Now that we have covered the background and the first two phases of the self-treatment plan for your specific condition, we are going to get a bit more practical. Regardless of what you are suffering from, the bottom line remains that in the end any form of intervention will help… Unless you’re being irresponsible and said intervention doesn’t make any logical sense. So please, before you embark on this self driven journey to recovery please do not take everything at face value. You will need to use a certain level of discernment to establish what is right and what is wrong for your specific situation.
The only reason we bring this up is simply because this process is on you, you decided to treat yourself so it will require you to make a little bit of effort to ensure the correct decisions are made along the way and if you mess up and make a mistake, you need to know how to get back on track. And that is where we come into the conversation, as the next part of this article will serve you greatly in this regard. So without further adieu let’s get started!
The lower back area of our body forms part of our core. Now I know many of you associate the core with the rectus abdominis, that’s the 6 pack for your information. However, contrary to popular belief the core is made up of much more than just your abs. To be exact the core consists of the following muscle groups:
And muscles that are not directly involved in the core but do play a minor role in its functionality are:
Now will you look at that? The core has so much more to offer than 6 symmetrical blocks of muscle. Do you now understand why doing more than just sit ups 5 times a week is necessary to strengthen your core? As you can see the rectus abdominis is one of twelve muscles that make up our core and five of the twelve muscles have both direct and indirect involvement in the lower back’s functionality. Is the picture getting clearer now?
The point we’re essentially trying to make is that before you can just start with a rehabilitation program you need to understand what your lower back does, how it functions and based on that you can infer why it got hurt and how to proceed from there.
That being said, it also depends on the type of injury we’re dealing with and the severity therefore. But for the sake of continuity let’s assume that each of the injury categories we’re about to cover fall under the moderate category.
Posterior Chain and Lumbopelvic Region…
The majority of the above mentioned muscles form part of the body known as the lumbopelvic complex. This area is on a micro level, all interconnected to the point that these muscles depend on each other to maintain your posture and mobility.
On a macro level, this is just a little caveat if you will, the lower back and by extension the lumbar region of the back, forms part of a bigger functional group called the posterior chain of muscles. Now, this isn’t a scholarly anatomical concept, this is a practical idea that stems from years of practitioners realizing that there are a chain of muscle groups that are all interconnected. These muscle groups run from the base of the skull all the way down the posterior aspect of your body to the base of your feet. The lower back forms a significant part of this chain as it is the middle point between the upper and lower body.
So as you can see the chain relies on efficiencies because if one part of the chain is negatively affected in any way, the rest of the chain suffers. Make sense? So we encourage you to look at your body as a whole in relation to your condition as it’s all interconnected in some way or form.
The reason we’re starting off with this category is simple- Pain. Yes, these injuries are usually painful. Have you ever had a tightness in the lower back that doesn’t get any relief from traditional stretching? Or have you ever had a moment where your back muscles all pull together resulting in severe pain and discomfort so much so that you can’t move much or even at all. The two likely culprits for these issues are myofascial pain and or muscular spasms.
So how do you go about treating them at home? Well if you have someone that is willing to assist you, some light manual therapy or therapeutic massage can significantly reduce the symptoms and in most cases resolve the underlying issue. However, we do understand finding someone that not only is willing but capable of correctly massaging you can be a bit of an issue.
That being said, if you have a little extra cash lying around and would like to invest in an affordable method of manual therapy, look no further than a percussion massage gun. Now yes, the fancy branded versions are quite pricey, but if you can look past celebrity endorsements and crude advertising you will find loads of affordable options that all have the same quality as the brand name massage guns.
Therefore, the best DIY method to relieve yourself of these issues has to be self myofascial release. Now I am not talking about foam rolling, yes it is the poster child for self myofascial release, but the truth is most foam rollers and foam rolling techniques are ineffective. Why? Well simply put, people really don’t enjoy the feeling. That’s because real myofascial release is an extremely painful experience.
