Preventing back pain is in our control, mobility coach Dana Santas writes
"A proactive approach to injury prevention and recovery is preferred in sports," she says
Editor’s Note: Dana Santas is the creator of Radius Yoga Conditioning, a yoga style designed to help people move, breathe and feel better. She’s the yoga trainer for the Atlanta Braves, Philadelphia Phillies, Toronto Blue Jays, Tampa Bay Rays, Tampa Bay Lightning, and dozens of pros in the National Football League, National Hockey League, National Basketball Association, Major League Baseball and Professional Golfers’ Association.
Whether you’re a corporate desk jockey or a major league baseball player, chances are you’ve experienced back pain that impacted job performance. It’s one of the most common reasons for missing work, and according to a report recently published in JAMA Internal Medicine, more than 80% of us will experience at least one bout of acute low back pain in our lifetimes. Many will face a recurrence within the first year.
But preventing back pain, particularly a recurrence, might be more in our control than previously thought, research suggests. Through a review of studies that covered treatment methods for more than 30,000 participants, the study’s authors found that the proactive use of exercise showed a greater reduction of lower back pain risk than commonly prescribed passive methods, such as support belts, orthotics and rest.
As a yoga mobility trainer to professional athletes, I can attest that a proactive approach to injury prevention and recovery is preferred in sports; it’s one of the primary reasons I’m hired. Team coaches, trainers and doctors consider prolonged rest or surgery as last resorts, not only because it’s impractical and costly to bench in-season athletes, but because they recognize active recovery as an effective means of overcoming pain for the quickest return to play. They also know that adding back-care exercises to an athlete’s overall strength and conditioning program is key to reducing the risk of re-injury – and preventing pain in the first place.
Prevent pain proactively
When creating back-focused programs, I include exercises to enhance stability and mobility of the spine through all of its functional movements: flexion (forward bending), extension (backward bending), lateral movement (side bending), and rotation (twisting). To that end, I also address alignment and function of primary supporting areas of the body, such as the pelvis and hips, rib cage and core muscles, especially the diaphragm. I’ve outlined a sample sequence of exercises I use with my pro clients that are accessible for most people – athlete or not – to do several times per week for lower back pain prevention and back health.
Not all back pain has the same cause. The exercises below are designed to address a number of potential causes. Check with your doctor to understand the source of your back pain and any associated contraindications before beginning this or any exercise program.
Bridge on chair with diaphragmatic breathing focus
Strengthens back, glutes, pelvic floor and core muscles, including the diaphragm; promotes optimal rib cage positioning and mechanics to support the spine
Because I teach breathing biomechanics as the foundation of my yoga training, I start with diaphragmatic breathing as a means of relieving and preventing back pain. Breathing is our most fundamental movement pattern. The diaphragm, our primary muscle of respiration, is also a postural muscle that attaches to our lumbar spine (low back) and influences spine and pelvis stability and mobility – and consequently back pain.
Lie comfortably on your back with your heels up on a chair and knees aligned above your hips. Place a yoga block or pillow between your legs. Without using your low back, activate low, deep core muscles and your glutes (muscles of your bottom) to lift your pelvis off the floor a few inches into a slight bridge. While bridging, inhale through your nose, filling the lowest lobes of your lungs. You should feel your lower ribs externally rotate to expand outward, as opposed to only inflating your upper chest. Exhale, using core muscles to help internally rotate your lower ribs and release your rib cage downward, expelling all air. A complete exhalation is necessary to fully relax your diaphragm. Inhale for a count of five, exhale for a count of seven, and pause – without taking a breath – for a count of three. Take five breaths like this while maintaining the bridge position. Take a break and repeat.
Strengthens groins, pelvic floor and core muscles while inhibiting overactive low-back extensor muscles
Most people have heard that a strong core is a key component in fighting back pain. But many don’t realize the importance of building core strength that integrates the pelvic floor and hips. Because muscles work in chains for postural support and movement, it’s important to strengthen firing patterns – not just muscles in isolation.
While seated on the floor, curl yourself into a ball with your feet on the floor. Keep your knees and feet together to engage adductors (groins) for hip and pelvic floor stability. Inhale as you reach your arms out to the sides, palms up, without letting your shoulders elevate. Exhale as you bring your arms together in front of you. Do three repetitions. Drop your knees out in a cobbler’s or butterfly pose to release your groins and hips; if hip mobility is limited, additional hip-opening postures are recommended. Repeat for another set of three.
