Should You Stretch or Strengthen Your Lower Back?

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Go check it out. You'll love it. Now onto the podcast. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey guys, it's Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the movement movement. This is the first time in the show. Welcome. You've missed a lot. This is, I think, 252. It's been about three years or so going. The purpose of this podcast is to help you guys find the right solution for your aches and pains. There's not going to be anything super technical. This might be some information you probably heard before, but hopefully we'll boil it down maybe in a different way. We're going to cover the topic today of should you be stretching or strengthening your lower back? By the way, docs, I'm sure you heard all the intro. There's clinical stuff, but it's not in this podcast. But hopefully you enjoy the simplicity of what we cover today.

There's a lot of docs and strength coaches who have listened in the past. We've changed the focus of the show just a little bit. And so just giving them a little bit of insight of maybe where to find the information that they want more of. So there's going to be different types of muscles that you might want to stretch and strengthen. And I'm sure a lot of you have actually had the experience where you're just kind of confused. Like you read up online that, you know, you went on to a runner's world forum and someone said, well, I should, someone said, I should stretch my hip flexor, but then someone else they shouldn't. And then I saw this person on Instagram that said, you should never, ever, ever do that. And then someone said, well, you should strengthen your low back. But when I did it, it actually bothered me. So how do you know what to do? I think the, the general thing that I've noticed over the last few months, I feel like talking with people when they first come in is they're just really tired of hearing different stuff from different providers and different practitioners of different styles and so on. Like they're tired of hearing all these different opinions because it's confusing to them. Sorry, I hear a siren out there, but it is confusing. It doesn't have to be necessarily very confusing. As long as we all understand that there's different reasons for your low back pain. And some people's low back pain might respond better or worse to stretching. Some people's low back pain might respond better or worse to strengthening, especially of certain muscle groups. Now, typically when we see someone with lower back pain, we do an examination process that we call plain Sherlock Holmes. The only way you can find a solution is knowing what the clues are and figuring out what the problem is. And so if you guys haven't actually done that yet, you probably should. It doesn't take too long and it is, it's not very expensive.

You just go to someone knows how to stress test your spine and figure out what it likes and doesn't like. And then who you'll be off to the races. Uh, we even have some programs on our website where they're 12 week programs currently. And some people are like, well, I have no idea where to start. Right. You need someone a lot. A lot of times you need someone to help you figure out a good starting point. So you go the right direction. And then it starts to get a lot easier. So as we go into the muscles to, um, or stretching or strengthening low back today, we're going to cover first, the ones that may be stretching might benefit, um, or, um, might bother. Um, but the most common one that probably a lot of you have already tried dealing with tried stretching because it always tends to feel tight is the hip flexor. Now we can boil this down a little bit more and say, well, which hip flexor specifically are we talking about? Yes. We're talking about all of them, or at least most of them. Uh, I don't know if there's a really, really, really good way or a need to specifically stretch one specific muscle. Um, maybe I'm, I'm going to reserve the right to change my mind. I've been doing this for about 13 years or so now. And I feel like general actually works a little bit better for most people than specific at this point in time, at least when it comes to stretching. Uh, I would consider it more of like an extension of the hip type of stretch versus actually the hip flexors, but the stretches we are talking about is going to get the iliopsoas, the iliacus, the, uh, rectus femoris, uh, as well as other muscles that might be considered hip flexors. Um, now it's important to consider number one, uh, again, if your problem, if your back pain responds well to hip flexor stretching, that might be something perfectly suitable for you.

