Managing Back Pain - Journey So Far & Where To Go From Here?

[daniel108]

Hi all,

I just thought I’d share a bit about my journey with back pain, where I’m at, and what’s helped so far. 

I’ve had one-sided lower back pain for over 10 years now due to a partially herniated disc. 

Though I’m still trying to understand this pain, what triggers it and what helps it, I did discover an assessment tool that examines pain related spinal movements; specifically flexion, extension and lateral movements. I discovered that spinal flexion triggers my particular pain and that extension surprisingly seems to help.  Since then, I’ve stopped doing anything hamstring related. (Side note: I really want to get onto stretching for the pike but I’m afraid of doing anything requiring forward bending, so I’m trying to sort out this back issue first.)

Exercises that I have found particularly helpful for relieving my back pain include:

• Piriformis / glute stretch 
• Hip flexor / psoas stretch
• Standing spine extensions
• Dead hanging 
• Hip hikes 
• Kit’s sitting side / lat stretch / Olivia’s kneeling version (although I do find that I have to be careful with stretches that get into that QL area)

While stretching eases the pain, I find that it always comes back. So I think that I’m missing something. 

Perhaps stretching alone isn’t enough? I’ve seen some talk online about the importance strengthening. Does anyone have any insight on that? My next experiment is to try adding core stability exercises (I’ve seen McGill emphasising those a lot). Another thought is to start mobilizing the hips in a more general sense (rather than focusing on specific muscle groups).  Any thoughts are much appreciated!

Disclaimer: Although I don’t have the OBP course yet, I do have, use and love the starter and mastery courses. 

Happy stretching,

Daniel 

[Kit_L]

On 7/8/2023 at 9:48 PM, daniel108 said:

So I think that I’m missing something.

Very likely. Have a look at this—unilateral LBP is most often caused by an actual leg-length difference, to which the body must adapt (we live in a sea of gravity). I go into this in detail in Overcome neck & back pain.

https://www.youtube.com/watch?v=Rt7zwss7kPo&t=2s

And please ask someone to take a picture of you from behind; stand with your weight as perfectly balanced over both feet when you do this, and post.

Medicine decided long ago that an "actual leg length difference" needs to be 10mm, or more, to be described as "significant". Like many of these determinations, it is not sensible and significance depends crucially on context (what the person does in his/her daily life). On the initial figures, about 10% of the population has an LLD of 10mm or more.

I looked at the actual measurements of leg length in all the researches that had been done up to the time of the research for the same book, and a simple spread-sheet analysis showed that ~35% of the examined population had measured differences between 5–9mm. If we look at all the measurements, almost 50% of the populations examined have an actual LLD of 5mm or more.

Please do this simple 'book test' and report back.

[daniel108]

That's fascinating...I've been so focused on stretching that I would never have thought about looking into leg length difference.

I did the test in a neutral position, with an 8mm block, and a 14mm block (just what I had handy) and did find what appears to be an asymmetry. It's difficult to tell in the original neutral position, but when assessing the difference in hip position with the blocks under each side the difference became apparent. 

The pain is on my left side.  It seemed that with the blocks under the right foot, my hip became more neutral. And with the blocks under my left foot, the hip went way out of alignment. 

Could this be the root cause of my back pain, and if so, then how is it treated?   

[Kit_L]

Well... Yes, this definitely will be a contributing cause to your LBP, and it also explains why it comes and goes. The adaptations your body has had to make are effective, much, if not most of the time. But in times of stress (the nexus is increased stress = increased muscle tension; the pre-stressed areas reach their limit before the others and signal pain) it is likely to flare up.

The muscles where the pain is experienced likely will be quadratus lumborum. And an actual LLD will mean that your hamstring length-tension relationship will be different L–R, as will be your hip flexors. These are the most important muscles WRT LBP (hip flexors THE most important). All the best HF exercises are free on the YT channel. You will need to stretch the quads, too (rectus femoris is the tightest of the HF). If you search for "quads and hip flexors" you will find the best ones.

