Sitting down to type this blog, all I want to do was rant. This subject gets me super fired up because low back pain is such an easy fix and, yet, everywhere I look people are recommending exercises that will only exacerbate the issue. What's even more infuriating is that healthcare and fitness professionals even know what the problem is! Their solution, however, woefully misses the mark. I can’t take it anymore.
Let’s set the record straight and get that low back fixed once and for all!
YOUR HIP FLEXORS ARE TOO TIGHT
The bottom line is that your hip flexors are too tight, specifically your poas major. There are two psoas muscles; the psoas major and the psoas minor. While the psoas minor does originate from the spine, it does not actually cross over the hip joint and is not considered a hip flexor. The psoas major, on the other hand, is a large muscle that originates on the lumbar spine, crosses of the hip joint, and inserts onto the upper region of the femur. When a muscle is tight it is constantly trying to bring these two points together. When your psoas major is tight it will LITERALLY pull your lumbar spine forward, collapsing it in toward the femur. A super tight psoas major will manifest as a swayed back. You can visually see the muscle attempting to pull the two points together. The pulling and tugging on the lumbar spine is what creates discomfort and pain if it is not addressed. It can also lead to more severe conditions (sciatica, herniated discs, etc.).
ANTAGONIST WORK FOR PAIN RELIEF AND REHABILITATION
As I stated in my “3 REASONS WHY YOUR KNEE HURTS (AND HOW TO FIX THEM)” blog, for every painfully tight muscle, there is an equal and opposite muscle or groups of muscles that are significantly weak in comparison. The pain indicates that there is an imbalance in the way the agonist and antagonist muscles are pulling at the joint. If you have pain due to a tight muscle it’s because the opposite muscle is no longer capable of generating an adequate amount of force to counter the tight muscle’s pull.
The equal and opposite muscle of the psoas major is the gluteus maximus. While the psoas major is a hip flexor, the gluteus maximus is THE primary hip extensor. If your psoas major is so tight that it is causing low back pain, this means that your glute max is weak in comparison and it cannot sufficiently fight the psoas major for balance at the hip joint. Your main focus should be to bring the glute max up to speed. DO NOT do hip flexor work. These are the exercises I see everyone recommending and is the reason why I get so fired up over this subject. If a muscle is tight, YOU DO NOT WANT TO MAKE IT TIGHTER! You ACTUALLY need that muscle to relax. The best way to make a muscle relax is to use reciprocal inhibition. The best way to ensure that you are correcting the balance at the joint is to target the antagonist (opposite) muscle.
For more information on my rehabilitation protocol, visit the very first rehab blog I whipped up called “3 REASONS WHY YOUR KNEE HURTS (AND HOW TO FIX THEM).”
PROGRESSING THE GLUTES
The psoas major has the ability to become ridiculously tight. In fact, I have seen the psoas major so tight that a client cannot perform a simple hip flexor stretch because it creates too much tug and pain on the lower back. Our goal is not to create pain. Our goal is to eliminate it. If your psoas major is so tight that stretching it puts strain on the lower back, we need to give you a different move and progress the gluteus maximas slowly. In fact, we may need to take this step by step from the beginning and that is a-okay! If this sounds like you, let me first present to you….
THE BOOTY FLEX
The booty flex is a LIFE SAVER, or should I say low back saver. It is a quick, go-to move that can be performed anywhere at anytime should your low back act up for any reason. The booty flex is basically just a glute activation that allow for an opportunity to produce a solid contraction. Because we can achieve such a solid contraction with this move, our body has a chance to trigger reciprocal inhibition in the psoas major and provide immediate relief in the lower back.
Whenever I have a client who has low back pain, this is the first move I will show them because it works so fast (within seconds) and can be used anywhere. You can do this exercise lying down or standing up. I also like to give this move as homework in the beginning. I recommend that this move be performed once in the morning and once before bed. All you have to do is squeeze the glutes as hard as you can for about 7 seconds. Throughout that 7 second hold, try to squeeze the glutes tighter and tighter as the seconds go by. After 7 seconds, relax for a brief moment and then do it again. Repeat this for about 10 rounds.
If you feel a tweak throughout the day, simply do this move and, if you get a super hard contraction in one round, the pain will immediately be gone. If the pain is super intense and your contractions aren’t that great, you may have to add an additional round or two in that moment. When performing the standing booty flex, make sure you are not shoving your hips so far forward that you arch at the low back. Simply stand straight up and squeeze the glutes as hard as you can.
If you follow me on social media or have read some of my other blogs, you may have noticed that I am not a huge fan of stretching. I think it is inefficient, only mildly effective, and terrible at addressing the real problem. I am calling this a stretch but it is really another glute exercise. This exercise is a progression from the booty flex. The booty flex offers only a bare minimum level of resistance to help us become familiar with glute contractions. In this move, however, we are upping the intensity and now requiring that we use our very own psoas as a means of resistance. This is going to feel as if it is a HUGE stretch and, because of the nature of the move, it will be. BUT, we are actually forcing your glutes to fight the psoas, which will begin training them to be the dominant force between the two opposing muscles. The most important thing you need to do here is engage your glutes. Do not stop squeezing and only go as far forward as you can with the glutes still engaged. Hold for 30s each side. When you can perform this move, add this to your morning and evening booty routine. Perform these first before the butt flexes.