Obviously this is not medical information. You should always be checked out, but sometimes just doing more of the thing that helps you is one of the easiest wins in the book. Um, I've met a lot of people who would say with their low back, they say hip flexor stretching really helps me. Uh, so I do about 10 reps in the morning and then, you know, I do it before bed for, you know, 20 reps or so and that's it. I say, well, how come you're not doing more? And like, oh, I didn't know. I thought that was it. Like, I thought that was what it was to stretch the hip flexor was just a couple of times. Well, no, you can do a lot more, you know, if a little bit is helpful, maybe a little bit more might be more helpful or it might not. But what you would be able to do with this information is figure out maybe it would help. And the other way you're going to know is if you test it for all we know too, it actually make it, make you feel worse, but the solution, or at least one easy win might be so close to your reach that if you just stretch maybe a little bit more, you know, double, triple that, you might actually find that all of a sudden you feel like butter the next day. You know, we don't know until we try. Uh, there's a lady that I've been working with for a little bit of time where we, uh, we'll probably cross this bridge when we talk about strengthening a little bit more, but one of her exercises is, is farmers carries. And so, or sorry, carries, uh, care, uh, there's different types of carries, loaded carries. And, um, she, she, she sent me an email and she said that I was, she was carrying a 25 pound plate up and down the street. And she said it really aggravated her problem.

Uh, and so she went next to a 25 pound backpack and then she went to a 50 pound sandbag and just held it like held it, hugged it like a bear. And I said, how did all those feel? And she said, well, the first one really kind of bothered me. And so I tried other things. I said, that's perfect. You know, um, you might be so close and there's all these different various slight variations on the stretch or strengthening that you could do. Um, now hip flexor stretching generally, uh, I haven't had heard a lot of fallout from people, at least when we're talking about low back. Um, but there are certain types of back pain that actually will not necessarily, um, it won't feel good to stretch hip flexor. Um, these types of back pain, I w I usually consult, consider them as extension intolerant back pain, facet syndrome, um, uh, foraminal stenosis. I think even central stenosis tends to fall into this category as well. Um, extension intolerant sciatica or radiculopathy or pinched nerve. These ones sometimes will respond. Okay. But quite honestly, like some people that they're like, when they're doing the hip flexor stretch, it looks like they're in complete agony, you know? And, uh, as they started doing 10 or 20 or so of them and they say it just gets worse every single time. Well then don't do it. It's as simple as that. Don't do it. Well, I was under the impression that hip flexor stretching would help me. Well, it appears to not be, you know, it's not, it's not like the magic stretch for low back pain. So maybe you just don't do that for a little bit. We actually find that a lot of people unknowingly will end up creating some of their own back pain. In this case, if you were somebody who was fully committed to making sure that hip flexor stretch was in your program and every single time you do it, did it, it made you feel worse and worse and worse.

Then you'd be probably contributing more to your back pain than you think. It might not be the only thing, but it's certainly a part. So another thing that people tend to stretch is their low back muscles because they feel tight. Now low back muscles will feel tight with various different types of low back pain. It will feel tight with discogenic pain, like a disc herniation, protrusion, that QL spasm that comes up in the, in the spinal rectors, the multifidus, all of them feel very tight. Super, super common. Even people with facet irritation and sciatica, pinch nerve, facet syndrome. By the way, we should probably put that degenerative disc disease in these. I don't tend to talk about it much just because I think it's, it's so poorly labeled. Um, it responds really, really, really, really well to, to usually strengthening, by the way, some stretching, but, uh, we should probably note that, uh, it, it, it can, it can get better because that's probably the one most disabling labels you can give someone as a, as a clinician. Uh, and if you're somebody who's been given that label, just know there is a lot of hope for you. There's a lot of hope for you. Like I'd take every penny I have for most people and throw it on the line in Vegas and say, yeah, you got DDD, you got degenerative disc disease.

Yeah, you'll probably get better if you do the right thing. That's just a side note. So, uh, back to the low back, spinal rector muscles, the QL, uh, yeah, they do feel tight. Um, now I might've mentioned this as an, in another podcast. Um, but generally kind of, I was talking about what the hip flexor muscles, if it feels good when you're doing it, it feels better later when, after you did it, then yeah, it might be the most, um, appropriate thing to do at the moment. So I call this the candy, uh, type of rule the now and later. Okay. Just like the now and later candy. If it makes you feel better now and later, then you might've struck gold and it's really, really, uh, might be really, really impactful thing for you to do. Now, if it makes you feel worse right now and worse later, that breaks two parts of the rule, but it makes you feel worse when you're doing it. And then it seems like it, Oh, it just slowly loosens up after I stretch it 30 times in agony. And then I've about an hour, I feel better. That's probably breaking the rule too. So most people with most types of back pain will, will can follow the now and later rule. It can make the stretch can make you feel better now and later. However, if you're pushing through it, you might be again, creating some of your own problem that you're just unaware of at the moment. Let's move on to the hamstring, which is probably the third most common stretched muscle. Or when you go, you can go to someone who just give you random information. I do my back hurts. Dude, did you stretch your hamstrings yet? You know, it's just kind of like goes out there with it. I used to think it was a little bit more BS. You know, it was just like a, like a throwaway suggestion. It's like, ah, you know, like I can't drive.