Put a small heel lift in the shoes you wear in the daytime; small because you do not want to make the adaptations maladaptive. 5mm (try firm cardboard to test) and chamfer the front edge so the bottom of the foot is not irritated.

Then compare hamstring ROM on each side, and similarly the hip flexors. When you do your stretching, start with the tighter side, then do the looser side, and come back and stretch the tighter side a second time – this way, the tight side will will become more flexible over time. Same with any strength deficits (and there will be).

[daniel108]

Wow, Thank YOU!!!!

About five days ago I serendipitously discovered that very wall-quad-hip-flexor stretch from your website and have been doing it daily since.  At the end of that video, you say "...go for a walk around and just see what amazing changes have happened in your body."  I do that little walk every time and it simply feels amazing...like I've oiled an old rusty bike chain!  Incidentally, I also liked boxing the compass, but since you said that the quads are important in this case, I'll stick to the first one and post back after a few weeks to share my progress. 

I also find that playing a few micro movements in the three positions of the wall-hip-flexor stretch changes the sensations a lot, and seems to move the feeling from the quads to the hip flexors.  The second and third part of that stretch is fairly torturous though!  My left side is most certainly tighter than my right and is more painful to stretch, and those last two positions really get stuck in the quad. And come to think of it, my left hamstrings are also tighter than my right hamstrings. In pancake I get cramps on the outer side of my left hip, and a few orthopedic niggles that I've had over time have tended to be on my left arm, left hip, and left knee.  Perhaps it's all connected). 

When might be a reasonable time to progress to more intense hamstring stretches?  I do some banded supine hamstring stretches at the moment (while still trying to activate the stretch with the quads), but I'm apprehensive about progressing onto the standing hamstring stretches like the squat to pike, elephant walk, single leg hip hinge and jefferson curls which have all previously triggered a flare up of back pain.  

  

[Kit_L]

@daniel108: micromovements are gold. Andd, based on what you report, start that exercise with the L, do the right, and repeat for the L. Same with any other asymmetry, too. And all of the standing hamstring stretches can be done as soon as you want—just follow the instructions closely!  None is dangerous, but leave the Jefferson Curls for a month or two (too easy to cheat in this one).

Speaking generally, you'll get better results medium and long-term if you only stretch (with contractions, etc.) twice a week. Limber on the other days, if you want to; see this article:

https://kitlaughlin.com/forums/index.php?/topic/215-limbering-mobility-and-stretching-what-do-these-terms-mean-how-to-best-use/#elControls_560_menu

All the other articles in that section are useful, too. 

[daniel108]

Just a short update about my progress.

To date, the most helpful stretch seems to be the hip flexor stretch. A few minutes on each side feels like gold and seems to help both prevent and relieve pain. The piriformis / glute stretches feel really good, but I can’t say that I’ve noticed that they have any affect on my back pain. Regarding the side / lat stretch, I really “enjoy” this one, but I’m not sure weather it helps or hinders. At certain positions it touches the exact point of pain and triggers some fear that I might be doing some harm.  

 

Meanwhile, a different lower back pain has reappeared which feels more akin to a bruised type sensation around around the lower spine / coccyx area. Is this something familiar to anyone? It is quite a different sensation to the nerve type pain in the QL. So the journey of pain-induced body awareness continues.

[Kit_L]

Have you ever tried any of the partner HF stretches? They are an order of magnitude stronger, yet easier to do because you use your partner's weight to deepen the sensation, and somehow the body contact helps this process too. Have a look here:

https://www.youtube.com/@KitLaughlin/search?query=partner hip flexor

The one labeled "Practitioner HF" is the gentlest; the ones Craig and Dave and I are demonstrating are the strongest. Nothing will change the body (and its propensity for back pain) than really getting into these (all three hip flexors, and quadriceps). Take your time.

