Hey, welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, physical therapist, and owner of El Paso Manual Physical Therapy. Today we are going to talk about the three most important muscles for good lower back health.
The reason why I'm doing this podcast is, I've had tons of questions lately, from people with back problems that asked about which muscles they need to focus on, and which exercises they need to do to focus on those muscles. Now, being that this is a podcast, I can't really show you exercises. So, I'm going to talk about some concepts more importantly. And I say more importantly, because there are tons of exercises out there, and a good exercise for certain muscle may be a bad exercise for another muscle.
So it really is situational and it depends on your specific situation if you have a back problem, there are different things that you could do at this time versus, if you are a little bit better. Then an exercise that may have hurt you in the past, could actually be beneficial to you now. Specific exercises I don't want to go into right now. We'll talk about the muscle groups instead. So let's get into it.
The top three most important muscles to improve your lower back health.
Number one is definitely your abdominal muscles. Everybody kind of gets that. It's no secret in the healthcare field, especially if you are in the healthcare field. People know that your abdominals should be strong in order to have good back health. But what we often see people do is it they will come in saying I've been working on my abs, I've been doing sit-ups, I've been doing planks. They will show us exercises that they've found on the internet for ab exercises. And they will tell us it hurts their back. Sometimes it even creates a popping or clicking sensation in their back, and it leaves their back even more sore.
Personally, I've had that feeling myself, so I know exactly what they are talking about. But what we are finding in these people is that if you think about the abdominal muscles, those muscles run from the bottom of your rib cage, all the way down to the top of the pubic area, on the pubic bone and the muscles wrapped around your sides. Through tendons, they connect directly to your lower back bones, and the vertebrae so they can influence the lower back quite a bit.
Within your abdominal muscles, you have four different muscles. You have the rectus abdominus, the transversus abdominus, the internal obliques and the external obliques. And because these muscles are so large, as far as the space that they cover, they are actually really thin, almost paper thin. But they are broad muscles. They function differently in different areas.
When we talk to people, here in the clinic about their abs, one of the questions that I asked them is: Well, you have been working your abs out for your back problem. Sorry, it hasn't been helping you. But tell me this, when you work out your abs, do you find that your upper abs mainly get the workout, or is it your lower abs? Or is it everything? What part of your abs is getting affected more when you exercise your abs?
We get all kinds of mixed answers, and really depending on the way that their back problem is presenting, and the specifics of their back problem, if it's more of a disc issue, or a stenosis issue, or a nerve issue, you want to target different parts of the abdominals. You also have to test to see where you are weaker. Some people can know where they are weaker, they can feel it, and some people have no clue. They can't tell themselves where they are weakest and that's our job here in the clinic.
We will muscle test specifics of the muscles and be able to tell you “hey, you are weak in your upper abs or your lower abs, or there is evidence that you have been using your upper abs more so than your lower abs, because of the way that other muscles look, how they counterbalanced the loss of muscle balance.”
So be careful when you are working out your abs, whenever you are doing an exercise for your lower back, it should not hurt your back, it should not hurt during or right after, it shouldn't leave your back more sore. The effect that you should feel is that it didn't hurt one bit. In fact, it is improved a bit. And over time, as you continue to exercise, it continues to improve and feels better. But let's move on to the second muscle.
The second muscle that's critical for lower back health is the glutes. People don't really think about this one because it's not really a part of the lower back in most people's eyes. It doesn't connect to the vertebrae, the spine bones of the lower back. It's more in the hips, around the hip joints. But these muscles are so important, because if you think about them in the grand scheme of your body, they are huge. They are enormous muscles. They are thick and they are large as far as how much space they cover.
Which means that they have a lot of power and a lot of potential for stability in the rest of the body. And because they control the hips and the pelvis, which are the foundation for the rest of the spine. Without good quality control and strength from the glute muscles, you are likely going to run into some back problems.
One of the next questions that I ask people, whenever they are dealing with a back problem is I'll say, “whenever you go to exercise, like you told me you like to do lunges or squats or run or jump on the bike, or anything like that, how often do you feel the burning in your butt muscles?” About nine 9 out of 10 people say never, once every few months at most. And that to me is evidence that they are not targeting their butt muscles very well.
