Hi, I’m Dr. Eric Cobb of Z Health Performance. Today, we’re moving into part two of our series on low back pain.
This is kind of a unique way to approach the idea that a lot of low back pain is driven by brain processes whenever the brain feels unsafe with a given movement.
So we began last week saying I want you to figure out if your eyes, your inner ear, and how the rest of your body are interacting and what is driving potentially some of the low back pain you’re experiencing.
We used all of that to try to identify a very specific postural position for you that would be a safe, starting position for our other exercises. As a quick reminder, we had you test rotation, flexion and extension, lateral bending, and combinations based of your unique low back pain presentation.
We then went through a bunch of different postural ideas to say, hey, is there a position that you can get into with your feet, with the amount of knee bend, with your pelvic position, with your eyes, with your inner ear, utilizing tools for balance to say, hey, right here, maybe for me, I’m very comfortable.
Although it looks odd if this is your comfortable position, This is where we will begin the work today because we want you to start off in the most comfortable position because our job is to achieve one pain-free rep of movement that will allow you to start to build a mental library of what it feels like again to be pain-free.
So for our purposes today, we’re gonna focus on lateral bending. There’s quite a lot of research in the low back pain world. And one of the components that is most often missing in people with chronic low back pain is the ability to comfortably side bend.
So if that is you, if this is the category that you fit into. We’re going to begin with some very simple mobilization drills. We’re going to begin with the pelvis because when we’re working with the low back, we want to think about moving the stuff below the low back. which is the pelvis.
And sometimes we need to think about moving the stuff above the low back, which is a thoracic cage. Often, if we move above and below the problematic area, it will allow the brain to begin accepting movement there more easily. So we’re going to begin with your comfortable posture.
For purposes of this video, I’m going to imagine that for me and my low back pain, that internally rotated feet bilaterally with knees bent is my comfortable position. And let’s say, maybe my eyes are down. Alright? And again, if none of this makes sense to you, please go back and watch the first video.
So what I would have you do first is get into your posturally safe position, take the eye position that you need, and we’re just going to begin doing anterior posterior tilts of the pelvis. It’s very simple. Alright? Just anterior and posterior.
You want to think and notice how far you can move in each direction before it becomes uncomfortable. I want you to work within the comfortable range. I want you to do twenty to thirty repetitions here. From there, I now want you to try to do side to side movements of the pelvis. Alright?
A little bit of a side to side, hula motion, whatever you wanna call it, a little dance motion. And you’re trying to figure out for yourself what is the most comfortable pelvic position? So if I find that I do a posterior tilt, so I tuck my pelvis, and as I hold that, I can do side to side pelvic tilting easily. Great.
You’ve now learned something. We’re gonna hold onto that and we’re gonna get some repetitions in in that position. After we’ve done anterior posterior tilting and lateral tilting, we’re then going to be doing full circles, alright, like a hula hoop motion. but you are trying to bias this movement toward holding the appropriate amount of either posterior tilt, the tucked pelvis position, neutral or anterior tilt, whatever is most comfortable for you. So I want you to figure out and achieve for yourself the most comfortable pelvic position. I want you to do twenty to thirty repetitions of anterior posterior tilting, lateral tilting, and circles.
Once you’ve done that, we’re now going to take the pelvis and we’re going to hold it in its most comfortable position. From there, we’re going to begin doing small gliding motions of the spine. So in other words, we’re fixating the lower body and the pelvis. and we’re now moving the spine side to side. Notice that we are not bending. We are translating.
There’s some interesting things that happen mechanically in the low back whenever we do translations versus side bending. So translations are often a great way to begin restoring movement that we’re interested in, which is a side bending.
So as you accumulate some repetitions, you’re going to try to make this motion a little bit larger and larger. Until you can be doing a translation that’s very comfortable. If any kind of translation is uncomfortable with movement. Your other option is to do this as an isometric exercise. What that would basically entail is standing with a wall to the side of you, your shoulders against the wall, you attain your appropriate pelvic position, and then you just simply put motion or put force into the wall.
And then you would turn around and you would go the opposite direction again pushing into the wall with your body. Isometric exercise can be very, very powerful for low back pain because we’re basically achieving muscle tension without movement.
So the brain has less to sort out.
It is a less threatening way to achieve tension often than mobility.
So if mobility exercises are problematic for you, you may find that isometric work is your best friend. So as a quick review. We’ve used our eyes, our inner ear stuff from the first video.
We found our position of postural safety and comfort. And now we started doing some work below the low back in the pelvis, and we’ve begun our very first rehabilitative exercise for the low back itself, which is translations, either in mobilizations or with isometrics.
As a practical reminder, this may not look perfect. I might not be in a perfect neutral stance, etcetera. Instead, I may have different body positions. I may even need to find that I’m rotated with my spine in order to find a position that is comfortable.
That’s going to be your number one goal. Is that pain-free rep. Alright, guys. So give this a shot. Let us know what you think in the comments. Thanks.