Low Back Pain and the Connection to Glute Activity
Looking for low back pain exercises? Well, the answers may not be as obvious as you think. In this article, I’m going to show how by training your glutes (and NOT doing sit ups or crunches)(STOP doing ineffective exercises), you can help prevent low back pain.
As more and more people develop lower back problems one cannot help but question the type and quality of their exercise, if in fact they exercise at all. Low back pain can arise for a number of different reasons from prolonged sitting, poor core stability, and even poor lifting mechanics in the gym.
Whatever the cause, a recurring theme is noticed in individuals with low back pain – inhibition of the gluteal (buttocks) muscles. Traditionally, core-stability programs tend to focus on the trunk muscles (transversus, multifidus, obliques and paraspinals); however, the glute (bum) muscles are also very important for core stability and preventing low back pain. Remember the more you sit the bigger your butt gets.
Anatomy and Mechanics of the Glutes
The glutes are comprised of the gluteus maximus (the largest muscle in the body), and the gluteus medius and minimus. The gluteals play a dual role – not only do they act as mobilizers (to create movement) but they also act as stabilizers. For instance, as mobilizers, the gluteus maximus initiates hip extension (pulls the leg back), meaning that it is involved in movements such as the push phase in running or jumping, whereas, the gluteus medius and minimus abduct the hip (move the leg sideways out from the body).
From a stability perspective, during running for instance, the gluteus maximus acts to maintain upright posture and stabilize the sacroiliac joint. The gluteus medius and minimus work to maintain a level pelvis when weight-bearing on one leg, preventing the free side from dropping down.
The problem that I notice most often is that many individuals train body parts and not movements. They opt for the “vanity” workout instead of the intelligent workout. At the same time, these same people are very often the sporty type engaging in activities such as running, cycling, tennis, and team sports. And this is where the problem arises. The body is being trained to look good and not necessarily to perform well and/or prevent injuries.
To Squat or Not to Squat?
Here’s an example of a functional movement that many gym-goers incorporate into their “vanity” workouts – the squat. The squat is a great functional movement that mimics many daily and sporting movements patterns.
But here’s the problem – it has been shown that individuals with poor core stability, inhibited gluteals, or pre-existing low back pain DO NOT activate their glute muscles properly , when performing exercises such as the squat. What’s happening here is that the hamstrings are firing first to extend the hip, followed by the lower back, and then (and sometimes not all) the glutes fire. I performed an FMS testing on a group of very fit individuals two weeks ago and the findings were very interesting. All individuals had some form of low back pain. However the most in shape individual who currently has 2.6% bodyfat was unable to fire his right gluteus medius or minimus at all.
This poor pattern of activation leads to tremendous stress on the lower back as the load is directly transferred from the hamstrings onto the lower back via sacraltuberous and dorsalsacral ligaments, thus, totally bypassing the “supposed” prime mover – the gluteus maximus! Thus, the load is dangerously placed on the passive structures (ie. ligaments and joints) rather than the active structures (ie. muscles).
Weak Glutes and Knee Pain in Runners
Here’s another example of how weak gluteals can even lead to other problems. Many runners often complain about knee pain due to the repetitive high stress nature of running. These runners often turn to buying new shoes, orthotics, or medicating themselves to mask the symptoms. Although these methods may have there place, preventing knee pain (and back pain) for that matter can often boil down to having functionally trained, endurant gluteal muscles, especially the gluteus medius. Any time I come across someone complaining of knee pain, one of the first things I assess is their gluteus medius. And guess what? It is often inhibited, misfires, or weak!
Therefore, to improve muscle function, it is easier to think in terms of the mobiliser/stabiliser system as it guides us into using exercises that will be more functional. The system tells us that stabiliser muscles need to switch on easily at low-load levels, they need to be able to maintain joint position and they need to have good endurance. Stabiliser muscles tend to become inhibited and are not active enough for sufficient duration.
Therefore to train stabiliser muscles correctly, exercises should involve positions that mirror your daily activities or athletic movements, they should be trained with light loads and many repetitions or made to hold the correct position for a prolonged period. In so doing, you will strengthen your lumbo-pelvic stabilty and help prevent muscle imbalances resulting from biased training. The end result – better core/pelvic stability, proper muscle activation timing, better energy transfer, and less chance of developing low back problems.