Many times, it's just a small tweak on an exercise that they are already doing to get the butt muscles to turn on the glutes, so that they can begin to do that same exercise in a way that is making their glutes work.
Classic example that we see here is with runners, most runners don't feel sore in their glutes unless they are sprinters. Srinters tend to use their entire leg muscles. You just have to if you are going all out sprinting. It's nearly impossible to do it without using every muscle. But for somebody who's doing more distance running, more cardio based running, not sprinting, somebody who is running, let’s say for several miles, 5K, 10K or longer distances, or even half marathons and marathons. They will usually say that they are sore and their hamstrings and their quads and their calf muscles. Hardly ever their glutes or if anything, they get just a tiny bit sore in their glutes, but it's heavily the quads and hamstrings.
This is evidence to me that they are not properly using their glutes, because glutes are a huge muscle like I said. Now some people say, well, the quads and the hamstrings are pretty big. And my response to that is, is Yeah, but they are mainly moving the knee, and the knee just bends and extends, the glutes control the hip joint and the base of the spine. There is way more importance on the glutes.
If you think about the quad muscles themselves, they are long and slender, they only have one direction to pull, the glutes actually have multiple directions of pull. If you pit them against each other, glutes are way more important than the hamstrings. Your quads are for just about any activity.
Some common exercises that that we give people, will be some lunges and squats. We do our lunges and squats quite different than what most people think or have been shown. Oftentimes when we show people the way that we do squats or lunges, they will say, I never learned it this way. How come nobody ever showed me how to fire my glutes? They will be surprised, and some people will say, Well, I played sports all through high school, and I worked out in the gym with my coaches and my trainers. And nobody ever showed me how to do it like this.
My response to them is always, I'm sure that they had the best intense and that they were doing the best that they could with an entire football team or volleyball team or whatever team you are on. But they just don't have a physical therapist background like I do. I just look at the body differently. Luckily, they probably didn't have a whole lot of injuries. What they've done has been successful most of the time. So that's what they've been continuing to do.
But over time, over the course of years and decades, that's when that wear and tear starts to build up. And that imbalance starts to build up where they get stronger in their quads or weaker in their ABS or glutes, and then it begins to affect the lower back. It's totally fine, don't feel bad if you are like holy moly, I've never been using my glutes on squats and lunges, and I've been doing them for years and years and years. You have to find a way to make sure that your glutes are working on a regular basis that's critical for back problems.
But let's go into the final muscle group that is important for your back health. The low back muscles. Now this is obvious, a lot of people are probably thinking I’ve been doing exercises for that, but I feel that I need to get stronger, my lower back muscles are weak. What I want to do is dispel a few myths about this area and just to be specific, I'm talking about the muscles that are directly on the lower back. If you reach behind yourself and touch the sides of your spine. If you move off to the right or left, of the center of your lower back, those are the muscles that I'm talking about.
They are called the lumbar paraspinal muscles in the medical books. And they work whenever you bend backwards. Or a common exercise that people do to work them out is the lie on their stomach, and then pick up their arms and legs. Sometimes this exercise is called the Superman. And it makes the lower back muscles contract quite a bit. Now, these muscles are kind of small, and some people they get really big, and that's not a good thing.
Their primary function is not really to stabilize the back but more so to decelerate certain movements like flexion and rotation, for instance. You got to make sure that you are not too heavily strong on these muscles they are more for control. Isolating them out is typically not a good idea. Now sometimes we do tell people to do that. But most of the time we want people to not really feel their lower back muscles work really hard.
A common exercise that aggravates these poor low back muscles is deadlifts, and squats can do this as well. But we often have people that have had a history of doing weightlifting and they will say oh yeah, deadlifts killed my back every time I do it, I feel tight in my lower back. And if I do it enough, I'm stuck in bed for a while, I can't get up, I can't move around very good. And my back muscles just feel way too tight, especially on one side more than the other.
That's usually a sign of an imbalance. Their back muscles have been too dominant during the deadlift motion and they haven't used other muscles that they should be using to accomplish a deadlift. Those poor back muscles are rebelling, they are letting the person know that they are not doing what they are supposed to be doing. They are supposed to be stability muscles, not big weightlifting muscles.
