Being your own PT: Back pain fear
Pain when bending forward (hip hinge vs spinal movement)
Recently I posted a video about the imbalance of bending forward too much through the spine and not enough through the hips.
WHAT IS THE PROBLEM?
Bending too much through the spine overloads, strains the spine and muscles around it, but if you learn to use your hips when you bend it can share the load of bending.
However! Many PTs will leave the patient with this information (of focusing too much on hip hinge) and often it leads to people being afraid to move their spine at all. This is bad. Your spine must move.
You must learn the skill of balancing this spinal movement with hip movement. It’s the imbalance that causes problem. Balance is the goal.
But here’s how being your own PT works more practically:
HOW DOES THIS WORK PRACTICALLY?
Step 1: In practice you identify and confirm with the patient that indeed there is an imbalance when bending forward where they use the spine too much. Usually, bending forward causes back pain.
Step 2: You show them drills to learn how to hinge through the hips while they keep the spine “quiet”. If they learn it properly you can often notice an IMMEDIATE relief in back pain when bending forward.
Step 3: This skill of hinging through the hips is learned enough so that it becomes automatic. Perhaps it is reinforced by weight or increasing repetitions.
( If you are a good clinician and have a good rapport with the patient they can learn this skill very quickly. Some take more time to learn, but it needs to be like snapping your fingers style automatic. )
Step 4: You have developed the skill of hinging so well that your body is primarily moving through the hips and you can now allow the spine the freedom to also move.
NEXT STEPS
If you have indeed learned the skill of a balanced bend through the spine and hips but you still have pain in the back then we need further testing to find what is triggering your pain.
The first solution is that this skill will take a little more time to master than one session. It’s different for everyone with how their bodies learn new things. The better the clinician the better they will give drills that will help this process move smoothly.
Adding weight or resistance bands often will add a new variable that helps the body learn faster. Though often the slow you move when you start the faster you will learn. Move slow. Learn fast.
The second issue that may arise is that the person has a habit that pulls them back into moving their spine before the hips. Sitting is a common cause, but again, it varies person to person.
Here I would try to become aware of when the pain came back. What were you doing just before the pain started up? and what were you doing before that?
Movement is an unconscious process the majority of the time so dont force an answer. Let it come to you. Ask the question and wait.
ADVANCED PROGRESSION
For me just getting out of pain is not good enough. Mostly because people will often slip back into their old habits unless you pull them so far out they CANNOT go back.
So if you have mastered the hip hinge and then you can also allow your back to bend without having pain it’s time to start training spinal flexion and extension.
The hip extension machine is a great way to do this and you can easily find ways to add load.
Seated good mornings are the next easiest way to strengthen the spine. Again you can also find a lot of ways to add load.
My personal favorite is the Jefferson Curl. It’s like a deadlift but you are moving more through the spine than the hips. The big trick here is you have to start INSANELY light. I could deadlight 400lbs pretty easy and I still started with a 25lb kettlebell. But then once you build up strength in the spine you truly become bulletproof.
It took me a few years of consistency and i really only got up to doing reps at 115lbs, but I havent had back pain in almost 10 years now. It’s nice. Trust me.
IF you need anything else!
Here’s how I can help:
The book I co-wrote - Stretching for a pain-free life
In-person bodywork and rehab - schedule
Online consults for pain-relief or general help - schedule
Online programs for back pain, sciatica, knee pain, shoulder pain etc
Stretch Club - Weekly Mobility Classes