Begin in front plank position with your low back core muscles activated. Keep your shoulder blade muscles engaged and step your left foot out to the side and then bring it back to the start position.

Then step your right foot to the side and then bring it back to the start position. Repeat 10 repetitions for each direction for 3 sets daily. 

This will help build strength in your core stability muscles after a lower back injury.

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. We're going to talk about more common the most, maybe most, at least a common type of low back pain. How are you doing Wil? 

Wil: I'm doing really well. Thanks Mark. Yeah. 

Mark: Stumbling all over myself here. 

Wil: Yeah, and people stumble quite often over, you know what is the cause of the back pain. And what I want to talk about today is just a type of back pain that is actually very common, very common in athletes, and just like an everyday type of pain that comes up from lifting, twisting or even just sitting wrong. I mean, wrong in terms of posture, that's not really ideal or optimal. So type of back pain is basically caused by a strain in your iliolumbar ligaments, which is basically a connective tissue and ligaments that stabilize and connect the last two segments of your lower back vertebrae, which is your L4 and your L5.

And so basically you have five vertebrae that make up your lower back. And your L4 and your L5 is your last two vertebrae. And these ligaments, there's a couple of different bands and they connect under your pelvic bone. And that's called your iliolumbar ligament, or iliolumbar ligaments.

Mark: So when you actually like feel along the iliac crest or your pelvis in your back, is that where these are attaching, basically? 

Wil: Yeah, it's hard to feel because it's all so deeper. You have to like palpate basically through your muscle and you also have another layer of connective tissue. And so it is really tough. So when we're testing for, you know, we're obviously doing a couple of different tests to see if it is stressing that ligament. But then we're also ruling out on different things because, you know, with the presentation of this type of injury, it can also present itself as possibly other things too. And so we've got to make sure that it's not that as well. 

So there's always a barrage of different tests to really go through. And this type of back pain is also something that can, like when you have it for the first time, it may not be like, oh, it takes a day or two to heal. It may take a little longer because of the nature of how it stabilizes that lower back and that lumbar spine in the pelvic area. And especially if you've had it like as a chronic condition. So what I mean by that is, if it's been recurring, like, you know, you get over it, and then it happens again.

And so when it's a chronic condition, it doesn't necessarily have to be like a specific, like lifting or bending or twisting or athletic type of movement. So like I've seen it in rock climbers and soccer players and volleyball players, and you know, it's common in athletes. Very, very common. And I've seen it a lot. 

And then with non-athletes, pretty common too. So you can be really out of balance in that area, and then you do something like you're sitting kind of with non-optimal posture for awhile, or if you've been sick in bed for, you know, like week with the flu or, you know, in this case a few specific clients that have had COVID in they're in bed for a little longer and then pretty inactive. And then it ends up straining.  So those are the kinds of the ways that you know, it can be injured and it's a lot more common.

Mark:  Would possible ways of dealing with it be that you make core strength training, has to be part of your regular training regimen. Is that going to help? 

Wil: Absolutely longterm. Yeah, for sure. And we also want to do too, when you have this kind of injury, like, especially if it's not going away, like general rule of thumb, is that if you hurt your back, you're not really sure what it is. You know, iliolumbar ligament strains will usually, you know, it's more than just a 24 hour thing. You'll feel it for a couple of days, for sure. You want to get it assessed and see what's going on because you want to also address the specific deficits that's causing it. So it's not just the core strength issue. There's imbalances going on there that you need to address.

And then now that you have this strain, there's in essence, a type of hyper-mobility, or it's like, there's a little bit more play in there now. So it's less stable is what I'm saying. And so, because you have less stability in there. That core strength is very key and it's specific core strength too, to making sure that that actually becomes more stabilized in there. And especially if you're going back and doing anything physical, like if you have a physical job or sports for sure. And the reason why is because would that instability, it can lead to then like more serious injuries if you're not actually rehabbing it, like a disc injury. 

And studies have actually shown that when you actually have a lower back injury and you don't rehab it properly, you don't get the core strength and you don't get the muscle imbalances corrected, then there is actually a high recurrence of back injury and something more serious. And this is a good example of it. 

Mark: So what's a typical course of treatment? 

