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How To Get Rid Of Chronic Back Pain

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By Bret Contreras January 10, 2010 Low Back Reconditioning, Spinal Health

* Update as of 12/25/13 This post was written in January of 2010. Four years later, Ive learned a
great deal about back pain. To the point where this article is laughable. Theres much more to pain
than biomechanics and posture. Please read up on the biopsychosocial model of pain, along with the
neuromatrix (in fact, Ive written on these click on the low back reconditioning tab). .

That said, I will keep this article simply because 1) the advice can indeed help certain people with
back pain, and 2) its a testament to my constant strive for continued learning and education. One last
thing dont become fearful of movement as this can lead to more pain. Movement is your friend
start with pain-free movement and then expand your boundaries

At some point in time, 80% of people will suffer from low back pain (LBP). As a trained specialist who
watches people move all day long, it is blatantly apparent why such a large percentage of people
have low back pain: They dont move correctly! The root of the problem is this:

People move with their low backs instead of their hips!

When the low back moves and the hips stay locked up, the gel inside of the lumbar discs propels
toward the outside of the disc and can cause bulges or herniations. This is often the source of lower
back pain.

The solution is not as simple as simply learning proper mechanics. Many people are unable to move
with proper mechanics due to poor mobility and motor control. It takes some time to reprogram the
body to move correctly.
In this blog I will teach you how to get rid of back pain by combining seven different strategies. Since
this blog is intended for the common person, I will refrain from using too much technical terminology
and try to keep it simple. In the interest of brevity, I will exclude speci c exercises and drills, as this
blog is intended to entice the reader to learn more about each strategy listed.

1. Improve Soft-Tissue Quality

Over the years people have built up adhesions and scar tissue that needs to be cleared. Furthermore,
trigger points need to be desensitized. A muscle cannot function optimally if it has adhesions, scar
tissue, and trigger points. By using self-myofascial release (SMR), which is simply a technical term for
a poor mans massage, you will restore optimal tissue quality and allow proper functioning of the
muscles nerves and blood ow.

There are two ways you will address your soft-tissue quality. First, you will use a foam roller. You will
roll out your entire back, including the erector spinae, lats, rhomboids, and traps. You will also roll
out your glutes, hamstrings, calves, quads, IT band, hip exors, adductors, and pecs. A simple Google
search will allow you to nd pictures and videos of foam roller drills for each muscle group.

And second, you will use a tennis ball or better-yet a lacrosse ball for more targeted therapy. You will
use the ball to focus on the arches of the feet, the calves, the upper glutes, and the mid scapulae.
Although you can nd many different drills on the internet for SMR, the best way to learn the correct
application of the foam roller and lacrosse ball is to simply buy them, get on them, and start moving
around. Your body will show you how to use them!

2. Improve Soft-Tissue Length

There are many different opinions in the tness industry regarding the role of static stretching, but I
believe its the best way to turn off inhibition and increase exibility. Two main points to static
stretching is to learn how to relax into the stretch and to combine rotational aspects into common
stretches (PNF techniques) in order to kill two birds with one stone by stretching multiple muscles
simultaneously. Never stretch so aggressively that you end up stretching ligaments! In particular,
hamstring exibility and hip exor exibility are critical components to minimizing low back stress.

3. Activate the Glutes

Many people have weak glutes. The glutes dont like to contract unless need-be. They like to let other
muscles such as the hamstrings and quads do a job and stay dormant unless you force them to
contract. Years of inactivity and sitting (which shortens the hip exors and causes more glute
inhibition) cause the nervous system to literally forget how to use the glutes.
Use two different strategies to increase your mind-muscle connection for the glutes. First, incorporate
loadless training into your arsenal, which is just a fancy term for exing your glutes. Seriously, start
squeezing your glutes as hard as possible every ten minutes or so throughout the day. Hold the
contraction for around one second and then shut them off. Do this around three times during each
session. This will equate to around 300 maximal isometric contractions per day and will go a long
way toward increasing your glute activation.

Second, start doing low-load training which simply means start performing relatively simple glute
exercises while focusing on high-quality glute contractions. Some good glute activation exercises
include bodyweight glute bridges, quadruped hip extensions, side-lying abductions, side-lying clams,
bird dogs, x-band walks, single leg glute bridges, and re hydrants.

