Stop Bending Your Back To Relieve Back Pain

If you’ve been struggling with a lumbar spine issue for a long period of time, perhaps caused by a herniated disc in your low back then you’ve probably been given knee hugs or other exercises to try to round your lower back for relief. It probably felt good too! But in our experience it really is not helping, what’s more it is something that is getting in the way of the healing process and something that should be eliminated entirely from your rehabilitation strategy. This raises the question “why do so many recommend such exercises then?”. We will explain it all in today’s podcast.

To watch the full video click here.

Rounding your back for relief from back pain

Over the years more or less all of the thousands of members and patients we’ve seen have originally been given exercises like knee hugs or child’s pose as exercises to help relieve their back pain. Unfortunately they do not work, what’s worse is that they often feel nice when you do them. The simple reason for this is two fold.

Stretch sensation to distract from the pain

Firstly, it is common to feel tension in the back which means that when you stretch the muscles in the curled up position, it feels nice. This pleasant feeling is a “relieving” stretch and so it is assumed that it is good.

Relieve pressure on the nerves

Secondly and more importantly, the flexed position of the low back when in a child’s pose enlarges the spaces in the spine where the nerves exit and travel down the leg. These nerves are often being irritated by congestion in the area giving rise to that stiffness, tension, or pressure feeling in the low back. Making the hole larger, immediately eases the pressure and so feels nice.?

Why rounding your back makes the problem worse

The overwhelming majority of injuries to the back involve the discs and ligaments that support the integrity of the segment, for example a herniated disc at L5/S1. These discs have been injured in the rounding position, repetitive strain over the years in the forward bending direction, coupled with bad lifting technique results in weakness and injury to the spine. For the overwhelming majority of people with low back pain, the injury was done in the forward bending and/or load bearing direction.

These structures in the back have therefore been injured and need to tighten up again. But, with the repetitive stretching of these tissues when doing the knee hugs etc, you are interfering with this tightening process.?

Loss of normal lumbar lordosis is everywhere

In modern life, the average adult spends about 9 hours a day sitting. Sitting is flexion, even with the best will in the world, getting into the car, getting onto and off the toilet seat, relaxing in the evening on the sofa, having dinner at the dining table, all of these things INEVITABLY have a greater or lesser degree of flexion. Modern life is HEAVILY skewed towards flexion. As a result there are already ample opportunities for you to bend your spine forwards and undermine the healing process in the lower back, which is trying to restore integrity to the normal natural curve of your lower back.

Lordosis: the natural position of the lumbar spine should have a backward bending curve to it allowing optimal load bearing and mobility.

It is the ligamentous tissues in and around the spine, between all of the bones of the spine that maintain this natural lordosis and balance, so all of the spine does bend and move together in all ranges. When one segment’s ligaments (including the disc) are affected and weakened due to damage, we have a weak link. All your body is trying to do is tighten that section back up again so stability can be restored. Yet daily life has small eliminations of this natural curve baked in every day.?

Take a moment to evaluate your daily life, perhaps even as you’re reading this right now, how’s your low back, is it upright and neutral or are you slouched in the chair?

DO YOU REALLY NEED EVEN MORE FORWARD BENDING IN YOUR BACK?

Semi-permanent change to your low back

Our bodies are amazing, and will change structure according to use. One thing that we’ve seen from load bearing X-ray imaging of thousands of patients over the years is:?

A loss of lumbar lordosis strongly associated with non-resolving lumbar disc injuries and low back pain.?

A normal person can collapse their lumbar lordosis when they bend down to tie their shoelaces, or round the back in normal life. Understand this is a normal movement.

The problem is that the person’s lumbar lordosis is significantly lost when standing upright!

This means their spine is already bent forwards yet their body is positioned in such a way that it is standing upright. Their spine is already flexed, putting more pressure through the discs in the standing position, particularly at L5/S1 and L4/L5, two segments which take the brunt of this change.

So when this person does something like a rounding exercise, a knee hug for example. They are not going from neutral to flexion, they are going from flexion to “even more flexion”. Something that focuses even more strain on the lower lumbar spine and the segments that are injured.

For some people where we’ve done X-rays in a backward bending position, you can see that the person, even when told to bend backwards, cannot get their spine to get to the normal neutral position, let alone extension! They’re stuck in forward bending!

Why do so many medical practitioners recommend forward bending

Simply put, many do not know about the above, as they do not have the experience, they have not been exposed to the imaging and therefore this reality simply is not on their radar. Plus, when a child’s pose stretch feels good in the moment, they are all the more ready to prescribe such exercises.?

In addition to this, most often the philosophy on back pain is often very much one of “muscle spasm” and “pain” rather than the underlying problem, we get into this in other episodes of the podcast.

Shouldn’t a normal spine bend forwards?

Yes, but as you’ve hopefully seen, if you have long standing back pain, there is a chance that you’re experiencing 1 or both of these realities:

• You already bend your spine forwards a bit every day in your normal life without meaning to.
• Your spine is actually already stuck in forward bending through a loss of lordosis.

Unfortunately the latter can only be accurately measured on X-ray imaging, but the simple fact is that in our experience, people with long standing back pain, months or years, already spend too much time bending forwards every day, even in small ways. And therefore elimination of this is of vital concern.?

Even in the normal spine with a normal lordosis and an injury, you’re still doing flexion in order to put your trousers on etc, every morning. The notion that you’re not going to be able to bend your lower back again if you stop doing knee hugs is laughable.?

Strategy for recovering from back pain effectively

Ultimately you need to work on your ability to control your spinal stability. Learn the skill of maintaining whatever “lordosis” you do have, hold your spine steady. We talk about strategies to do this extensively in the Fixing back pain masterclass. We also have tutorial videos on exercises like the modified dead bug exercise for core stability, and others to help get you started on this safely.? Commit to the elimination of forward bending exercises from your rehabilitation, do your best to limit forward bending and rounding of your back in the activities of everyday life, focus on building a strong ability to maintain the neutral spine. If you do this correctly, you’ll find your back pain resolves in time, and you are all the better for it. If you need more help with this then you can check out the membership to the Back In Shape Program where we help you with a structured approach and expert support from our team along the way!