Wil: Yeah, so I'm thinking about a couple of people that came in with this type of injury recently. And the first thing I do is I address their mobility issues and figure out what's going on. So there's usually a lot of spasming and these people came in, I'm thinking about two specific patients that came in. One who is actually a little more athletic, recreationally. And then another client who's not athletic, but just sits a lot for her job. And they both present with the same type of things in terms of muscle spasms, a loss of mobility, and also a lot of imbalance happening.

And usually that's also really key too, because you want to look at what kind of areas are like really shortened in terms of muscles. And also you want to look at the movement patterns. So we're addressing the bigger picture of what's going on in their movement patterns and why that's caused it to strain. 

So for example, the person that sits a lot for her job, you know she does a sit and stand. So we corrected that. But also just looking at how she walks even something as simple as that and we need to really correct the alignment of that area and part of that is okay, you know what? Her hip flexors are super tight, pulling all that, compressing things. And then her other bigger back muscles are also super tight. In addition to the spasming, that's protecting the injured area. And then she's got weaknesses in certain areas that are not just from this injury.

And they're like chronic weaknesses that she's had which are very apparent because there's some atrophy going on. That's more than just like a week's worth of injury.  So those are important to address. She had a lot of tightness up in her upper back,  which meant that she wasn't moving through her upper spine and she's not getting this rotation movement. She is pretty active, but not athletic. You know, that she's going to move a lot through her lower back when she does things like gardening and everyday stuff. And so that puts more stress in that area. And then those muscles tend to get tighter and get used more like in the lower back area, causes it to be a precursor to something happening and she wasn't a big fan of stretching and mobility work and core work to begin with. And then we would address the muscle spasms and do things with manual therapy in that specific area, and also IMS, dry needling and stuff like that.

Mark: And what's the typical. Kind of treatment timeframes for this to get better. And of course it always depends on how bad it is, but, or how chronic it is, but what's a more typical recovery time. 

Wil: Yeah. So for someone who's experiencing that pain, especially like I'm talking about like these two individuals, you've had pain for a week and finally, like, I need to come and see someone about it because I don't know what's going on. And they're a little more concerned. You know, the ilia lumber ligament was specifically diagnosed then, you know, four to six weeks is a typical timeframe for it to heal. And it doesn't mean that you're not going to get any better. Like with both of these people within one session, they felt like night and day. So they went from like, basically a six to seven out of pain. Pain scale on a visual analog scale in terms of subjective rating, to like a three out of 10 within like 24 hours. Which is significant. 

And then when you look at that timeframe, like it's that healing process is important, because the soft tissue injury needs to heal where you strained it. And then once that sort of, you know, heals up. And then when we talk about the person who's more athletic, we get him doing more higher level core stuff, but, you know, he even came in to see me like six weeks later. And he was no longer having problems with that ilia lumbar area, but he was still having, yeah, it's like a one out of 10 pain Wil, and like, I can do stuff now. Six weeks later. But now he's like, I want to like start lifting more and, you know, it's sort of that process of like getting him ready physically to do that. And wanted to go in the gym and started lifting weights. And he liked to, you know, typical sort of gym routines that involve a lot of your traditional, like squats and deadlifts and bench press even too. So you gotta be careful with bench press even at this stage. 

Mark: So the basic message here is that the most common low back pain is not from discs. It's from this ligament you're talking about. 

Wil: Yeah. It's very common, which then can lead to possible disc injury, if you don't rehab it correctly and then make it a part of your daily routine. 

Mark: So if you're in Vancouver and you have lower back pain, you can call Insync Physio to book your appointment in Vancouver at 604-566-9716. In North Burnaby, they have a North Burnaby location as well, 604-298-4878. Or you can book online insyncphysio.com. Thanks Wil. 

Thanks Mark.

With both sides of the pelvis level squat down on one leg sitting your butt back (like in a chair). Keep the knee over the ankle and aligned with your hip and second toe while preventing it from moving past the toes as you squat.

You also want to reach both arms out in front of you to keep balanced and bend your hips so your chest comes forward. Your weight is on your entire foot as you come straight back up. Place the emphasis on pushing through the heel while squeezing your butt all the way back up. Repeat this for 10-15 repetitions doing 3 sets on each side.

This can help with lower back pain if your core stabilizing and Gluteus Medius muscle weakness is consistently causing your pelvis and low back to compensate. The weakness in this area can also be caused by your lower back pain, pelvis or a lower limb deficiency such a as previous ankle or knee injury that was not rehabbed properly.