A trick that I do with a lot of our back pain clients is we actually want them to get relatively weaker in their lower back muscles. Now I'm not saying you need to get weaker, like lose muscle, that's rarely ever a good thing. It's more so that we want the other supporting muscles to get stronger so that your lower back is relatively weaker, it's keeping it same strength, but we are not going to strengthen it aggressively like we might other muscles. We do it so that it is more in in proportion strength wise, so that the balances normalize around your lower back.
But these lower back muscles, they are critical. You can't live without them. They are extremely important, and you need them in good health. Most of the time when we are talking about good health for the lower back muscle, we just want them to not spasm, that's a common place for people to get spasms. If they are getting spasms, it means that they are using them way too much and using them inappropriately.
We are teaching people to move better in a way that doesn't make them spasm, we are teaching them to avoid twisting too much, because that will tend to set it off. Twisting is sneaky and it happens all the time. Whenever we are at home doing chores and awkward positions. It's almost inevitable to twist. But if you can take a moment to think about how you are going to move so that you don't twist, it can save you a heck of a lot of trouble later on in life.
Sometimes you have to twist it's just the nature of the situation that you are in. I can tell you I never twisted so much in my life until I started having children. When they were little, we had to get them in and out of the car seats. And getting a child into a car seat, especially when they are really little, and they have that big carrier those are pretty heavy. When they are like a year old, and they are almost starting to walk, and they are getting big and pudgy, that's a heavy baby. In order to get them in and out of the car in the backseat, it's just a little rough on the back. Sometimes you have to twist a bit. Now, I'm not saying you can't ever avoid twisting, but you want to minimize it to make sure that your lower back muscles are healthy and happy.
So there you go guys, those are the three most important muscle groups. It's more of a strategy than it is some specific exercises to do. Like I said, the specifics come from a well thought out plan on how to improve a back problem. I don't like to give out specifics online just because, I haven't had a chance to look at you. I haven't had a chance to figure out how your joints are moving, or how the muscle feel. What your specific actions activities are throughout the day.
The best is to get all of that factored in to diagnose and then develop a well thought out plan that we begin to systematically execute, and march to better health. It's amazing. I love helping people with back problems because it's like week to week, they are getting better, a little better, a little better. And you are going to love it when we hit the plan, right as we intended. When we get to week three or week four, and I tell people Yep, this is exactly where I expected you to be, you are sleeping better, you are moving better. I know, it's not completely gone. But you are definitely on the path to avoiding a surgery.
When we get to the end of the program and they are sometimes lifting weights, they are running, or they are back to their normal previous activities, at least. Oftentimes, they want to do even more than that. And I tell them, Hey, you got to just keep up a few things. It's not going to be as intense as it was the beginning. But at least now you know what you need to do to keep healthy for the long run.
We talk with them about these three important muscle groups, and we go into detail about what to do about each of them. So that once our clients end with us, they are no longer seen as for treatment, they know how to manage any flare ups they are going through later on in life, if the back problem starts to come back a little bit, in six months, or a year or two. They jump right back onto those exercises that they they've done in the past. And they have a much better sense of awareness about how to help themselves, before having to call somebody for specialist help.
So hey El Paso, I hope that this was beneficial to you. I hope that you learn something about your back problems, and the muscle groups that are important. How to decipher which exercises are good and not good, and when to pay attention to what you are feeling and all that. If you have any questions about your specific back problem, please give us a call. Our phone number is 915-503-1314 and talk to us about your back problem. We'd love to learn more and see if we can help you out and see if we are the right people to help you out.
Especially if you are looking to avoid having a back surgery. If you had a parent or grandparent that that had a back surgery or suffered from back problems, and you saw them in not the best shape at the end of their life, or are they getting older right now, and they are still around, thankfully, but not moving too well. Their quality of life isn't the greatest. The last thing we want is for you to end up like them.
If you have no back problem right now that's similar to theirs. More often than not, definitely 9 times out of 10 it is preventable. You can get a better without ever having surgery. And you don't have to be taking pain medications. You don't have to have a bottle ibuprofen on your grocery list every few months because you go through it. You don't have to have injections. If you are getting injections, that's just medication that they inject directly into the spine. And it's not getting you stronger. It's not teaching you to move better. It is not preventing the surgery. It's really just putting it off. So make sure that you do the right treatment to make to get this problem healthy again, we don't want you to have a lower back surgery that you could have avoided. Anyways, I wish you the very best day and we'll talk soon again.