Okay, so how do we go about it? First of all you need the correct apparatus and the following are all suited to assist you to release your tension within your body:
All of the above are tools designed with the sole purpose of releasing knots and spasms in your fascia and muscles. There is one single gold standard method of treatment but we have found that a combination of one or two of these options will definitely help you manage your symptoms.
This is where the rehabilitation process becomes far more intentional and specific. This is because these injuries follow a healing pattern that has a specific timeline. This just means that over the years doctors, physical therapists and researchers have monitored how the body responds after these types of injuries and developed a sort of template on how long recovery takes without and without an external stimulus such as rehab. Now we’re not saying you can fully recover without rehabilitation, but we strongly recommend that you do indeed follow some form of rehabilitation regime.
That being said, when it comes to our backs we need to consider the differences in anatomy. What we mean by that is if you take an injury to one of your muscle groups or tendons within your lower extremity it’s pathophysiology is markedly different to that of your lumbar region. The biggest consideration here is that there aren't more than one movable joints in the lower back. So things such as open and closed chain kinetics or forces and leverage don’t play as big a role in our lumbar region as it does in other areas of our body.
Strains and sprains are very similar, the only difference is the connective tissues they affect. Now yes, the official definitions are as follows:
So if we think about it, that essentially means that sprains affect tougher tissues such as ligaments or in some areas of the body tendons, while strains affect softer tissues such as muscles and ligaments. But regardless, there is significant overlap between these connective tissues.
In spite of this, there are certain aspects that are relevant for strains and not for sprains. If we referred back to the muscular anatomy we covered a few sections back, you quickly see how easy or rather how probable it is to suffer either a sprain or strain. The bulk of the stability and strength in the lumbar area comes from muscle. Yes, there are significant ligamentous and tendinous structures in the lumbar region of your body, however due to the layers and layers of muscular tissue, a muscle injury is more likely than a harder connective tissue.
But that doesn’t mean that ligament and or tendon injuries don’t happen, they do, but they require there to be either of following mitigating factors:
Both of these factors can lead to a lower back ligament or tendon injury. In the case of the latter factor, more often than not there will be an accompanying muscular injury.
But in both cases the rehabilitation strategy relies on timing. Connective tissue injuries require time to heal, you cannot, I repeat you cannot force the injury to recover before it’s set healing time. It’s physiologically impossible. So when approaching your rehabilitation, particularly because you’re doing this by yourself (without professional help), you need to be sure you’re not trying to force the issue here. Allow your body to heal, and then you can start the process.
The 3 Rehab Principles you Need to Follow…
Because there aren’t any limbs in this region of the body, leverage between joints really isn’t relevant. So when it comes to these types of injuries the three rehab principles you need to implement are as follows:
Together these principles form part of a training philosophy known as Triphasic training.
This form of training is designed and based on the above mentioned loading techniques. Triphasic training focuses and implements the different techniques of muscular contractions.
To define them we’re going to give you short descriptions of each:
Isometric training refers to a method of training where there is muscular contraction without motion. The length of the muscle remains constant despite an increase in or a maintenance of constant tension. A good example would be performing a plank exercise.
Eccentric training refers to a method of training where the length of muscle increases as there is an increase of tension. I.e. The muscle gets long while a load is being applied. A good example would be the second half of a chin up where you are lowering your body downward and straightening your arm.
Concentric training refers to a method of training where the length of muscle decreases as there is an increase of tension. A bicep curl is the best example here, where the muscle decreases in length while increasing the time under tension.
Okay, so now that we have an idea of what these techniques are, the question remains why is Triphasic training relevant to this form of rehabilitation. Well, you remember us discussing the fact that injuries of this nature need a set amount of time to heal? Well, that’s where this training technique comes into play. As each of these training types will need to be implemented at different stages of the healing process.
Isometric training will be implemented during the initial stages of healing as this is the safest technique for strains and sprains. Why? Because of the absence of motion. The less movement there is in the injured tissue the better it is for the overall recovery process. This is the greatest benefit of isometric training, as you are essentially able to load an injured tissue, within limits, without causing any significant pain or further damage.