LYING HAMSTRING CURL
Regardless of if you have back pain or not, learning how to utilize the glutes in order to stabilize the hips is a prerequisite for several things we do in the gym. The lying down hamstring is a PERFECT move to learn how to use the glutes as hip stabilizers. On the lying down hamstring machine we must use the glutes to stabilize if we want to produce maximum output in the hamstrings. If the glutes are not stabilizing, the hips will lift off of the pad and the butt will shoot up in the air. Learning how to stabilize with the glutes will be exhausting. The goal of this move is not to load up the weight and work the hamstrings. The goal for you and anyone else in the beginning is to focus on the stability aspect of this exercise. This is no longer a hamstring move. Consider it a glute move. Begin with a light weight, squeeze your glutes hard through the ENTIRE REP, take it slow so you can make sure your hips don’t move a millimeter, and ONLY focus on your glutes as you bend your knees to perform the exercise. If you have never thought of this exercise in this way, you are going to be surprised at how difficult it actually is. As you bend at the knee and lift the legs through the range, think “squeeze the glutes tighter and tighter and tighter” as your legs come up. Check your glutes at the top of the rep to make sure they are engaged.
Now that you know what glute contractions feel like, have the ability to overcome your own psoas, and can stabilize the hips with the gluteus maximus, it’s time to perform glute isolation exercises to make sure that low back pain never returns. Remember, the reason why your low back is in pain is because your glutes are too weak compared to your psoas major and they are losing the tug of war fight at the hip joint. We need your glutes in the game and taking home Ws on the reg. Hip thrusts are a fantastic gluteus maximus move because they overload the short position and automatically place the psoas in a lengthened position.
Hip thrusts can be performed easily on the floor for beginners. As you get stronger, consider elevating your thrusts by placing your upper back on a bench. In this position you can add weight to the hips to further progress the exercise and build a tremendous amount of glute strength. The key to a fantastic glute hip thrust is to think about teeter-tottering at the pivot point where your upper back meets the bench. A common mistake is that people try to keep their upper back in one position and arch at the low back to move the hips downward. Keep your spine in a neutral position and teeter on the bench. Another common mistake is that people go super wide with their feet and try to band this move with booty bands. Keep your feet hip distance apart and focus on hip extension NOT abduction. The glute max is actually poor at abduction. The glute medius and minimus are far better at abduction but those two muscles are not the priority right now or the key to fixing your low back stuff. Keep it simple and direct. Use hip thrusts for hip extension ONLY.
EXERCISE TO AVOID
During this time of recovery and rehabilitation, avoid exercises that have a lot of hip hinge or flexion in them. Hinging at the hip will require the psoas to do one of two things. It will either be the primary mover in the exercise or it will be the stabilizer in the exercise. Either way, it means that your psoas will be doing work (contracting) and these moves could lead to a painful flare up in the lower back.
I have a few examples of exercises to avoid at this time but let me first stress the leg press. Eliminate this exercise from your routine. Even if you are doing the leg press for glutes, this position is not where you want to be during this time. The glute leg press, keeps the glutes in a more lengthened position, meaning that your psoas will be in a shorter position. You need your glutes short and your psoas long. The complete OPPOSITE profile of the leg press. It is also a move that I see people abuse range of motion on frequently. They go wayyy out of their range and end up rocking the hips back and forth, causing pain in the lower back. Do not do this exercise for quads and do not do this exercise for the glutes for the time being.
Other moves to avoid would be any deadlifting exercises so regular deadlifts, stiff leg deadlifts, Romanian deadlifts, etc. I would also advise people not to lean forward on the seated hamstring curl or the leg extension (if you’ve seen my videos on both you know why I usually recommend leaning forward). Utilize the back pad for both of these exercises for now. If you’re going to do any squat type movements, I recommend elevating your heels in order to reduce the amount of forward lean in the torso as much as possible.
In today’s world, so many jobs require people to sit for extended periods of time. This sitting position trains the psoas to be in a shorter resting state. This is why so many of us experience low back pain at some point in our lives. Hopefully, though, you now understand exactly what needs to happen in order to resolve this issue. Those who expericence low back pain need to stay away from hip flexor work and avoid anything that puts the psoas major in a shortened position. There is no reason to make a painfully tight muscle even tighter. Instead, we should focus on getting the opposite muscle back in the fight. Working out the gluteus maximus will significantly improve balance at the hip joint and will provide relief in the lower back. You can now go forth and preach this message of healing to your friends and family members who may also be experiencing low back pain due to a tight psoas major. Furthermore, together we can combat information that will only exacerbate the issue. Together, we can put a stop to low back pain once and for all!