4. Increase Mobility and Stability in the Hips, Ankles, and Thoracic Spine

The best way to improve mobility is to add strength and therefore stability at new ranges of motion.
By performing the right drills, you can simultaneously increase mobility and stability. Learn how to
contract the muscles being stretched at the end range of a motion and pull the body into new ranges
of motion with opposing muscles. There are many great mobility exercises that can easily be found
online.

5. Learn How to Control the Core and Prevent Lumbar Movement


This could very well be the most important tip of all. Most people move by contorting their lumbar
spines. Proper movement mechanics usually involves keeping the lower back locked into place
(bracing) in neutral position while moving about other joints such as the thoracic spine and hips.

Even while exercising, most individuals have poor lumbar mechanics. They overarch (excessively
extend) their low backs during squats, deadlifts, bridging, quadruped, lunging, and back extension
movements, they round their lower backs ( exion) during deadlifts, bent over rows, good mornings,
and reverse hyper movements, and they twist their lower backs during rotary movements. In all of
these examples, this is improper mechanics.

Advanced lifters and high level trainers/coaches often have an insuf cient understanding of lumbar
mechanics. It takes much diligence to reach optimal core control but it is a critical component to
moving, exercising, and eliminating back pain.

An excellent trick to learning core control is to perform anti-movement exercises. Anti-movement


exercises teach the lower back how to brace heavily to resist movement and strengthen the core in a
manner that uses all of the vital core muscles involved in bracing the core.

There are three types of anti-movement core exercises: 1) anti-extension, 2) anti-lateral exion, and
3) anti-rotation.

Anti-extension exercises prevent lumbar arching and include front planks and ab wheel rollouts. Anti-
lateral exion exercises prevent lumbar side- exion and include side planks and suitcase carries.
Anti-rotation exercises prevent lumbar twisting and include Pallof presses.

Cable chops and lifts are valuable core exercises as well. These exercises should not be thought of as
less dif cult or challenging than traditional core exercises. If performed correctly, they are very hard.


6. Increase Hip and Leg Strength

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Most people who suffer from back pain have strong backs, and thats precisely why their backs hurt.
They use their erector spinae musculature (back muscles) to lift things rather than relying on the
glutes, hamstrings, and quadriceps. By strengthening the hip and leg muscles, the body will be
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encouraged the appropriate muscles. This doesnt mean that the erector spinae will not be
involved in lifting mechanics, as they will always contract heavily as stabilizers. However, the lumbar
discs will be spared as the lower back will be stabilized to allow the muscles of the hips and legs to
be prime movers.

It is imperative to start out with basic exercises and move up through the exercise progressions
gradually. One must master bodyweight with a full range of motion before using extra load.

7. Learn How to Move Properly and Incorporate All of the Aforementioned Qualities Into Your Motor
Patterns

Contrary to what is often said, one does not need to lift with the legs. The low back muscles are
stabilizers, while the hips and thigh muscles are prime movers. It is perfectly ne to lift with the hips
high as long as the lower back stays in neutral position. This simple act requires many of the qualities
listed above, such as hamstring exibility, glute activation, core control, and core/posterior chain
strength. Learn proper movement mechanics and reinforce those movement patterns over and over
until it becomes automatic. Finally, keep the load close to the body.

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If people learn how to follow these steps, many lives could be improved dramatically. To give you a
personal story, a 21-year old former client of mine (now hes 23) was told by three different doctors
that he needed to have surgery on his lower back. He was in and out of the emergency room and
constantly taking pain killers. After three weeks of training with me, his lower back pain completely
disappeared. Within two months he began performing loaded squats and deadlifts with 135 lbs.
Within six months he was squatting 300 lbs and deadlifting 380 lbs. It is now two years later and he
has never suffered a single bout of lower back pain despite lifting heavy week-in, week-out. While this
story isnt the norm, it clearly shows that low back pain can be alleviated and a LBP-free life is
possible if the correct strategies are employed.

26 Comments

Imerson says: Reply


January 11, 2010 at 3:16 am

Nice tips! Thanks!

Gravity Gardener says: Reply


January 11, 2010 at 10:44 am

Good info

Proper exercise using low impact methods like Yoga or Pilates can provide the
exibility and strength you need in the various areas that are problematic. Yoga
can be especially well suited of you are under a great deal of stress from work or
other issues.

Best,
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Gravity Gardener
http://gravitygarden.com/back-relief-pain/index.html

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Craig says: Reply


February 17, 2010 at 3:01 pm

Brett nice job on the article.you mentioned about s.m.r work using a lacross ball
under the arches of your feet.how does that in uence or aid in recovery of Lbp?
Thankz and catch you on the sc forum.