And you try driving school yet, you know, like versus actually teaching them what to do step by step. Um, the hamstring stretching actually does have some value. Um, more so people, I think with people who have chronic lower back pain, meaning it's been six plus months, um, if hamstring stretching does not actually abide by the now and later rule, then throw it away. Um, but a lot of times people with chronic lower back pain will have chronically tight hamstrings, which can come from various reasons, um, as well as hip flexors. And sometimes stretching the hamstring actually really helps them.

Uh, I tend to use a little bit more of a, uh, neural flossing type of, um, like a sciatica type of slide type of exercise. Um, and there's a progression of, of a way to do this to make it so it doesn't light people up. But if people are stretching their hamstring and they have what we call flexion tolerant, low back pain, like a low back disc or a sciatica that does not respond to rounding the low back, then it's going to get worse. And this is one of those categories where if you were stretching your hamstring and was shooting pain down your leg every single time and it was agony to get through, but then later you felt okay for about an hour, this is probably not the right thing. I remember the first time we had somebody respond to one of our YouTube videos where we basically made the suggestion of if it hurts to stretch your hamstring with sciatica, don't do it. And somebody was like, wow, I really took that information to heart and I just stopped stretching. I feel better than I have in months. It was like mind blowing. Right. Um, yeah. So your body is pretty smart. It knows what's good and bad for it. Pain is a way of telling you what's up.

It's a way of telling you, uh, if things are feeling better or, or if, if something is good for it or not, at least at the moment, this isn't to say you should never stretch your hip flexor, low back or hamstring. Um, it's just to say it a certain point in your recovery, it might not be beneficial for a week or so. Typically adding it a little bit later, um, and see if it does fall under the now and later rule is a little bit more respectful to the body. It makes it so you don't have to force it through, uh, what it doesn't want to do. Um, I don't think anybody, at least I can't think of any times off the top of my head right now where someone would respond well to super, super, super aggressive stretching and it was like agony every single time they did it, or they would have someone force them into a position. I can't think of one situation at the moment. Maybe I'm wrong again. Um, I always reserve the right to change my mind, but I really think some of the solutions you guys are looking for don't have to be as painful as you think that whole, like, uh, no pain, no gain thing. Uh, I don't, I don't think it's appropriate in this situation. Let's see other muscles that might fall into the low back category. Um, I'd say these kind of like the oddity ones, the oddball ones that people tend to stretch the TFL, um, the IT band, the quad muscles. Um, those ones are, or even the groin muscles, those ones are kind of, uh, I'd say if the other three actually had benefit for you, I don't think there's a big value in doing these ones aside from maybe the TFL, like the TFL, uh, I'm not going to say the TFL, uh, like it's not really muscle, uh, fascia is actually tight on people, but in the process of stretching them, people tend to lean away and, and move their body into what we call the frontal plane. Sometimes there's some magic that happens when people move their body in the frontal plane, because a lot of times throughout our day, we're forward and backwards. We're sitting to standing. Um, and that's, that's kind of it for most people, at least people who are sedentary side to side movement and turning sometimes unlocks like these, uh, magical moments where you just start to feel better. And so there's magic in the frontal plane. And I think more people will benefit from going into the side to side leaning side shuffles, um, type of frontal plane type of movement versus the twisting ones, at least when they're trying to recover from back pain. Uh, I forget what the saying was, uh, somebody told me years ago, uh, we live in the sagittal plane, which is forward backwards, kind of bending forward and bending backwards. Um, we, uh, I forget what it was about the frontal plane, but it was a side to side one. And he said, we play into the other plane, the rotational one. Um, and so add the frontal plane, add the side to side.