Next up we have eccentric training, which comes with a bit of a catch twenty two situation. On the one side eccentric training is the perfect technique to implement during the midpoint of your recovery process as you will be utilising and stimulating the muscle when it is at its longest points, making it an overall safer option. However, eccentric loading places the most stress under tension on the connective tissue of all three of these contraction types. Thus despite it’s greater potential it also comes with greater risk. Therefore we suggest that you use eccentric loading very wisely by simply not overdoing it during your rehabilitation.
Lastly, we have the classic contraction type… Concentric loading. This type of loading should be implemented at or towards the final stages of your rehabilitation. This is because it poses the greatest risk of reinjury. Shortening the muscle or other connective tissues while loading places stress on the fibers that can lead to micro and even some cases macro tears. That’s why we implement this contraction type toward the later stages of the recovery process, as the initial isometric training and consequent eccentric loading will help provide a good foundation to build on.
Triphasic training is a great example of a training method that takes into consideration the various stages of rehab and recovery. Because injuries of this nature tend to respond differently as its pathophysiology can be impacted by multiple factors such as the physical stature of the patient, the extent or severity of the injury and the mechanism of injury, using this method allows you to apply a sense of uniformity to an already complicated rehabilitation process. That is why Triphasic training, When used correctly, has the potential to yield amazing results. As a matter of fact, I have personally seen how this training technique has been effectively used in multiple situations and different injury profiles.
Let’s put it all together… Your plan of action!
Now that we have covered all the bases with the theory side of things, let’s get a bit more practical. We’re about to put together an outline of a template program that you can follow at home to treat and manage your myofascial pain, muscle spasms, muscle strains and connective tissue sprains. The first part will cover your mobility needs as well as focusing on releasing those knots and painful fascia areas. The second part will focus on the initial rehab needs of both muscle strains and tissue sprains. And finally we will be rounding off the program with strengthening exercises to complete your rehab process. Please note that this program was designed and suggested for use with patients that require help for lower back or lumbar region injuries.
Please note that this template is merely just a suggestion, please do not use this as a form of diagnosis. Each patients’ anatomy is unique therefore we assume no responsibility for the success or lack thereof with regard to this program. Please always remember to consult a professional primary care or allied health provider to ensure your specific needs are met.
SECTION 1: WORKING OUT THE KNOTs
For this section of your rehab program you will need a foam roller.
Control your breathing
A lumbar release is performed by sitting on a gym or yoga mat with your legs out in front of you. Place the foam roller tightly at the base of your lower back. Stretching out your arms above your head slowly lay over the foam roller. Make sure to keep your feet and glute muscles firmly planted onto the ground/mat. Hold this position for 60 seconds and slowly return to the starting point. Repeat this movement 2-3 times.
The Lats release refers to the release of the latissimus dorsi muscles of the back. The lats are indirectly linked to the lumbar region of the back via the core. Providing release to this area can significantly reduce the tension on your spine and in turn provide better postural control for the lumbar spine which could in turn reduce your pain in that area.
The Glute release is necessary as the gluteal muscles play a vitally important role in your lower back posture as well as biomechanics. I cannot tell you how many times I have had clients who suffered from lower back pain only for us to realize that they have an underlying glute weakness that resulted in the lower back taking the brunt of the load during movement. Alternatively, it doesn’t necessarily mean that your issue is glute weakness, it could be that your glute muscles are just extremely tight. Which is why we’re adding this specific exercise to your program as this will help with your mobility and improved loading patterns. Which hopefully, will reduce your overall pain and discomfort.
SECTION 2: ISOLATING THE PROBLEM WITH ISOMETRICS
In this section we’re going to move onto more specific rehab exercises, starting with isometrics. For this section you will essentially just need a yoga or a gym mat.
