoveling, he was bending and doing a lot of twisting, not engaging his core. So he shifted to tightening up here and here while we're actually doing the work with it, shoveling, getting out of bed. Lock it in and don't have the twist, move your body with it and your feet. It's kind of like you're dancing with your shovel.
Mike: You're not going to shovel very much snow with that.
Brad: No, well there's no end on here.
Mike: Oh no.
Brad: Yeah, let's go on. Alright, the next scenario is a common thing that you can kind of irritate your back every time throughout the day. Simply getting out of a chair wrong. Mike is going to demonstrate the wrong and the right way.
Mike: So this will depend upon your back issue. Again, as we mentioned earlier, whether it's stenosis or a disc bulge issue. So the first one is flexing forward like this and then standing up. If I have a disc bulge, this is not going to feel very good, because again, we're getting in that rounded forward posture, causing more irritation, and then trying to stand up.
Mike: So a good solution for that is to scoot your butt to the edge, try to have a nice upright posture, and make sure to use your hands to push up, keeping a straight and level back.
Mike: Now, if you're someone with stenosis, and it actually feels better to bend forward a little bit, that's fine. Figure out which position feels optimal for your back when standing up.
Brad: And this is actually a really good time to engage the core, tightening the core as well.
Mike: Yeah, and it's also important when you're doing this, to have a nice wide base of support at the edge. And if you are sitting down, try to control it. Because oftentimes that jarring effect is not going to feel good on your spine.
Brad: That hurts just watching that. Okay, well it's go into the next one, number seven.
Mike: And the final mistake is not lifting something correctly off the floor. Oftentimes when we're not thinking about it, we just reach down, again, notice the curvature of my spine, and then we lift up. And then it hurts even more because I bent down and I'm lifting something. Depending upon the weight, it can really make it worse.
Mike: So what we want to do is try to keep a nice neutral spine when we're going down. There are variations of this, so we'll show a few options. So what I want to do is keep a nice straight back as I'm bending down. If Brad puts that Booyah Stik on my back here, you can see it's touching the back of my head, my shoulder blades, and then my lower back region. As I'm going down, try to keep this position as well as you can. If you start rounding, this is going to cause some problems.
Mike: Now, some people are not going to be able to keep a straight back, you're probably going to have to start bending your knees. If I try to keep a straight back, I get stuck here. So it's good to use your legs when you're picking something up off the ground. If you do not feel comfortable doing this, Brad, do you want to show another option?
Brad: Sure, you can do the, what we call the golfers lift. The only thing it has to be a light object, which you should be lifting light anyway if you've got a back problem. So I'm going to actually kick one leg out. One hand for balance probably will need that out. And then pick up the object. Again, it's going to be a light object you can do with one hand. And it works really well.
Mike: And a final option, if your legs and knees are feeling good, you can simply hold onto something if you want, but you can kind of just do a little lunge, go down, and then come back up. That may just be easier for some people. Again, try to maintain a nice spine with this. Don't get rounded forward because you certainly can.
Brad: That's right, a very good option. Mike, what do we have next?
Mike: That's all of them.
Brad: Whoa, number seven. You can't go wrong with the number seven. So all of these, now you may find that only two or three of these really affect your back and make it feel better. That's the goal. Go through all of them in detail with us, and enjoy the day. We have one more video that can be helpful, right, Mike?
Mike: Yes. If you want to check out more videos on back pain, this one actually has exercises and stretches you can do if you're having chronic low back pain, "Simple, Easy Treatment Routine For Chronic Back Pain."
Brad: There you go it's a good video.
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