- Proper sleeping positions
- Sparing strategies to use during every day activities
- 3 exercises for the prevention of low back pain
Since every body sleeps, let’s begin with proper sleeping positions.
Back pain is easily aggravated by poor posture and certain positions. That is why sleeping correctly is so important to managing your low back pain.
The best way to sleep (whether you have back pain or not) and keep from irritating your low back is to lay flat on your back with a pillow under your knees. This position promotes a straight spine, taking pressure off the load bearing joints in your lumbar (low back) spine. The pillow also helps take out muscle tension and relieves the low back of spinal stress. Avoid using multiple pillows for your head. This props your head too high forcing your neck into flexion.
If you are not a back sleeper and cannot become one, the next best position is your side. When side lying keep both knees bent and in line with each other and place an extra pillow between them. The pillow helps keep your top leg level, which reduces the torque and stress on your pelvis. Whatever you do, do not sleep on your stomach. Stomach sleeping exaggerates the natural curve of the low back. This increases pressure on the discs and can cause neck issues from keeping your head turned to one side (stay tuned for neck pain article).
Now if your mattress is ten years old or older, it’s time for a new one. When purchasing a new mattress, make sure it is firm and supportive. Do not buy a mattress that you “sink” into. This promotes poor spinal posture like we already talked about. If you are waking up with low back pain it may be time to check your mattress.
Standing up seems like a very basic activity but the truth is many people with low back pain cannot easily move from a sitting to a standing position with out pain. Here’s how it works. People in pain bend forward, putting stress on their low back, to gain momentum to push themselves up. Repeating this behavior over and over again can slow down the healing process. Think about it. If you are constantly aggravating your back how will it ever get better?
To spare your back, move to the edge of the seat, sit up tall (straighten spine) as if balancing a book on your head, stagger your feet one under your knee, the other just in front, and lift your body with your knees. While lifting up, make sure your core is activated (tighten your stomach) and squeeze your glutes tight. This is called the “hip-hinge” mechanism and it is the way you were meant to rise from a seated position.
To further prevent and avoid low back pain, you must learn what NOT to do. For example, when lifting heavy objects (avoid if possible) do not bend at the waist and lift. Instead bend your knees and get into a squat position, pick up the object and pull it in close to your body, straighten your spine, brace your core and lift up with your knees. Prolonged or repetitive forward bending should also be avoided. Sitting for long hours without activity breaks is also low back provoking for all the reasons mentioned before.
So now you know what to do when your back hurts but let’s talk about some exercises you can perform to “fix” low back pain and prevent future exacerbations.
Core Stabilization Exercises
Most people think core strength is abdominal strength, but that’s only part of it. What they don’t know is that your core is a circular band of muscles that is made up of abdominal muscles, obliques (muscles on your side), back muscles, as well as the diaphragm, pelvic floor and glute musculature. Think of it like the trunk of a tree. A large trunk can support large, thick branches, but a small, slender tree can only support weak, thin branches.
Core strength is an extremely important factor when it comes to low back pain prevention. It is a vital component of proper lifting and exercising techniques as well. The core muscles (not just abs) act as protection and stabilization for the joints in the low back. When the muscles are strong and coordinated, they can support the structures in the low back (joints and ligaments) and evenly distribute the forces throughout the joints. This prevents dysfunctional performance and abnormal stress, which is often the cause of low back pain.
One easy way to begin strengthening your core is the “bracing” exercise. This is a base line core exercise designed to teach you how to activate your core musculature. To do this, lay flat on your back with your knees bent and feet on the ground in line with your hips. Straighten your arms with palms up and thumbs pointing away from your body. Then follow these steps, in this order:
- Lift toes toward ceiling, pushing heels into the floor
- Tighten stomach and buttocks and flatten lower back (tilting pelvis backward)
- Hold for 5 seconds, then relax
- Repeat 15-20 times, 2-3 times each day
This exercise is a great way to begin activating your core muscles. It helps build a foundation for more advanced exercises that involve using the abdominal brace.
Here is another exercise used to strengthen the core. The Bird-Dog exercise is a progression of the abdominal brace and should only be implemented once you can effectively perform the abdominal brace. To begin, start on your hands and knees. Hands are shoulder width apart and knees are hip width apart. Keep your head in a neutral position and make sure your back is flat. Activating your core first (by bracing your abdomen), slowly lift opposite arms and legs, extending them straight out (i.e. left arm and right leg). Hold this position as still as possible for about 10 seconds, then relax back to the beginning position. Alternate sides (i.e. right arm, left leg). To start, just try one arm or leg at a time and be sure to maintain the abdominal brace all the way through. Once you feel comfortable with only one extremity, you can add the alternate arm or leg as described above.
To begin, lay flat on your back with your knees bent, feet flat on the floor. Your arms should be at your side with the palms facing the ceiling. Using the technique you learned in the first exercise (abdominal brace) activate your core by tilting your pelvis backward toward the floor and flattening your back on the ground. Once your core is engaged, activate your glutes by squeezing them tightly. Then slowly dig your heals into the ground and lift your lower body (hips and legs only) toward the ceiling. Your head, arms and shoulders should remain on the ground. Keep your thighs straight and in line with your hips and hold this position for 10 seconds. Repeat this exercise 12-15 times/day. Progression of this exercise is to extend one leg straight out while holding the glut-bridge. Alternate legs.
Once you have mastered these three, there are many more exercises and variations to help reinforce low back strength and further prevent future problems.
I hope I have explained the first steps to take when you are suffering from low back pain. You now have the tools to begin managing your low back discomfort. Your daily habits and activities have built up over the years, leaving you in your current status. It may take a couple of weeks, even months to get you on the right track. If these suggestions do not work for you (remember to give it some time) you may want to consult your chiropractor or primary care physician.