If you have any problems or questions with this exercise consult your local Physiotherapist before continuing.

Start on your hands and knees with your spine in neutral alignment. Engage the inner core stability muscles of your lower spine by pulling the muscles below your belly button inward without changing your neutral spine posture.

Then, bring your hands forward on the mat and straighten the knees one at a time so that you’re on your toes. kick back and extend with one heel while keeping the hip square and lined up with the other hip and reach the opposite hand and arm forward. Hold this for 10 seconds doing10 reps on each side for 2-3 sets.

This is a great core stability strength exercise to help progressively strengthen your lower back after you have injured it. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

Start out lying on your back with your knees bent. Hug one knee to your chest. With the opposite leg, squeeze your bottom and push through your heel to raise the hips up towards the ceiling. Hold at the top for 10 seconds. Slowly lower down.

Repeat 3 sets of 10 repetitions.

This exercise is great for low back pain to strengthen the gluteal muscles. 

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann, Insync Physio in Vancouver consistently, currently rated one of the top physiotherapists clinics in Vancouver as voted by their customers, the people who count the most. And we're going to talk about that low back pain. Adam's going to talk about a client of his, that injured themselves. How they injured themself?

Adam:  So came on kind of out of nowhere they were cycling, for about 50 kilometers on the weekend. And then they felt this sharp pain in their back the next morning. and it was pretty sharp, but the thing that was really bizarre about this pain is it actually caused a shooting pain down into the heel of her left side.

And so it was pretty short and it was different than other back pain that she's had in the past. And she's had back pain in the past, but this was something new where there was this kind of zinging, electrical feeling down into the foot. So, she was quite scared and she went to the doctor and the doctor referred her to physio.

Mark: So how did you go about assessing the injury? 

Adam: So, yeah, we started with a thorough assessment. We basically, again, did a nice history where we talked about, what caused this. And so again, it kinda came out of nowhere, but we found out that she did have back pain in the past, but usually it was just in the lower back and never shot down in the past.

I found out that actually she was born genetically with an extra vertebrae in her back, meaning an extra spinal segment and that's different, but it's normal. It's considered just a normal thing. Isn't something that would have caused that pain necessarily.

 What we found out is where the numbness and tingling, where that zinging pain in the leg was. That gives us a clue where that possible nerve could be compressed. So it gave us a bit of a homing signal where we should focus our assessment. Nerves if we think about them. So tingling and zinging pain is usually a sign of a nerve injury and so nerves perform three things. They do reflexes, muscle strength and they do sensation. 

So we tested all three of these components and we just basically compared, the reflexes sensation and the muscle strength to the other side, to find out what was normal for her. The thing that we did differently in the way I approach back pain is I actually really want the spine to move.

So I look at the range of motion pretty carefully. And this is a, this is a different style of assessment. It's called The Mackenzie Method or MDT. And we use it for diagnosis and treatment. And basically it's a very safe method where we get people to perform some repeated spinal movements. So we find out if their spine has a preference to go in the direction of backwards or forwards, or if that increases or decreases some of the numbness or tingling sensation.

We look at if sitting is aggravating or if I'm walking is aggravated. So basically we find different ways how their spine likes to move, and doesn't like to move. And so with these repeated movements, we found out that actually this person, liked a flex spine. So we found a certain type of motion that her spine responded to.

And how did we find that their spine responded that way? It was basically, the pain stays relatively constant at first, but the location of the shooting pain moved closer to the spine. So it wasn't necessarily in this case that the pain or the shooting sensation went away entirely, but it was closer to the area where there was a problem. If that makes any sense. 

Mark: So tell me some more about that. How does that work? 

Adam: So basically if we can get the pain closer to where the spine is, that's called centralization in this McKenzie Method. And basically at that point, we can really focus in on the joints that might be dysfunctional or the muscle tone or the pelvis position, some of these other components and deal with it.

If we find emotion, alternatively, that makes the pain in the foot stronger or more intense then we can sort of get a clue that that is emotion, that the spine doesn't like, but that further aggravates pain. And the reason why we do this is at the end of the day, back pain, although we can get people pain-free and get them moving much, much better, it tends to come back. So if someone is doing something that's pretty explosive or snowboarding, and if they haven't done it in a long time, they haven't been keeping up with their exercises. It tends to come back. I'm not sure if that's just why they call it the back, but, this is a good way for us to find how each spine likes to be moved and what exercises we can give them so that they can self manage some of these problems on their own. 

