When it comes to exercise, too much of a good thing can be, well, back breaking, says physical therapist Sridhar Yalamanchili of Atlantic Spine Center. Workouts overdone or performed with little advance preparation are among the leading causes of back pain, particularly pain in the lower back, says Yalamanchili, whose expertise includes biomechanical analysis and functional rehabilitation.
“Failure to stretch before a workout, over-exertion, improper technique, and exercising when fatigued are all risks for back sprains and strains, lower back muscle and ligament tears, or just plain soreness.” Strains occur when a tendon or muscle in the back is pulled. A stressed ligament/ligament is what doctors refer to as a back sprain. Strains and sprains most often occur due to overload on the lower back muscles and supporting tissues like ligaments.
Fortunately, most exercise-related back injuries are relatively common, acute, and likely to resolve themselves with rest and proper care within four weeks to six weeks. But a sudden twisting or rotational force during a workout or sports play can damage one of the spinal discs and require more extensive medical treatment, Yalamanchili says.
“Pay attention to what you are doing and how you are moving during your routine. Change direction with your feet – not your back and hips – especially if you are working out with weights,” Yalamanchili says. “Even a seemingly minor, out-of-balance movement or pivot can cause post-workout lower back pain.” Often overlooked, returning your weights to the stand or floor after a workout without proper form can cause injury.
Most susceptible to back injury in the workout world is the “weekend warrior,” the individual who engages in strenuous activity only on Saturday or Sunday, according to Yalamanchili. “Sitting behind a desk or in front of a computer screen during the week is no preparation for undertaking several hours of intensive lower back exercises or competing in basketball, tennis or touch football on the weekend,” he says. “Sports can be hard on the joints, put stress on the back, and require some level of fitness to play them safely.” The extra few minutes of warming up the muscles help in injury prevention. Elite athletes do it for that precise reason, and that is a valuable lesson for all.
Lower back pain is considered the most common musculoskeletal complaint globally and a major reason for chronic back problems. The lower back is defined as that area where the spine curves inward, between the lumbar discs, L-1 through L-5. It is a complex of muscles, tendons, and ligaments that hold the spinal vertebrae in place and share space with an array of nerves emanating from the spinal column. “Any tweak that affects how all these parts work together can lead to back pain,” says Yalamanchili.
While regular lower back exercises is a necessary component of achieving overall good health, Yalamanchili says too many workout routines focus merely on slimming the waist and building arm and leg muscles rather than on strengthening the body’s core.
Core muscles are located beneath the exterior musculature in the upper and lower torso and are crucial for stabilizing and controlling forces on the body’s trunk, including the spine, hips, abdomen, and pelvic floor, and for protecting the inner organs. Weak core muscles contribute to an increased risk of a back injury during exercise and athletic activities, Yalamanchili says.
Experts agree, indicating that strong core muscles improve performance not only during intensive exercises like swinging a bat or a tennis racquet but even for the simplest of daily activities, such as reaching up and removing an item from a top shelf.
“Any exercise requiring coordination of abdominal and back muscles builds the core musculature,” Yalamanchili says. He cites the “bridge” as just such a routine. In the “bridge,” a person lies on his or her back, bends knees, tightens abdominal muscles, and then raises the hips from the floor until they are at the level of the bent knees. (Exhale as you raise up the hips and inhale while bringing them down). This is a simple starter exercise to get a feel for what core activation should feel like.
Other activities that can benefit the “core” are yoga and Pilates – both mind-body exercise regimens, Yalamanchili says. According to spine and physical medicine specialists writing in the journal Current Reviews in Musculoskeletal Medicine, “Pilates focuses on the [body’s] ‘powerhouse’… This includes the abdominal, gluteal and paraspinal muscles in particular.”
“Research and clinical experience show that, by strengthening the core, one can limit – or avoid – episodes of activity-related back and neck pain, reduce the severity of pain should it occur, promote healing of back problems, and improve overall posture,” Yalamanchili notes. He also recommends including regular, low-intensity, low-risk aerobic and cardio exercises like bicycling, jogging, brisk walking, and swimming into any activity regimen.
In addition to aerobics and core-enhancing exercises, Yalamanchili offers the following tips to prevent back injury from workouts:
- Stay active, exercise regularly and daily if possible. “Too much sitting not only increases stress on the spine but contributes to weakened trunk muscles,” he says.
- Stretch muscles before a workout to warm them up and after a workout to loosen them.
- Avoid exercises like the classic sit-ups that are hard on the back.
- The old adage: “No pain, no gain” is only true if you feel post-exercise soreness. Otherwise, “If you experience pain, stop what you are doing, take a break and rest,” Yalamanchili says. “Playing through pain could cause further injury.”
“And, if there isn’t lower back pain relief after exercise, the pain even becomes more intense, awakens you at night, or radiates below the waist to your buttocks and legs, contact an orthopedic spine specialist immediately. You have a condition that needs medical attention sooner than later.” Yalamanchili advises.
Sridhar Yalamanchili, PT, MSPT treats a variety of spinal and upper and lower body musculoskeletal disorders as lead clinician in the outpatient physical therapy clinic at Atlantic Spine Center. Contact us to learn more about our physical therapy services.