Bret Contreras says: Reply


February 17, 2010 at 4:26 pm

There is a string of fascia called the Super cial Back Line (Anatomy Trains
Thomas Myer) that runs from the underside of the toes, up the back of
the leg to the sacrum, up the back to the skull, and over the skull to the
forehead. By exerting pressure on the arches of the feet, it may cause the
rest of the fascial line to relax and allow for a greater stretch in muscles
like the hamstrings. This would allow you to move, bend, and lift properly
which would reduce pressure on the low back. Try it and see if it works;
bend over and see how far you can stretch (toe touch stretch). Roll out your
feet, then repeat the stretch to see if your exibility improved. Most notice
instant exibility improvements.

Cris says: Reply


March 3, 2010 at 2:36 am

Hy Bret. I just starting reading your blog and ive discover this article. I was
diagnostic with 2 bulging discs, and since i was sure that my wheight training is
kinda over(im still training but with small weights and evoiding exercises like
rows, squats, deadlifting) i try to do bodywheight training chins, inverted rows,
etc..I read in your article that a former client suffered from a low back pain and
after training with you he had recovered, maybe you can offer some tips about
how was his routine and what kinda of exercises has he done for recovering. I
dont have huge pain or nothing like that, just some sciatica, one or two
times/mont but low back pain is there, and i have somthing like a permenante
soreness in the moscles of the lower back( not the erector spinae) the other
muscles deeper that are stabilizing the spine and the hips..
Sry for some grammar mistakes..im from Europe.
Hope youll take a look at my story.
THX.
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Events Bret
Contreras says:
Reply
March 3, 2010 at 5:33 am

Cris The best possible thing to do would be to see a quality physical


therapist. They can work wonders. There is a reason why you have those
bulging discs and you must get to the bottom of it. You can certainly build
a great physique and tons of strength and power with just bodyweight
exercises, so dont feel like you have to go heavy. If you do start to
incorporate heavier lifting back into your workouts, always use picture
perfect form. Make sure your hip mobility, core stability, and glute
activation are up to par! Progress gradually back into things if you go that
route! Best of luck.

Ab Workout Machine says: Reply


March 14, 2010 at 7:45 pm

Ab routines are a excellent way to build con dence in your body as you can see
the improvements happening. So many people have shame and a lack of
con dence in their appearance.

Thierry Sanchez says: Reply


April 23, 2010 at 6:07 pm

Another great tool I started using recently is The stick ( easy to carry around to
events as well!) and of course, I always refer to the trigger point therapy
workbook by Clair Davies.

Bret Contreras says: Reply


April 23, 2010 at 6:18 pm

Yep; the stick works great! And Clairs book is a classic.

Rick says:
April 30, 2010 at 2:17 am
Reply

Great article. My son is a pitcher and keeps reinjuring his low back. I had not
thought of using the Pallof Press to help with anti rotational stability. We will be
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incorpaortating it into our planks and hip/upper thoracic mobiliy work.

Also, where do you get the pad for barbell that you use when you do weighted
glute bridges.
Events
Thanks

Rick

Bret Contreras says: Reply


April 30, 2010 at 2:42 am

Thanks Rick! The pad is a Hampton thick bar pad. Its a must-have if you
plan on doing hip thrusts or barbell glute bridges! Makes an excruciatingly
painful exercise pain-free.

Mark Tomlinson says: Reply


July 2, 2010 at 10:35 am

You write very interesting and captivating articles but one problem; with this
article in particular, it mainly states preventative methods for lower back pain.
What about after the herniated or bulging disc has occurred? Thanks in advance
and keep up the good work

Tyciol says: Reply


July 9, 2010 at 2:28 am

These are great tips

Jef says: Reply


July 21, 2010 at 8:34 am

Hi Bret,
I have scoliosis(10 degrees) which have caused my right lower back and left
upper back to become weaker. As a result my left lower back and right upper
back are always in constant pain due to the extra stress. I used to workout out
religiously but for the past 2-3 months my upper back would start swelling and
running my hand across I can feel lumps and tightness. Is there any tips or advice
for me? I am desperately looking for a cure and I have tried physiotherapy.

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thank you for your time,
jef.

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Erik Petersen says: Reply


August 25, 2010 at 8:36 pm

Bret,

Any good ideas about how to get people to squat fully without their upper body
pitching forward? I have been using doorway squats and band work (FMS Gray
Cook) to help.