It's like, you're in a pane of glass and you're like going side to side, not coming out of the pane of pane of glass front or back. I should probably figure out a better way to, to relay that information to you guys, but I'm hoping you at least got the gist of it. The side to side movement can be helpful and it does come in the form of stretching the ITVM. So, or at least a standing version. Now the muscles that strengthening might help with lower back pain are, um, when I put my notes right here. So typically the glute max, the quads, the abs, the obliques, the spinal rectors, um, giving you some basic, um, parameters about this. I like to have people first do it in a non-movement contraction. Obviously there's many, many, many different types of exercises that people can and will do when they're trying to challenge these muscles. If you can do it isometrically, at least that, um, cause if you're, if you're fearful, uh, of movement, uh, if you're concerned that the exercise may be too much for your body, isometrically is a really good starting point.

Uh, if, if my memory serves me right, cause we don't see a lot of post-op people, I'm pretty sure post-op people with different joints end up doing non-movement contractions first because their joints can't go through the full range of motion. And so as they start to gain more range of motion, they challenge the other parts of the range, but isometrically, uh, isometric means non-movement. It's kind of like grabbing something that is, is too big for you to move and pulling on it. It's like grabbing a truck by the bumper and trying to pull the truck when it's in park, you're not going to move it anywhere, but your muscles are still contracting. So doing some of these in that fashion are a little bit easier for people, mainly because you can find a position that's not really painful for you. And then you can challenge that position. So the glute max is one that I like to start with people, uh, um, with low back pain and it's, um, I should back up one moment.

Uh, the glute med, the glute minimus, all those other glutes, you kind of get them when you get the glute max. Should we bias our activities to strengthen the other muscles? Uh, I don't think so. Uh, I think you get the glute max, you get the rest. Um, and so doing the glute max, at least is a nice starting point to get a lot of glute muscle activity. Um, I think it was perfect for a lot of people with low back pain. Now people who have like their diskey type of stuff, like bending forward hurts. Um, so discogenic back pain, we call it or flexion tolerant back pain. Uh, there's other types of flexion tolerant back pain, but this is just the most common. Uh, usually you don't have to overcoach glute exercises. They tend to do okay. It's not like, um, they have a fallout with the exercise itself. Um, doing it even in a half heartedly coached way usually works. Okay. Usually something like a banded bridge, something like a cook hip lift, something like, um, just a, just a general bridge, two legged, single legged bridge. Those usually work okay for people as long as they're not completely floored on the ground. Like it hurts to move any, in any movement. If you are one of those people, this exercise might not be right for you right now, but it could easily be right for you in a day, two days, one week, um, depending upon the severity and when everything kind of cools down, these exercises help to build support. Stretching the muscles, by the way, I should, I guess I should, I guess I should go backwards is typically the muscles that we're stretching. They're called the tonic muscles. So if you look up tonic and phasic, I'm pretty sure I did a podcast on this, um, months back is, um, we, we talked about tonic and phasic muscles. Tonic muscles are the ones that every time when you have a tight muscle anywhere in the body, probably it usually falls in the tonic muscle category. It's people always have tight upper traps. People always have tightness in their rhomboids. People always have tightness in their hip flexors. These are the tonic group. Um, they can be tight for various different reasons. Uh, I didn't, uh, I won't go too deep into that, uh, technical aspect right now. Um, but there's gonna be a lot of articles online. In fact, uh, we have some in the book too, that we have, uh, um, there's the low back book, which, uh, it will be in the link description.