[Nathanc]

I began stretching using Kits stretching and flexibility book and have been focusing on hip flexors and hamstrings. Recently I started getting back pain after forward flexion. It’s not until I stand up that I get the pain. The muscles seemed really tight after standing up and is difficult to straighten my back. I can then lateral flex to the right and the tightness and pain goes away. Sometime I can do a more intense left hip flexor stretch and that helps to but not always.
Before I started the stretching I didn’t have the pain after forward flexion. I’m not sure if I’ve created some imbalance or missing a stretch for another muscle? 
I’ve had low back pain for seven almost 8 years and have seen multiple specialist and no root cause. The doctors never suggest a muscle problem but now that I’m listening to my body more I think it’s muscle and flexibility related. I began Pilates 3 years ago to help with core strength and improved flexibility. I started the flexibility training to help improve my mobility and to be more active without the fear of back pain. I haven’t done the leg length test yet but I know my flexibility from left to right is different. I’m wondering way am I gettting the forward flexion pain now but not previously before starting the flexibility training?

 

[Kit_L]

@Nathanc:

Have you done the leg-length test yet? Please do that before we make any recommendations. R–L differences in flexibility are a clue, for sure. I sent you the link to this test by email, but here it is again:

https://www.youtube.com/watch?v=Rt7zwss7kPo&

Please watch it through first, and better yet if you have a friend who can assess you as you do it. If you've seen multiple specialists and no cause has been found, then likely you are suffering one of the "hidden causes" I write about in this free e-book:

https://pdf-versions-of-books.s3.us-west-2.amazonaws.com/2020-HCOBP-v6.pdf

These hidden causes are all muscular, too.

[Nathanc]

I have done the leg length test and I don’t really see much difference in the leg length. 
I have a feeling it’s probably hip flexors and hamstring issues. I can touch my toes but hardly any hip mobility. I can’t sit on the floor with straight legs and a flat back. I also have no range of motion when trying to forward fold while sitting.
I grew up in agriculture and was sitting in a tractor for 12-16hrs a day. I did this for many years. My lower body was basically in constant tension bracing myself because of rough terrain. I’m not sure if this history helps. 
 

[Kit_L]

@Nathanc: does a book feel better (or worse) under one foot vs. the other? If it feels the same, then probably not important.

The next step is to reduce any left-right differences in the key ranges of movement: hip flexors, hamstrings, L–R rotation, and piriformis. The capacity to touch the toes is strongly related to one's proportion—if you can't sit on the floor with a straight back, then the hamstrings and possible piriformis are too tight for your proportions.

Please search the kit laughlin channel on YT; all the important exercises are there, and free. Tight and asymmetrically tight hip flexors will be my guess (I drove a tractor for many hours too) and they can definitely cause the symptoms you describe.

Usually, in my clinical experience, tight hamstrings are not a cause of low back pain; rather are a symptom of deeper causes. If the leg-length test is inconclusive, then assume hip flexors and piriformis. Try the recommended exercises please and report back.

[Nathanc]

I have two of your books and have been following along your YouTube videos. The hip flexor, piriformis, as well as the standing side stretch has helped a lot. I can’t really tell a difference from one foot to another. Have you had any experience with tight hip flexors cause back pain? I included a picture and circled the area where the pain was coming from when I came out of forward flexion. 
I do notice  what I believe is the semitendonosus muscle is still tight even after some of the hamstring stretches. Also, thank you for responding I feel like I am finally on the right track to figuring out what could be the underlying issue. 

[Kit_L]

@Nathanc: The area that you have circled above is a classic location example of where hip flexors can cause low back pain.

Can you try the wall quad hip flexor stretch and report back? If your hip flexors are tight, then you will need to do the parter hip flexor stretch when you are ready for it. Both of these are on our YT channel. There is no substitute for this. What our advance class found was that until you can get all of the front of the back leg on the floor, habitual tension in this area persists.

 

And the partner ones:

https://www.youtube.com/@KitLaughlin/search?query=partner hip flex

[Jim Pickles]

"all of the front of the back leg on the floor" - really? - does that include all of the front of the thigh? That sounds a big ask. It means the angle between the thighs of the front and back legs must be about 210 degrees. Most people cant get beyond (or even to) 180.

 

[Kit_L]

@Jim Pickles, I am talking about having all of the front of the back leg on the ground in the straight-leg partner version of the exercise, as I demonstrate in the Mastery series and the YT videos.