So basically when we found that this person liked to flex spine, we gave them some exercises that basically would get their spine into a more flexed position. And it would take away the pain. And so once the pain got under control and that shooting electrical pain was in the spine area, we actually could work on other things. Like joint mobilizations, how this position, like I just sort of talked about and of course, core strengthening. 

Mark: That sounds really good. So any final points you want to make? How did this end up for the client? 

Adam: So basically this person is back to full activity and we talked a little bit about return to full activity looked like, cause they really like cycling. So, if they're going to go for a longer cycle, they have a routine of exercises that they do basically right before it. They keep up with some strengthening components that we give them, you know, that they have to do at least once a week, maybe twice a week.

And if they do those things, their back pain is pretty well under control. They don't have any of that shooting, electrical sensation anymore. And they're able to return to full activity, which is snowboarding, cycling, and climbing. And they live a very active, happy life. So basically, the idea is that this Mackenzie Method is a fantastic way for addressing back pain because it gives the clients some self management tips. Like I mentioned before, and then they also have a bit of self awareness.

They know if they're going to do something in particular, like walk for a long distance or get their spine in a position where their spine doesn't like it, they can avoid it or they can prepare for it. 

Mark: There you go. If you're looking for some relief for your back pain and especially, if you're willing to take some responsibility and maintain it, the guys who can really help you with a course that not only takes the pain away, but helps keep you pain free as much as is practically possible. Back pain is the number one problem that people have in terms of pain in their bodies.

Adam: It is Mark. 

Mark: So this is really important and I'm sure lots of people who are watching this have encountered this in the past. I certainly have. Adam Mann, at Insync Physio, you can check him out at their website, insyncphysio.com. Give him a call in Vancouver, (604) 566-9716 to book or in Burnaby (604) 298-4878 to book. You can also book online right on their website. Thanks Adam. 

Adam: Hey, have a good one.

Progressively strengthening your core stability muscles after a back injury can help you become functionally stronger.

Start by lunging forward with your right foot and reaching up with the opposite arm and hand high up above your head while keeping the low back in neutral position. When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Don’t let your knee fall into the middle or go past the front of your toes and the opposite arm reaching straight up without deviating past the midline or off to the side.

Push back up to the start with the forward foot and repeat this for 10 repetitions doing 3 sets for each side.

This exercise is great for returning to activities and sports that require a lunge and reaching motion. If you’re unsure about the exercise or have uncertainty about where you’re at with your lower back book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out. 

Increasing mobility in your middle back or your thoracic spine when it’s stiff can help you rehab and recover from those low back strain injuries even faster. By doing something like thoracic rotations, you can utilize the entire mobility of your spine and also improve the overall functional movement of your body!

Start by taking a wider stance, cross your hands over your opposite shoulders and pull in your inner core muscles. Without rotating the hip or pelvis, turn the body leading with the shoulder in one direction until you reach the barrier of your full range of motion.

Then turn the body leading with shoulder into the opposite direction until you reach the barrier of your full range of motion. Do this for 30 reps two to three times per day.

If you’re unsure about the exercise or have uncertainty about where you’re at with your low back book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out. 

You can perform this exercise with your ankles secured under a bar, on a squat rack or wall bar or have a partner hold your feet and ankles down.

Use a yoga mat to make it more comfortable for your knees. Start by pulling in your inner core and keep it engaged the entire time. With your hands out in front of you, then slowly lower yourself down to the ground in a controlled manner into a push up position.

Once you make contact with the ground, then push yourself back up. Repeat this for 10 repetitions, doing 3 sets daily.

This is an advanced level strengthening exercise for your low back that works on increasing your functional core stability strength. 

Kneel down with a big exercise ball in front of you. Keeping your back straight and your inner core muscles engaged, slowly roll down your forearms on the pinky finger side.

Straighten out your elbows and move slightly past them on the ball. Come back up with control to the start position. Repeat this for 10 repetitions, doing 3 sets per day.

This is a great exercise to strengthen your lower back after an injury and retrain your core stability muscles to help them work better.

If you’re unsure about the exercise or have uncertainty about where you’re at with your recovery book an appointment and have one of our Physiotherapists at either our North Burnaby or Vancouver locations to check things out.