"If your spine is inflexibly stiff at 30, you are old; if it is completely flexible at 60 you are young." Joseph Pilates
Back pain can be debilitating, frustrating and depressing. It is probably the most common complaint among adults, certainly in the UK where at least 7 out of 10 people suffer from some period of back pain during their life. It also accounts for the most days of sick leave in the UK. This has not been helped with the pandemic causing many people to switch their working environment from the office to their homes, where desks and chairs may not be as suitable for working at, playing havoc with our backs and our overall postures.
Thankfully most back pain will resolve within 8 weeks, however some 20% of people with back pain go on to develop chronic persistent back pain, lasting 12 weeks or more.
Our backs are complex structures with many parts.
Primarily we may think of our spine, the upright column of 24 individual vertebrae which are divided into 4 sections:
7 cervical vertebrae in the neck which are the most mobile.
12 thoracic vertebrae which are attached to the ribs, together they protect the internal organs.
5 more weight bearing lumbar vertebrae, forming the lower back.
Then the fused vertebrae of the sacral coccyx region.
Additionally, between each vertebrae are the cushioning intervertebral discs. Many nerves run through the central spinal cord and nerve roots reach out from the spine to other parts of the body. Multiple muscles attach to each vertebrae. Unlike the muscles of our limbs which are often distinguishable individually, the deep intrinsic spinal muscles are composed of numerous bands of densely interwoven fibers that make it difficult to isolate a particular portion of muscle. These smaller intrinsic muscles provide huge support and stability to the vertebrae as we move. Furthermore there are bigger extrinsic muscles (latissimus dorsi, rhomboids, trapezius and levator scapulae) which are more superficially positioned on our backs and control our movements.
With all of these various structures comprising parts of our back it is perhaps easier to appreciate why back pain is both complex, common and sometimes hard to really pinpoint it’s exact cause. We have also not yet mentioned how our abdominal muscles also play a synergistic role in supporting our backs, but from the front of our bodies.
There are many pathologies of back pain and as a Pilates Instructor I am not qualified to enter into trying to diagnose someone's exact cause of pain, I highly recommend you seek professional medical advice for that. However, the current thinking for relieving most back pain is now actually movement. Gone are the days where the advice was to lie flat on the floor for hours to rest, we now know mindful movement and strengthening are much more effective. So, if you experience bouts of back pain or want to prevent back pain occurring here are five of my go to exercises/stretches to try to help keep you pain free:
Hip rolls - Lie on your back with your knees bent and your feet hip width apart, arms long by your side with the palm facing down. Using your abdominal muscles first tip your pelvis in towards the rib cage and feel the spine come down towards the mat. Keep rolling your pelvis in so that the tailbone lifts off the floor, now start to push through your feet and roll up through the spine to come up into a bridge position resting between the shoulder blades. Reach your knees away from you stretching your body long from the shoulders to the knees, then roll slowly back down replacing your spine back onto the mat from the back of the shoulders, to the back of your ribs, to your lumbar spine and the back of the pelvis reaching your tailbone towards your heels. Repeat 6 times.
Spinal Rotation - Lie on your back with your legs in a table top position (you can squeeze a small ball/yoga block/cushion between the knees to help keep alignment). Take your arms out into a T position on the floor, now lower your legs towards the floor on the right hand side, keeping the back of the shoulders heavy on the mat. Take a breath, then using your abdominals draw the legs back up to table top. Repeat to the left hand side. (If you find this too much, you can keep the feet on the floor and only take the knees to the side.) Repeat to each side 3 times.
Knees to chest - lie on your back, hug your knees into your chest, allow your spine to sink into the floor beneath you, reaching your tailbone down towards the mat. Hold for a few breaths. This could also be done one leg at a time, keeping the other leg bent with the foot flat on the floor.
Swimming prep: Be on your hands and knees looking down at the mat with your spine long (you are like a table). Imagine a bowl of water resting on your lower back, now reach one arm forward and the opposite leg back behind you, stretch the fingertips and toes long away from each other and draw in on the lower abdominals. Then lower that arm and leg and switch to the other side, trying to do it without spilling the imaginary bowl of water resting on your lower back. Repeat 6 times.
Hamstring and lower back stretch using belt/flex band - lie on your back, place a belt over the sole of your right foot keeping hold of the ends of the belt in both hands, lengthen your left leg long along the mat, make it heavy on the mat. Now straighten your right leg up towards the ceiling pushing the foot into the belt. Reach your tailbone towards the mat, and keep the hips level. (You can bend the leg that is resting on the mat and plant the foot on the floor, if the stretch feels too much.) Hold for a few breaths, feel the thigh bone sinking into the hip socket and the back relaxing onto the mat. Repeat with the left leg.
Assuming that there is no underlying medical condition, then gentle and regular movement is generally more beneficial to a stiff or painful back, than no movement or limited movement. Whilst it might seem counterintuitive initially, trying the exercises above may help. Alternatively, even simple walking is a great option for people with back pain because it’s non load bearing and easily accessible. As well as checking your posture regularly too. Are you sitting or standing tall, or are you slouching? Even small self corrections on your posture to lengthen your spine and not slouch over time will strengthen your muscles and hopefully create new positive postural habits to keep your back pain free.
“We retire too early and we die too young. Our prime of life should be in the 70’s and old age should not come until we are almost 100.”
Joseph Pilates
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