You know the feeling. That achy, twingy, “feeling-like-you’re-gonna-lock up” in the lower back feeling when you bend forward to do even the simplest task.
Well, have no fear! I’m going to show you the best way to handle this situation without further aggravating your lower back when bending.
How to Bend and Lift Safely As a Back Pain Sufferer
Normally, when no back issues are present, we can round our backs to bend and lift light items from the ground, bend over a sink to do dishes, or perform other basic tasks without a problem.
When you have back pain, however, this is frequently a problem. The forward rounding position of the back (called flexion) stimulates a guarding response as your body feels a “threat” from moving into that position.
This response may be for a completely valid reason (for example pressure on a disc thats bulging or spinal joints aren’t moving correctly), or it may be due to lack of strength and/or endurance of the back muscles.
Stop Hanging Off Your Back Ligaments
As we bend forward, it forces our back muscles are work harder to keep us upright. At a certain point of forward bending, our muscles disengage and we get to the point of “hanging” on our spinal ligaments.
This can give the appearance of relief from discomfort because the muscles relax, but as I explain in the video above, hanging on these ligaments for extended periods of time may provoke inflammation and even weakening over time. This is NOT what you want.
Tip From Your Hips
Bending forward from your hips rather than your spine forces your muscles to work while maintaining the position of the spine. Since the butt muscles (glutes) are very well equipped to doing this job, you will feel much less stress in your lower back because the work is being shared between the spinal muscles, the glutes and the hamstrings.
The best way to accomplish this is with the use of a dowel rod (shown in above video) or with a simple broomstick. Hold the stick behind your back, and it should make 3 points of contact:
- Back of head
The next step is to unlock your knees, and shift your weight back toward your heels. While maintaining the 3 points of contact, bend at your hips.
You can continue to bend until you reach the desired bend to perform your activity or until you start to feel any discomfort. If you start to feel any pain, bend your knees a bit more to get your body more upright. This will reduce the workload on the back muscles.
But how do I get down to the floor??
What are you going to notice is that there is virtually NO way you would be able to maintain this alignment and get down toward the floor to pick something up. This is EXACTLY why you would continue to bend your knees until you can reach to pick something up. We call this a SQUAT.
I’ll save the “why you need to squat if you have back pain” for another post, but you can easy see why this is super important.
Using the Bending Movement as an Exercise
This movement is often one of the first exercises I teach my personal clients. Being able to achieve this position is crucial in order to protect your back, but you also need to strengthen these muscles to improve tolerance to repetitive activity.
As you can imagine, much controversy surrounds manual testing for dysfunction of small joints that move as little as 2 mm. Many clinicians believe the following manual tests produce non reliable evidence of SI joint involvement in pain, but presently there are few other options.
Medically, the customary procedure for SI joint diagnosis is joint blocks via injection, but these as well have difficulty standing up to criticisms. Clearly more research needs to be devoted to the accurate diagnosis of SI joint pain.
The above, however, does not necessarily mean these tests are not clinically useful. They can provide valuable information, particularly when they are able to reproduce symptoms, and of course be used to follow up and assess changes after therapeutic interventions. Since these tests are relatively safe and easy to perform, they can be used to gather clues.
The following tests are the most customary ones, and I will not delve into more complex testing in this post, as that is better suited to a clinician’s textbook.
Side-Lying Sacral Compression
Femoral Shear Test:
To Sum Up…
It is suggested by some therapists that at least 3 out of the 5 tests above must be positive to indicate SI joint involvement, and that if all 5 tests are negative, move on to testing other areas as possible pain generators. Physical therapist Stuart Fife, reports dismal numbers with regard to reliability and accuracy of manual testing methods, and Richard DonTigny asserts that often the correction validates the diagnosis.
Based on this information, it appears that all tests may give clues, and instead of any one given test, multiple tests should be performed to accurately test for SI joint involvement in pain, and which corrective measures should be carried out for resolution.
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The sacroiliac joint belt is a lesser known tool that can be very effective at stabilizing and reducing pain, BUT it must be used correctly under the right circumstances.
What does an SI belt do?
The SI belt serves as an artificial locking technique through compression of the surfaces of the joints. These belts have been found in studies to reduce laxity of the sacroiliac joints and improve stability.
The theory for the use of a belt is that the surfaces of the sacroiliac joints are pressed together, which increases friction and reduces shearing forces.
Does the sacroiliac belt really work?
YES! In the video, I said that the biggest issue is whether you actually HAVE pain coming from the sacroiliac joints or not. Attaining an accurate diagnosis of pain from the SI joints isn’t that easy, simply because there isn’t an established “gold-standard” test.
Some people get significant and immediate reduction in pain once the belt is properly used, while others only have a minor reduction in pain, but often times there is some improvement in mobility or strength in the pelvic muscles. These are positive signs that you may benefit from the belt.
Is there a simple test to find out if the belt COULD work for me?
Yep! In the video above, I show a test that can be performed while lying on your back. Since the belt’s job is to compress the pelvis, we can mimic this action with a set of hands. Definitely ask someone to do this for you, which will be a much better test than attempting it on yourself.
Lay with your legs straight out. Lift your leg up from the floor in a controlled speed while assessing how it feels, both in terms of muscle strength, coordination, and pain levels. Test the other side as well.
Next, ask someone to gently compress your pelvic bones inward, toward your midline, and hold while you repeat lifting your legs. If there is improvement, then you will likely benefit from wearing the si belt.
Does it matter if I put the belt on standing vs. sitting vs. lying down?
Yes. I recommend only putting the belt on while lying on your back, AFTER doing your si joint corrective mobilizations.
How tight does the belt need to be?
Its important to understand that the emphasis should be placed on the position of the belt, NOT how tight it is. One study in particular showed that a belt with a tension of 100 N did not significantly differ from one at 50 N in terms of reducing sacroiliac motion.
More is NOT better in this case!
Which belt is the best?
They all do the same thing so its really a matter of comfort, since most people who benefit from it will wear it often. Nothing is worse than having to deal with a poorly designed belt that is constantly riding upward when you sit or move.
I personally like Serola. Now, I don’t have SI joint pain, so I can’t comment, but many of my clients like this belt.
Does relying on an SI belt make my own muscles weak?
No. Using a sacroiliac joint belt is not the same type of thing as a lumbar spine brace. SI joint instability is a ligamentous/joint problem. Since there are no muscles that directly move those joints, wearing the belt will not weaken anything. You can wear it 24/7 if you want.
That said, it does NOT mean you shouldn’t address the muscles that support the pelvis. In fact, this is the CRITICAL element. Without adequate muscle balance, strength, endurance, and coordination of the core muscles, you are very likely to have ongoing setbacks in your corrective process.
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