One rep is 10 seconds long
TA activation into
One rep is 30 seconds
The TA in this case stands for transverse abdominus, which is a large muscle that forms part of your deep core as well as your lower back. It plays a very important part in providing stability to your lower back. By intentionally activating this muscle group we’re essentially trying to improve its contraction during movement and general posture.
In terms of performing this exercise, you will lie down on your back with your legs bent at the knees and feet firmly placed onto the ground. You will now place the palms of your hands on your belly button. Now I want you to visualize you’re pulling up your pants zipper without using your hands. Once in this position you will hold that position for a total of 10 seconds and repeat the movement for a total of ten sets[c].
The progression for this exercise is a TA activation into a bridge or pelvic lift. For this exercise you will be doing the exact set up like you did with the above mentioned exercise. However after you’ve done the “zip up” maneuver, you will then lift your buttocks and back off from the mat. How high you lift yourself up will depend on your specific capabilities and your severity of pain. You will maintain this position for a total of 30 seconds and then lower your back down to the mat and repeat the process for a total of 3 sets.
SECTION 3: LET’S GET STRONG!
This is where we get a bit more serious, incorporating isometric, eccentric and concentric exercise movements in order to not only increase your muscle strength but also your overall muscular endurance.
10 reps per side
Reps are counted in seconds
Prone Back Extensions
Add 2 second pause between reps
Side Lying Abductions
20 reps per leg per set
Planks and deadbugs are two of the most effective core exercises. This pair of exercises strengthen the core as a whole rather than just the lower back area. Most people know how to perform a plank so we’re not going to get too technical with the instructions. However, the deadbug will require a little bit more coordination to pull off. You will lie down on your back, bend your knees and lift your feet off of the ground maintaining a 90 degree angle at your knee joints. You will then strengthen both of your arms and lift them up directly in front of you so that they are in your line of sight.
Now slowly lower your right arm until it is parallel with the ground, while simultaneously straightening your left leg until it is about 10cm off of the ground. Now return your right arm and left leg to the starting position and repeat this step for the opposite arm and leg. When both sides have completed this action once, that equates to a single rep. Now we are aware that this can be really confusing, so to make this a bit easier to understand we’ve included some demo pictures for reference.
Prone back extensions are a very simple exercise, you lie on your tummy on the mat. Place your hands underneath your chin. Then you proceed to lift your chest up off the ground. Holding that pose for about 2-3 seconds before returning it to the starting position. Repeat this process for a total of 3 sets. In order to progress this exercise, you can lift your feet off the ground while extending your back. However, this should only be performed when the initial exercise has become too easy to perform. I.e. Not challenging enough.
Side lying abductions are one of those exercises that are old but gold! Seriously, don’t be fooled by this exercise’s simplicity as it remains one of the most effective ways to train your glute medius muscle group. And this is a muscle group that you want firing on all cylinders as they significantly improve your mobility and overall posture. Additionally they also help stabilise the lower back during single limb stance and or movement, making it extremely important to the overall postural control of your lumbopelvic area.
Okay, so how do you do this exercise? You lie on your side, with your legs stretched straight out and placed on top of each other. Now lift the top leg straight up in the air about 40-50cm from the ground, hold it in that position for about 1 second and slowly lower the leg to the starting position. And repeat this for 20 reps. Fair warning, your butt will burn, it’s normal. So try and have fun while you’re at it!
Okay, now that was and is a lot of words! Now our aim wasn’t to bombard you with so much information, we simply realised that we need to give you enough depth of knowledge in order to give you the best shot at being successful. Rehabilitating an injury by itself is such a daunting task, much less when you’re attempting to do it by yourself. But that being said, we want to take this moment to encourage you to persevere through this time. If you stumbled onto our articles or this one in particular it means that you are in need of help, and that is what this is! A concise, generalized approach to rehabilitation based on real science and real world experience, that you can do at home or in your garage or wherever you are comfortable. Regardless, this is where you take matters into your own hands, but with a safe and well thought out approach. Good luck!