Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world.
Avoiding the following most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services.
More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content!
The 3 Most Common Mistakes:
1. Sitting too much.
Prolonged sitting (and especially, prolonged sitting on a vibrating surface) is one of the biggest risk factors for LBP. Sitting (slouched in particular) causes excessive strain on the lumbar discs and ligaments. It also leads to tight hamstrings and hip flexors and generally tends to inhibit proper gluteal muscle function.
Despite running or cross training during most days of the week, we all spend too much time sitting whether it’s at our job or traveling each weekend for destination races. Even worse is sitting with chronically poor posture.
- Limit the amount of sitting that you spend at one time. Ideally, move from your sitting position every hour to walk preferably. If you aren’t able to walk, then try to shift your position at least once every twenty minutes. Frequent position changes can help you to avoid LBP. Avoid a long car trip directly before or after a long run or a race. For destination races, it’s best to arrive at least a day or two early and wait a day prior to returning home.
- Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. A McKenzie lumbar roll is a great tool to help you maintain correct posture.
2. Not training the core properly or adequately. Don’t forget the back extensors!
Proper core and lumbar extensor strength is the key to preventing an episode of LBP, which is estimated to affect nearly 80% of the U.S. population at one time or another. In general, most runners don’t spend enough time strengthening their core muscles (particularly, the back extensors).
The core muscles are part of the body’s natural method of stabilizing the spine. The core muscles, along with intra-abdominal pressure, help to form the round cylinder that is utilized to support the spine. Ligaments and boney articulations are also important in spinal stabilization. Most people don’t realize that the core actually consists of two separate groups of muscles, the inner and outer core muscles, and neither group involve the rectus femoris muscles (the six pack).
- The inner core consists of the muscles of the pelvic floor, the transversus abdominis (TVA), diaphragm, and the multifidus muscles (which span the vertebrae along the back side of the spine as shown below). The TVA wraps all the way around the stomach and attaches to the spine. This is what helps to form the cylinder. When contracted (in conjunction with the pelvic floor and diaphragm), it helps to increase the intra-abdominal pressure to support the spine.
- The other muscles that help to support the spine are known as the outer core muscles. These muscles are responsible for movement of the trunk and spine as well as aiding in stability. The inner core muscles do not actually produce any trunk or spine movement. The outer core muscles consists of the following muscles: lumbar paraspinal muscles; the quadratus lumborm; the internal and external obliques; and the psoas major and minor (hip flexors). Some may also include the glutes (buttocks muscles), hamstrings, and quadriceps as part of the outer core muscles.
Those that work on core strength may not be performing the correct exercises. Performing proper core exercises and particularly, lumbar stabilization exercises are the primary treatment modality for LBP. To learn how to effectively exercise and work the core muscles in order to prevent or treat LBP, CLICK HERE.
3. Not performing a proper warm up.
An adequate warm up should always be performed to help minimize the risk of injury and maximize your ability to perform at an optimal level. A proper warm up should include: a cardiovascular warm up; a dynamic warm up; a specific spine warm up; and when indicated, a sport specific warm up.
- Cardiovascular Warm Up. To properly prepare the body for activity, the first stage of the warm up is to increase blood flow throughout the body, but in particular, to the core muscles and spine. I recommend approximately 10 minutes as this allows for better mobility in the joints and tissues of the body. It starts to prime the nervous system for activity. It also promotes healing as movement is necessary to bring in the nutrients necessary to heal (if there is already damage or an injury).
The cardiovascular warm up will vary and is dependent on your activity or sport. I will typically start by performing a light jog or possibility some jumping jacks. Then I may progress into some more intense heart rate increasing exercises, such as jump roping or any other form of standing movement (jumping, bounding, and burpees), in order to increase my heart rate. The goal is to increase your heart rate and promote blood flow throughout the body. The warm up shouldn’t be overly intense.
- Dynamic Warm Up. After my initial cardiovascular warm up, I progress into my dynamic warm up series. This will typically involve warming up the muscles and joints of the spine, pelvis, and lower legs.
The purpose of the dynamic warm up (specifically in the lower extremity) is to insure adequate mobility in the areas that will be involved in the activity. This will almost always include the hamstrings, hips, and pelvis. Adequate lower leg mobility is important in order to perform your specific exercise or activity. The more motion that can occur through the pelvis and legs, the more force can then be generated and passed through the pelvis. More mobility in the lower legs and pelvis means less need for mobility in the spine. This means less stress during motion will be placed on the spine—therefore, decreasing your risk of injury. You want to maximize spinal stability and encourage movement through the hips, pelvis, and upper thoracic.
Within the dynamic warm up, you would perform exercises such as: forward and backward leg swings; side to side leg swings; squats with rotation; and press-ups. Utilizing a foam roller as part of a warm up is acceptable. However, I don’t advocate static stretching before activity as it has been shown to decrease force production and performance.
- Spine Specific Warm Up. I am a big proponent to performing a very specific spinal muscle warm up upon completion of the cardiovascular and dynamic warm ups. Since you may have already experienced an episode of LBP, a very specific and thorough warm up is important for prevention. Priming the specific muscles of the core (particularly, the multifidus and lumbar extensors) is a critical step to avoiding re-injury. The multifidus is a critical muscle in preventing LBP and must be active to properly stabilize the spine. It helps to prevent shearing forces from affecting the spine which is critical to avoiding LBP.
- Sport (Running) Specific Warm Up. This warm up will vary significantly depending on the type of terrain you are running and the speed at which you run. A sprinter will need a very different warm up compared to an ultramarathon runner. You will want to warm up differently if the race is flat or a very hilly trail run.
Examples of running specific exercises include: butt kickers; strides or bounding; and warm up sprints. Even running a little on the actual terrain you will be competing is a good idea. This is also the perfect time to make sure all of your equipment is appropriate for the conditions of the race.
Regardless of your training or event time and/or location, don’t skip the warm up! You may be the only one performing a thorough warm up, but it’s because you understand the importance of one in order to prevent LBP and to improve your performance.
- An inadequate cool down is another common mistake that runners often make. Be sure to take the extra time to cool down and stretch. Start with a slow jog, and then progress to walking until your heart rate returns to normal. This is an excellent time to utilize the foam roller as well as performing static stretches and press-ups.
Now that I have identified the three most common mistakes runners make, which of these prevention strategies can you implement in order to avoid an episode of LBP? I’d like to encourage you to avoid prolonged sitting and to continue working on strengthening your core muscles so that you can avoid injury and keep training! Running and fitness are a lifelong pursuit. If you are injured or just not having fun, then you will not stay engaged and motivated in the long term.
If you are currently suffering from LBP and/or have experienced it in the past or you desire to prevent the most common complaint in today’s society, then you need to check out Treating Low Back Pain (LBP) During Exercise and Athletics. I have designed this complete guide and system to help runners just like you (and me) prevent, treat, and manage LBP so that you don’t have to waste any training days because of ineffective treatment measures.