3 Awesome Glute and Lower Back Exercises to Prevent Low Back Pain
The following are several excellent movements for developing better glute activation, lumbopelvic stability, and eventually improved back health. They start very basic and progress in difficulty.
Equipment needed:
• Your Body
1. Deer in headlights – Lying flat on your back with your knees bent and your feet flat on the ground, place both hands on your glutes. Try to contract your right glutewithout engaging any other muscles, specially the hamstring. Hold for 5 seconds trying to squeeze as hard as you can. Repeat this on the leftside and then on both sides.
2. Clams – Lying on your side with both legs bent, ensure that your feet are still in line with your torso. Then, open legs (like a clam shell) apart while ensuring that your feet remain together. Only raise the leg to about 45°. You should feel this in the glute of the working leg. Perform 15-20 reps per leg.
3. Bridge – Level 1
Lie on your back with knees bent. Brace your abdominals and squeeze your bum cheeks together as if holding a $100 bill between them. Curl the bum off the floor, lifting the hips until the knees, hips and chest are in line. Hold this position, purposefully squeezing the glutes to support the bridge position. Start with 10 x 10 seconds, building up to 2 x 60 seconds. If you feel a strong contraction in the hamstrings or the lower back is straining, then you are not using your glutes strongly enough. Focus on them to ensure they do the work.
Synergistic Dominance of Hamstrings & Low Back Pain
Low back pain is one of the most common medical problems reported in Western societies, with an average 60-80% adults experiencing low back pain at some point in their lives (1). With the advances in research, the exact mechanical or biomechanical causes for low back pain still not fully understood. When presented with a client experiencing low back pain, a general postural and movement assessment should be performed. Special attention should be directed to pelvis position (specifically the degree of anterior tilt) and to foot position.
Muscle activation patterns and strength testing should be performed to the gluteus maximus, hamstrings and abdominal muscles. Research has demonstrated that adults suffering from low back pain, often present with underactive gluteus maximus and overactive hamstrings (4). This blog post will review the association between low back pain and underactive gluteus maximus, and how you can correct this muscle activation pattern in your client suffering from low back pain.
Since low back pain is often a myriad of muscle imbalances contributing to the low back pain, it can be difficult to find the postural or movement compensation which initiated the low back pain. In a client presenting with low back pain, but no osseous changes in their spine (no arthritis, no stenosis) the low back pain is often a case of altered reciprocal inhibition and synergistic dominance.
The gluteus maximus plays an important role in human locomotion, by decelerating hip flexion during the swing phase of gait, extending the hip back for the propulsive phase and by stabilizing the SI joint for attenuation of ground reaction forces. Since all muscles are assisted by synergistic muscles, if the main agonist is not firing correctly the synergistic muscle will activate. This is referred to as synergistic dominance. In this case, due to a decreased neural drive to the gluteus maximus, the hamstrings act as the synergist and take over the role of the gluteus maximus.
Although the hamstring functions acts as a good synergist to the gluteus maximus, it is not designed to be the sole hip extensor. Synergistic dominance by the hamstrings can lead to pre-mature fatigue, overuse and over-activation of the hamstring muscles. This could put the client at risk of hamstring strains, hamstring cramps and SI joint pain.
Reversal of altered reciprocal inhibition & synergistic dominance
The reversal of the reciprocal inhibition includes inhibition and lengthening the hip flexor complex, coupled with activation of the gluteus maximus.
References:
Larsen, K. Prone hip extension with lower abbdominal hollowing improves relative timing of gluteus maximus activation in relation to biceps femoris. Manual Therapy, 2010. 15: 61-65
Lewis, C. Muscle activation and movement patterns during prone hip extension exercise in women. J Athletic Training, 2009. 44(3): 238-248.
Nourbakhsh, M. The relationship between pelvic cross syndrome and chronic low back pain. J Back & Musculoskeletal Rehab, 2006. 19: 119-128.
Wagner, T. Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings. J Orthopedic & Sports Physical Therapy, 2010. 40(2): 112 – 119.