Strengthens back muscles; enhances spine mobility in extension, especially thoracic (midback); supports shoulder girdle stability/mobility; stretches upper-core muscles
Enhancing movement and stability in the shoulder girdle and midback helps prevent compensations that overwork lower back muscles. When done properly, prone backbending poses, like cobra, can lengthen the low back while simultaneously strengthening the mid- and upper back in extension.
Lying on your stomach, place your hands next to your mid-rib cage with your elbows bent and snug to your sides. Press through your palms as though you’re trying to slide your upper body forward through your arms, creating length in your lumbar spine (low back). Inhale as you slowly begin straightening your arms and lifting your shoulders. Exhale and focus on drawing your shoulder blades down toward your waist, feeling your midback muscles engage to create and sustain extension in your spine. Take five long deep breaths. Rest and repeat.
Lengthens and flexes spine, especially lumbar (low back); promotes healthy pelvic movement
Functional squat encourages the pelvis to move through a posterior tilt and release low-back extensors. Like the traditional yoga child’s pose, functional squat lengthens the low back; however, it does so actively rather than passively because you must maintain deep core and pelvic floor activation to the full squat in proper form.
Standing with feet hip distance apart and arms extended forward at shoulder level, exhale and drop back through your hips and pelvis into a deep squat. Maintain weight in your heels with your toes pointed forward. Avoid allowing your knees to bow out. If you have difficulty squatting all the way down without lifting your heels, hold something secure for support. Take five long, deep breaths. Focus inhalations on breathing into your midback and exhalations on relaxing your lower back. If you experience discomfort in your ankles, knees or shins, make sure you’re dropping back into your hips as opposed to pushing forward into your knees. Rest and repeat for two sets of five breaths.
Warrior one with side reach
Moves the spine laterally; releases hip flexors; lengthens side-waist muscles
Prolonged sitting is definitely a contributor to back pain, as well as many other health issues. This posture supports a release of tension in the low back and enhanced pain-free movement by lengthening compressed waist muscles and overactive hip flexors that come from sitting too long and too often.
From standing, step your right foot back, as though coming into a lunge, but place your heel down with your toes angled slightly out. Bend your left knee to align above your ankle. Keep your back leg straight. Place your left hand on your left hip. If balance is a challenge, place your left hand on a wall or other support. Inhale as you reach your right arm overhead to the left, stretching your right side and front of your hip. Avoid arching your low back. Hold the stretch for a few breaths. Repeat on the opposite side.
Standing windmill hamstring twist
Releases tension in backs of legs (hamstrings and calves), low back (quadratus lumborum) and glutes; enhances thoracic spine (midback) rotation
Tight hamstrings are blamed for many things, including back pain. However, hamstrings aren’t usually the culprit, since their tension is generally caused by a dysfunctional pelvis position pulling them into a state of overuse or inhibition. That said, addressing hamstring tension and pelvis position together can provide some back pain relief and prevention. This multipurpose posture also stretches the glutes and each side of the low back, which can sometimes relieve sciatic pain as well as prevent lower back pain caused by lack of hip mobility. Additionally, the windmill aspect of this pose facilitates thoracic spine (midback) movement to avoid low-back compensatory pain.
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From standing, use an exhalation to squat down and place your left hand on top of a yoga block or other similar support. Inhale as you reach your right arm forward and up, rotating from your shoulder, midback and rib cage to twist open to the right. At the same time, straighten your right leg while pulling back through your heel as if you’re sliding it backward. You should experience a stretch in the back of your leg and across your right low back. Hold for five breaths, using respiration to facilitate the twist. Focus inhalations on the open side of your rib cage (the side you’re turning toward) and exhalations on the opposite side, employing side waist muscles to internally rotate your ribs for greater rotation. Unwind back to standing and repeat the movement with rotation to the left.
Educate and empower yourself
It irritates me when I hear people say their “back is going out” on them, like a lightbulb burning out that they can’t control. We have a responsibility to take care of our bodies – our backs included – and the only way we can do that is through action and education. In fact, the recent report noted that combining education with exercise actually reduced lower back pain risk by an additional 10% versus exercise alone.
Don’t hesitate to ask your doctor, trainer, or anyone else involved in supporting your health and wellness, for educational resources. Continue to learn as much as you can and stay aware of the latest research in order to be be proactive in preventing pain. There is no magic pill to create and restore health – at least, none better than self-care.