I was fascinated by research published by the George Institute Sydney last week which concluded that taking drugs for back pain is largely pointless. A bold statement, I thought, given that back pain is most commonly managed by prescribing medicines such as anti-inflamatories.
The team’s analysis of 35 trials concluded that only one in six patients treated with non-streroid anti-inflammatory drugs (NSAIDs) received any pain benefit that they would not have got from a placebo, and that was so small it probably made no difference to their lives. Manuela Ferrerira, senior author of the study, said “when you factor in the side effects, which are very common, it becomes clear that these drugs are not the answer to providing pain relief to many millions of people who suffer from this debilitating condition every year.”
The team went beyond the negative conclusion about the efficacy of drugs to give practical advice, saying “patients with back pain should consider an exercise programme to help them manage their condition, eg aerobic exercises, strengthening/stretching exercises, pilates, yoga, core-stability exercises”. This isn’t dissimilar to the advice given on our NHS website about managing back pain. Whilst the NHS includes anti-inflamatories as an option, this is only third on their list of advice. The first two recommendations are to stay as active as possible and to try exercises and stretches for back pain.
Whilst I’m neither a medic nor someone who suffers from a bad back, it comes as no surprise to me that back mobilisation and core strengthening exercises are key to back health. During the seven years I’ve been teaching Nordic walking dozens of you have told me how much better your back is thanks to Nordic walking - often in conjunction with pilates and or yoga. The reason? Besides being an aerobic exercise which gets the whole body moving, the blood circulating and the lymphatic system energised, Nordic walking strengthens both your core and postural muscles. Both of which are key to back health. Last month I gave the science behind why rotating your upper body when Nordic walking is so good for your spine and general back health. Today I want to share some issues which seem to be common to those of you who suffer from a sore lower back and how Nordic walking might help.
Weak glutes. The gluteal muscles are a group of three muscles in your buttocks. These muscles are responsible for stabilising the pelvis and moving the hip and leg. They are extremely important – I’ve written a whole blog about them previously (click here if you wish to re-visit it). Unfortunately, most of us now spend more time than we’d like sitting down. For some this results in the glutes literally ‘switching off’ and they stop functioning properly. The body is so clever that if this happens it recruits other muscles to take the place of the glutes – and its muscles of choice are those of the lower back. Needless to say, these muscles are not strong enough to do the job and the result is an aching lower back.
Tight hip flexors. The hip flexors are a group of deep muscles that help connect our legs to our pelvis. When we bend our knee or hinge at the waist we use our hip flexors. Weak glutes and tight hip flexors generally go hand in hand. Sitting keeps our hip flexors in a tightened position for an extended period of time. For some people, they never quite stretch out fully. The result is that the hip is permanently tight which in turn inhibits the glutes from doing their job properly. Again the lower back has to come to the rescue and take the strain.
Weak core. I don’t entirely know why so many of us suffer from weak core muscles but I do know that, if you don’t have a strong core, your back will take over the job. A favourite expression of mine is ‘the bully back’ because often when people first start Nordic walking they get a sore lower back. This is usually a signal to me that their core muscles are weak. Understanding why this is happening and some simple technique tips will both stop the pain and strengthen your core.
Emotional stress. Besides the physiological stresses placed on our lower backs we can also hold emotional stress in this area. This tension often manifests itself as lower back ache. The fact that Nordic walking is outside, in nature and often in a supportive and sociable group environment helps relieve this stress and help our lower back health.
Nordic walking of itself may be enough to alleviate lower back pain. Or it may be that Nordic walking in conjunction with some other form of back care (osteopath, physio, pilates etc) may be the solution for you. In any event, Nordic walking will teach you to use your muscles in the right way and in the correct sequence and give you the best possible chance of being free from lower back pain going forwards. Here are some of the key focus areas:
- The heel/toe roll. Ditch your passive foot strike and concentrate on actively rolling your foot from heel to toe, opening your ankle joint as you push off with your toes.
- Stand tall out of your hips by pulling your tummy muscles in slightly, lengthening the gap between your hip bone and rib cage (the most important gap in your body in my view) and opening your chest.
- Squeeze your glutes and push into your hips when you push off with your toes.
- Keep the downward pressure through your pole for as long as possible – the more effort through the pole, the more your core will work and strengthen.
- Keep your hips level (not possible of course if you have one leg longer than the other). The best advice I can give on how to do this is to try and sink your lower body into the ground as you walk and imagine balancing a glass of water between your two hip bones, trying not to spill it.
- Torso rotation as you walk. This gentle movement helps boost circulation the whole way down your spine and increases the oxygen and nutrients to the discs and vertebrae (click here for my fuller blog on spinal rotation).
Don’t forget we also incorporate some wonderful back warm-up exercises and stretches into our classes. Building these and the more specific technique points into your regular and Nordic walking will certainly make your back more mobile and better supported and it just might make the difference for you. Here's a brief video of some of our walkers demonstrating the cobra-type exercise which helps strengthen the small muscles supporting the length of your spine and is a real favourite of mine.