We have three of them. Uh, I think it's under the, um, the section of diagnose the diagnosis book where you'll find things about tonic and phasic. Um, phasic ones are usually the ones that are kind of quote unquote off or weak. And so normally those are the muscles that you tend to strengthen. Obviously there's exceptions to these rules. These are not hard, fast rules, but they're general categorizations. The glute max muscles are usually ones that through general observation, people with low back pain, their glutes quote unquote, turn off. They're not off. They're not completely off. They're just kind of lazy. And so if you do stuff to stimulate that, you're kind of, um, breaking the positive feedback loop. Cause a lot of times when people's glutes are lazy, sometimes they have low back pain, but when they have low back pain, the glutes end up getting lazy. So there's this endless circuit, you know? And so the easiest thing to do is give your back a darn break, make your hips work more by shifting the hinge point to a different point of the body. Cause a lot of times people backs end up hurting because there's too much movement in the low back. And so if we just spare the back by almost, um, we'll say an easiest thing to say is move the movement down or up around the segment, that's the symptomatic one, but probably a better analogy you guys are accustomed to is that a lot of times people with back pain, they're given a back brace. They're not given, a lot of times they're not given back stretches because it hurts to move. So they give you back brace and that's to stabilize and almost duct tape that area up while it's kind of forcing movement into other parts of the body, like the hips or the mid back. These areas can certainly help to decrease the amount of, of irritation and, um, pain coming from the back or at least for a period of time.

So you can use the exercises to strengthen or, um, build endurance in some of the muscles that will be helpful to spare the spine. The glute max is just one of the first picks. Okay. If the, uh, there's other ones called clamshells and banded clamshells. I'm not a big fan of them, although that will put you a little bit more into the frontal plane, which I'm okay with. But, um, I think they're a little bit, like it should be hard. It should be hard, but not painful to do. It should follow the, all the strength and exercise should follow the now or later rule as well. If it, uh, it should be challenging to do now, but not painful. And then later you should feel better. I tend to think the muscles, when you strengthen them, you'll actually have a period of time. Uh, I, I, I called the two hour protective window, although it's not two hours. It can be, it can change. It can be, I remember one time I did a strengthening exercise for the abs when I had back pain and I had like, it was like three weeks. I felt great. You know, I didn't even do anything else. Like I didn't have to do any other exercises. I just did that one, that one time it took under five minutes and it really helped.

So in that case, it was like a three week protective window. And I could just, if I wanted to, I guess I could abuse my back a little bit, you know, and I, it would have been fine. Like I didn't do any habit changes. I didn't have perfect posture. I just kind of did what I did. And so these exercises can help to build that protective window where you don't have to be so neurotic about your posture and what your back's doing. So the glute exercise is a really good starting point. Another one, which I just did mention is the abs. The abs can be very helpful. The problem is, is if you don't know what type of back pain you are and you just simply start doing ab stuff, the most common thing that people know is crunches and sit-ups and Russian twists and V-ups and boat pose, which, uh, I have given for rehab just like very sparingly before, but isometrically it's a lot easier because then you're building a braking system on the front side of your body against too much extension, just in case your back was extension intolerant. But also if your back was not tolerant to rounding, then you wouldn't be forcing your low back to round in the exercise itself, like a crunch. So a good compromise is something like a plank. We'd like to do hard planks at our office, but planking, it gets, as long as it is, as long as you feel it in the abs and maybe the glutes and shoulders, then you're getting probably the right thing. And it's building a braking system against so much movement in the low back. So planks are good. Uh, ab wheels are good. If you don't have an ab wheel, something like, um, like a slider will work. Okay. Um, a dead bug is okay. I don't love dead bugs, but they're okay.

There's variation dead bugs. I do like pull bug and push bugs. Um, crawling is fine. There's a lot of exercises that are fine that work abs. Heck even pull downs or, uh, pull ups can be ab exercises. I know it sounds crazy to think that, but next time you try to reach overhead and grab something that's heavy, try to do it without your abs. You can't, it's impossible. You'll feel your abs stiffen up just as soon as you grab that heavy object. You don't even have to pull. You just grab the heavy object and automatic, automatic abs are going to start contracting. The body is one big unit. The body is one big unit. You can't separate them. The obliques are another one that you might want to strengthen. Uh, side planks are great. Uh, I don't think those things like the, uh, I forget what they're called. Like you put your barbell on your back and you stand, you lean side to side. I don't think those are worth it. Uh, farmers carries and suitcase carries can certainly work. Uh, I mean, shoot hanging from pull up rings and just going side to side, like you're on the monkey bars that will get the obliques too. Uh, there's a lot of things that can. And so generally we'd like to use like, like I mentioned earlier, the frontal plane side to side movement, or at least anti side to side movement. The obliques can really help out to stiffen that or buttress up the spine and, and, um, it'll be protective of the spine. Um, and it's a good starting point if you really don't know which direction your spine doesn't like. So I think it's a very adequate starting point.