Thanks!
Erik

Bret Contreras says: Reply


August 28, 2010 at 2:18 pm

Erik, I have Gray Cook bands too, which can be useful, but it really just
takes practice. Its usually a combination of poor mobility and/or stability at
the ankles, hips, and t-spine. You just have to keep reinforcing good form
over and over. I like to use mobility and activation drills in addition to
squat variations that individuals can do well (usually box squats) so I can
provide a good training effect.

maddie says: Reply


November 9, 2010 at 11:00 pm

Hi Bret,
Just started reading your blog and Im very impressed with your knowledge! I was
just diagnosed with a labral tear and FAI in my L hip which hasnt improved with
PT. Its very disheartening because I know Ill be sidelined for a while (as I pretty

much am right now) but as Im reading a few of your posts, it seems that my LBP
could be a direct result of those hip injuries and how they reduce my hip ROM
and seemingly robbed my L glutes of power. I feel stuck because I want to
progress with training my lower body and improving my form but dont have the
ROM to even perform a dead lift correctly! Have you heard of a correlation
between the hip labral tear and LBP?

-Maddie

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Bret Contreras says: Reply
November 11, 2010 at 2:01 pm

Maddie,
Events
This isnt a stretch in your imagination at all. Hip dysfunction is very
closely linked to lumbar dysfunction. Serial distortion patterns creep their
way through the bodyin this case the hip problem only had to creep
directly above (wellhip, sacrum, pelvis, lumbar spine, you get the idea).
Anyway any loss of ROM at the hip will result in compensatory movement
in the spine during movement.

You need to nd a quality PT or strength coach in your area who knows


how to deal with your situation. Id say you need to gradually restore hip
ROM and stability and then work on progressively advancing the exercises
in range of motion, repetitions, and eventually load. The degree of
degeneration in the labrum matters and you need a quali ed person to
help x you. Maybe your PT wasnt that good? Just speculating.

Cas says: Reply


January 8, 2014 at 9:18 am

Hi Bret.

Bret, when doing stretchs, how do I know, im stretching the hip


exors and not the quads?

Hansen Kenimer says: Reply


June 24, 2014 at 7:15 am

Bret, I would assume, by the same token, that dysfunction in one of


the shoulders can cause dysfunction in the hip/glute? Would it be
the ipsilateral or contralateral hip? I was thinking contralateral due
to the thoracolumbar fascia connection.

Audrey says: Reply


November 16, 2010 at 5:07 pm

Hi
Thank you for the information having had a disc bulge for 6 months I have been
seeing an osteopath which has costs heaps of money but is still no better in fact
getting worse by the day because of no exercises and I am a cleaner for 15 years
and am struggling to clean everyday now
Please could you recommend a good therapist for me I live in Coogee nsw and
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need help as soon as possible
thank you

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Juliette Johnson says: Reply


November 29, 2011 at 12:45 am

Thanks a lot for the information here. Do you have any thoughts about Whole
Body Vibration Therapy? I have been hearing a lot about it lately and I wanted to
know if it really is effective.

neha says: Reply


October 25, 2012 at 9:11 am

hi , i am having hip pain on my left side from past 7 months now. it all started
during zumba sessions. i ve not been working out since then but my pain is not
just going. i am going for walk everyday but have problem in any activity if it
prolongs for more than 20 min. MRI of back and hip was clear/ no problem.
then wot can be the reason?

A'Mar says: Reply


October 9, 2013 at 8:35 am

If people learn how to follow these steps, many lives could be improved
dramatically. To give you a personal story, a 21-year old former client of mine
(now hes 23) was told by three different doctors that he needed to have surgery
on his lower back. He was in and out of the emergency room and constantly
taking pain killers. After three weeks of training with me, his lower back pain
completely disappeared.
>>>

Im curious, what problem did he have with his back? In your opinion, can a
person with a herniated disk especially in the lower back do deadlifts and
back squats? Thanks in advance

Michael says: Reply


October 15, 2013 at 9:46 pm

I am also interested in your example client. Did he have true chronic back pain,
i.e several months duration or was it more of an acute injury?

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Ron says: Reply


December 13, 2013 at 4:57 am

Events Nice
articles, Some of the exercises shown might be too hard to achieve
Brett,
for anyone with a severe spasm. When in too much pain a good walk might be
too much. The self massage with the ball is a great tip. Thanks.

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