Thread by @sam_soete

How I fixed my lower back pain:

For the past 11 months I have struggled with debilitating chronic lower back pain. It is gone now.

This 🧵explains the pitfalls, revelations and lessons I learned to overcome it.

There was no injury, no accident, no obvious cause for my pain.

Over several days my lower back developed extreme stiffness and pain on leaning forwards and bending down.

Wtf.

It was a crippling feeling, and impaired my ability to do the things I loved:

Running, stretching, exercising.

I couldn't touch my toes.

I couldn't pick something up off the ground.

I couldn't put my socks on while standing.

I couldn't tie my shoes without sitting down.

I quickly realised how important the back is for almost all movements in daily life.

It connects everything together.

I thought it would go away over time, but it didn't.

It lasted for days... and then weeks.

I decided to stop working out entirely to avoid any undue stress on my lower back.

I became a walker. I did over 15,000 steps a day during that first month.

I also implemented thermal contrast therapy in the form of hot and cold packs.

It reduced the pain & stiffness significantly.

Now that the acute pain was gone, it was time to address the stiffness.

So I implemented a stretching routine twice a day.

1. Cat cows

2. Upward & Downward facing dog

3. Child's pose

1st month: Walking + Thermal Therapy
2nd month: Walking + Thermal Therapy + Stretching

My back pain had markedly improved, so I thought it was time to slowly build up the strength again in my lower back.

I did these exercises:

1. Superman back extensions
2. Lower back extensions
3. Glute bridges

I also wanted to focus on glute strength because all of these muscle groups work together in generating movement.

So I did some basic glute exercises.

Relapse:

Unfortunately, within a couple days of re-introducing strength exercises the pain was back.

Worse than before.

This time it was more localized to my right lower back.

After doing some reading, I felt that my right quadratus lumborum (QL) was the problem.

I looked up some QL stretches, and when I tried them...

It felt incredible.

During the stretches my QL felt like it was on fire, but it felt euphoric at the same time.

I was definitely getting somewhere.

These are the QL stretches I did:

1. Bench/Bed QL stretch

2. Post QL stretch

3. Ring QL stretch

During my research, I came across the concept that asymmetry can develop from certain sports such as football, basketball and throwing sports.

These tighten the non-dominant QL.

pubmed.ncbi.nlm.nih.gov/23135366/

Once I had successfully stretched my right QL over a few weeks, combined with my previous stretching and walking routine,

I felt it was time to get back on the horse, and try to strengthen my lower back again.

Drum roll...

Once again, within a couple days, the pain was back.

Ffs.

I felt lost. Desperate. I didn't know what to do.

Out of the blue, a friend told me about glute activation and its relationship with back pain.

I remembered my previous attempt to strengthen the glute, but did I really focus on glute activation?

I decided to go all in on activating my glutes and implemented these exercises into my routine. I was now doing:

- QL stretching
- Lower back mobility
- Walking routine
- Thermal contrast therapy

Here are the glute exercises I focused on that did not cause any pain in my lower back when doing them:

1. Glute pops
2. Lunges
3. Glute bridges

Weak, underactive, or tight glutes can cause biomechanical imbalances in the pelvis and hips, as well as instability in the lower spine.

The gluteal muscles, consisting of the gluteus maximus, gluteus medius, and gluteus minimus, play a crucial role in stabilizing the pelvis, supporting the lower back, and generating force during various movements, such as walking, running, and squatting.

The biomechanical connection between glute activation and lower back pain lies in the intricate interplay of muscle groups and their roles in stabilizing and mobilizing the spine and pelvis.

Proper glute activation helps maintain optimal pelvic alignment, which, in turn, reduces the stress on the lower back.

But tight glutes can cause as much lower back discomfort as weak glutes can, so I added in some myofascial release with a hard ball and some glute stretches as well.

Surprisingly, within 3-5 days the pain was gone. Entirely.

I never took any medications, pain killers or OTC drugs.

And it is still gone.

After several weeks.

Looking back, this is what I believe my problem was:

1) Glute inactivation
2) Increased reliance on lower back muscles
3) Inflammation of lower back muscles
4) Asymmetry of back muscles causing acutely-tight QL

Because my glute inactivation was never addressed, every time I had reintroduced lower back exercises into my routine, the pain and stress would in my lower back would return.

The question is, what caused my glutes to stop activating properly?

I remember from looking back at my journal, that the back pain initially started a couple days after 2 nights of camping and a very long car journey.

I wonder if sleeping on an irregular surface followed by a long car ride might have caused my glute inactivaion?

Who knows.

While my problems may have been solved quicker by consulting an expert physio, I have learnt a lot about my body and biomechanics on this long journey.

It is crucial to not adopt a victim mindset in these situations.

Something that I was often tempted to do.

We have to take responsibility of our health.

Health is not a destination.

It is a never-ending journey of discovery, learning, iteration, recalibration and adaptation.

This is the way.

I am not a PT or a physio.

This is just a documentation of my journey in dealing with my personal back pain.

I hope it is useful.

If you want to link any PT or physios here that might have some cool insights, tips/tricks or alternative explanations please do!

If you found this story helpful and think others may as well, please retweet the first tweet!

https://twitter.com/sam_soete/status/1687767249220976640?s=20

Forgot to add video for the Ring QL stretch. Didn't feel right cus it is one of my favourits.

Here it is.