The spinal rectal muscles, sometimes they do need some more tone. Um, this would be more for someone who's like a deconditioned person. Uh, their low backs always kind of rounded. They're sitting a bunch, something like a bird dog might be helpful. Uh, it doesn't require the spine to go through too much movement. If you do it well. Uh, I don't really like things like Superman's because if you pick wrong and you arch your back, then you're going to feel your back start to light up as you're doing the exercise. Then you'll maybe think that, Oh crap, I don't know what to do next. Um, even, even bridges are a form of getting the spinal erectors to really work too and stiffen up.

Deadlifting will work. Split squats will work. Goblet squats will work. There's a lot of things that can work. Uh, I apologize. My dog is going to start playing with my hand now. She started to wake up. So, uh, if you feel a grumbling, that's what's going on there. Um, the last thing that might be helpful too, which is a, um, I don't like to leave the rest of the legs out, but also too, I know we're talking about specific muscle groups, but really if you do squats, you do more than just the quads and the glutes, you'll do other things. Um, I've personally found that people who have a lot of back pain with arching backwards and they've been diagnosed with their degenerative disc and like, and they have a lot of arthritis, older people who have this, the gnosis and arthritis to their spine.

10, I think 10, if they don't have any knee issues, it's really easy to get them into a squat position. You just put something on the ground, have them sit on it and just being in that position and coming up and down a couple of times, it actually can be very helpful. I remember somebody, um, she was about 65 years old or so. She had chronic low back pain. Um, she was an extension intolerant case. She couldn't arch your back very far and she had signs of arthritis and all that kind of stuff too. And, um, all we did really on day one, or at least the most impactful thing was I had her squat about 15 times at her own pace. The only rule was slow and low. And she went down to, we have, uh, lifting blocks in the office, which equate about one foot high. She sat on them. Do you feel comfortable there? Yes, I do. Okay. Go ahead and stand. Ooh, it's a little hard to stand. Does it hurt? No, it's just hard. Okay. Go ahead and go up. At some point she needed to use like, um, like a door handle to, um, help her get up, which is fine. Uh, all I cared about is the slow and low type of rule. And, uh, after she did about 15 or so, she, she felt a lot better. She's like, haven't felt this good in years. I don't have any pain at all. Now, if that lasts or not really comes down to how well she can keep movements like that into her lifestyle. Um, cause it's a lifestyle change. She probably had a lack of exposure during those reps. She didn't do anything really to strengthen or build endurance too much. Cause all we did was one, uh, what is about two, three minutes of squatting. That's it. And so she more so built, we call movement exposure. Her spine, when she's seated, it tends to round a little bit, not in a bad way, but it does round, um, and her hips flex. And so she's exposing her body to like a flexed, flexed position when it didn't like extended, extended. I don't recall, but I would gamble to say that she would not respond well to hip flexor stretching. She would not respond well to supermans. Um, she might respond really well just to given her crunches, you know? Um, but I've personally found that people that have a lot of stiffness in the low back that tends to root out of just extension and tolerance, or they've had a chronic pain. Um, I tend to find that deep squat to get the quads and adductors really helps out quite a bit. Um, I personally had that experience, uh, and, uh, I still do them on a weekly basis to this day.

