The lumbar spine of the low back is one of the most common pain areas in the human body. This is in large part due to the fact that it's a juncture between the spine and the pelvis. This transition zone can tend to take the brunt of the damage from any dysfunction in the legs and hips, especially a pelvis which is off from natural alignment.
This area of the spine is also responsible for much of the rotation experienced when we turn our bodies. With so many people spending much of life moving and facing forward, it's common to see lack of movement efficiency with lateral or rotational movement. When this is the case, the lumbar spine is a common area of overcompensation, causing low back pain and sometimes injury.
A healthy and properly aligned lumbar curve can create overall better posture, better movement and allow one to more easily transfer strength between the upper and lower bodies. This article will go over the three most common lumbar spine issues and some simple strategies for how to overcome them.
#1. Lumbar Lordosis and Compression of the Low Back
For many, the curve of the lower back has become more pronounced than it should be, known as lumbar lordosis. This results in compressive forces being applied to the back of the vertebrae and the spinal discs between each vertebra. When injury does occur, it tends to be caused by this excessive compression and is often in the form of herniated discs, muscle strains or nerve impingements on the back side of the lower spine.
This can also alter the posture and mechanics of the rest of the spine, often promoting cervical lordosis (excessive neck curve) and thoracic kyphosis (excessive upper back curve). In fact, many dysfunctions of the neck and upper back will not resolve until the lower back and hips have been addressed and realigned.
Lumbar lordosis also causes or is associated with anterior pelvic tilt, causing the bowl of the pelvic to tip forward. This often causes kinetic issues down into the legs and increases the likelihood of knee and ankle injuries. This same anterior pelvic tilt also causes the lower abdomen to bulge outward as the contents of the pelvis tend to “spill out” from the forward tilt. Many people who work hard in the gym to lose stubborn lower belly fat are actually just seeing this lower abdominal bulge.
To correct excess lumbar lordosis, the muscular imbalances which allow it to exist will need to be addressed. Often the abdominals and anterior obliques are weak in comparison to the muscles of the low back and need to be strengthened. This will pull the front of the pelvis and ribs closer together and lessen the curve of the lower back.
A great exercise for this hollow body holds, as they engage most of the anterior muscles of the core and do so in an elongated position similar to standing.
To perform the hollow body hold...
Lay on your back, bend your knees and point your knees up to the ceiling.
Raise the arms so that the hands point towards the ceiling as well.
Now tuck the pelvis up, so that the butt slightly comes off the ground and crunch the ribs down as you would in an abdominal crunch, slightly lifting the upper back, shoulders and head off the ground.
If done properly you should be laying on only your lower back and engaging the muscles of the core.
Hold this for 30 seconds if possible.
To make this more difficult, simply lower the legs and arms while maintaining the same core position.
It can also be helpful to stretch the lower back and relieve some of the compression directly. The child's pose is perfect for this as it's very simple to hold for long periods of time. In fact, it can even be relaxing and makes an excellent addition to a cool down after a workout.
Simply kneel onto the ground and sit back on your feet. Then lower your upper body so that your head and outstretched arms lay on the ground. Once in this position, relax and take deep breaths into the belly, allowing the low back to expand out with each inhale. Do this for anywhere between 30 seconds and 2 minutes each day.
#2. Loss of Lumbar Curve
The reverse orientation of the lumbar curve is often commonly seen, where curvature is lost as opposed to increased. This will often present as a straight lumbar spine or in extreme cases the curve becomes completely reversed.
This is more commonly seen in those who have to stand for long periods of time and often spend much of that time slouching in an effort to conserve energy. The slouching causes loss of lumbar curve by tucking of the pelvis into posterior tilt, much as a dog tucks its tail. This rounds the back into a giant “C” curve, reversing the natural curve of the lower back.
This can create excess pressure on the organs as the ribs crunch down, causing diminished organ function. This can often be seen in the form of digestive issues or shallow breathing. The loss of curve also makes the spine less capable of absorbing the shock of normal athletic activity, thereby increasing the likelihood of injury.
In this posture the glutes, hamstrings and abdominals are often overly tight and need released and stretched. Whereas the muscles of the lower back and quads are often weak in comparison. Emphasizing these weak muscles during workouts alongside conscious attention to posture throughout the day can do a lot towards restoring curve. However, there is often an issue with the ligaments of spine having already been shortened on the front side of the lumbar spine.
Ligaments require long periods of stretching in order to actually lengthen, periods of time too long to hold an active stretch. To solve for this, you lay over an object which will put the spine back into a proper curve. A common method of doing this is to lay on a rolled-up towel, placing it right in the middle of the lumbar curve. Lay on this for 20-30 minutes at least 3 times a week.
The only issue with this is that the rolled-up towel isn't exactly standardized to the shape of a lumbar curve. So, while it still does help and I would certainly recommend it, the process can be improved by using a device specifically shaped to restore the lower back. Lumbar curve pillows are a great option for this. They are inexpensive and easy to use, and models are made specifically for the seated position. I use one of these in my car to maintain a lumbar curve during long commutes.
Below are some amazon links to a few of these products if you would like to check them out.
#3. SI (Sacroilliac) Pain
SI joint pain has quickly become one of the most common issues I see in the clinic. The SI joint (sacroilliac joint) is the joint between the two halves of the pelvis and the sacrum of the lower spine. This is a joint which is mostly designed as shock absorber for the spine and hips. As such it doesn't like to open very much, in fact any joint opening greater than 3-4mm is likely to cause pain.
The problem comes when the joint is opened further than it can tolerate, or it is chronically held open near the end of its range. Many nerves exiting the lower spine travel through this area and the irritated SI joint can really cause a lot of pain by putting pressure on these nerves. This pain is usually centered directly over the SI joint and can sometimes radiate up into the low back or down through the glutes and into the hamstrings, often mimicking sciatica.
In the short term this is usually caused by twisting motions. For instance, it's common to see in golfers who are constantly twisting the lower back when hitting the ball. In the long run the joint is made weak and susceptible to injury by strength imbalances between the glutes and low back versus the abdominals and the hip flexors. When the abdominals and hip flexors are stronger than the glutes and lower back, the forward pressure on the pelvis pulls the SI joint open in a chronic manner.
So, solve this imbalance it's important to strengthen the lower back and glutes while stretching and/or releasing the abdominals and hip flexors.
The simplest strength routine to hit these areas would be glute bridges and prone arch holds (supermans). Performing each of these with just the body weight for 15-20 reps, 3 times a week is often enough to begin taking the pressure off the SI joint. Especially when paired with abdominal stretches such as the cobra pose from yoga, and hip flexor stretches such as lunge stretches.
While these exercises and stretches are rearranging the pressures on the SI joint, which may take a few weeks or longer, you can often get temporary relief with an SI belt (trochanter belt). This is an elastic belt designed to go over the hips, putting compressive pressure onto the joint to help it temporarily stay closed. For many people this stops the pain immediately, and as a bonus it helps the joint heal more quickly by allowing the ligaments holding the joint together to begin to shorten and heal.
Though I would certainly still suggest doing proactive exercise to help heal the SI joint in the long run, this belt can be a god send for those with intense SI pain.
That's the end of the 3-part spine series. I hope it's been helpful and feel free to comment below and let me know if it helped or if there are any other topics you would like to see covered.