And I had a little bit more weight. Now you might, uh, like I wrote down a couple of questions here at the end because I thought these would be interesting talking points. Uh, first thing is why would, when would you choose to stretch some and not the other? Um, like how, basically how do you know when to stretch knowing when to stretch and when to strengthen or what to stretch is, is, it's pretty challenging. Um, but as I mentioned in the very beginning here, it's, um, it comes down to what have you tried already? Um, notice what is working for you and what's not. Um, if you find something is working for you, maybe try it a little more to decide whether it's actually given you the benefits you want. Then you start to pick other things that you might not have tried yet. Have you tried stretching hip flexor? Have you tried stretching your low back? Does it follow the now and later rule? If it does, then maybe increase the dosage effect. If you haven't found a stretch that works for you, at least out of those three basic ones, then maybe try to, um, add a little bit more of a variety. How about that TFL? Maybe stretching the abs a little bit, you know, like hanging over a BOSU ball a little bit or a, um, a Swiss ball might be okay too. It really comes down to testing the water. A lot of times people are unsure of what to do about their back because they don't have enough information. Um, working with someone, a clinician that knows what they're doing and having someone actually coach the exercises to make sure you're doing them well is very important. Uh, and they help you decide what part, what exercises stretches might be helpful for you because it's hard to do both. It's hard to interpret the information and also be the patient or the client too. Um, how would you decide to strengthen it instead of stretch it? Well, what have you tried? Have you already stretched the hip flexor, hip flexor, low back, IT band, TFL, adductors, uh, abs, and none of it works, but you haven't tried strengthening yet? Maybe strengthening might be the thing. It really boils down to what you have you tried. Um, there was a podcast I did probably about, um, I want to say six months ago or so. And it was like mistakes made during rehabilitation. And one of them was not doing enough challenge in it. Uh, I, I get this question over and over and over again. So how many sets do I do? How many reps? I don't know. Doing five. Is that hard for you? No. How about 15? Nope. It's not hard.

How about 30? No, it's not hard at all either. I don't know. You won't just make a number up. I think it has to go down with effort. The weight and how much tension you put into the exercise dictates how long you'll do it, how many reps and how many sets. Um, generally we, we try to take people to 70% of their effort. And now this is another very common question that we get. So when you say 70% of your effort, what do you mean? Well, what is a hundred percent of your effort? Well, I can't do anymore. Great. 70% is 70% of that. Um, and it's, um, all pain free. It's just hard. And that is sometimes the hardest thing for people to take away from this is they said, well, but I I've done exercises before and they said it might hurt. Uh, and maybe I'm wrong, but I don't think any of them should hurt. It should just be hard. And so this comes down to selection of the right exercises for you. Um, we're always looking for a green light exercise. What is the first exercise that this person can do without any pain whatsoever? It's just hard. And when people talk about loading the body, I'm sure you've probably seen someone, you know, on Instagram or YouTube talking about like, Oh, we need to load the person up. What is, what does that mean? Well, it doesn't mean you have to back squat the person to make them feel better. It means load their body in a way that their body is acceptable to load. If we do low, if we have someone with low back pain, that everything we do from the glutes, the quads, the abs, the obliques, the rectus, uh, or the spinal rectal muscles all hurt when we load them. Is it okay to have them do bicep curls? Yeah, it is reloading the body. As I mentioned earlier, the body's one unit. It's not the typical starting point, but it doesn't matter what the starting point is. Just, we need to get your body to start working and supporting itself and stiffening the torso. As I mentioned earlier, doing overhead pulling exercises, do, it does make the core work and we might need to get the core to work somehow some way to build some support. Now this is not, again, it's not the, it's not the typical starting point for most people. And I always tell the interns that, uh, work in our office, I say, please don't do this to somebody. When someone comes in with low back pain, don't give them bicep curls. They're going to think they like, how, how silly does that sound when they go tell their friend, I went to this office and they told me I need to do bicep curls for my back. It sounds ridiculous. It might be a very valid starting point though, but I'm sure we can find something that's more socially acceptable to the person than doing bicep curls. Let's try something, maybe calf raises a little bit more appropriate. You know, what will make this person feel that they're actually doing the right thing? Because it's very common. We've had this in some of our programs after week three, some people are like, well, I'm here for a knee course, but you're doing side planks. So that doesn't make any sense. So I'm going to stop. The body's one unit.

Okay. Last thing is, have you combined stretching and strengthening yet? You might have to combine things. I'd love to say that everybody's solution is just one easy thing. Oh man, what is going on back there? Okay. Let me grab that dog real quick. Hey, there you go. Yeah. So we used to have actually a whole podcast room with all the popcorn and everything on the, on the walls at our old office. We moved. Um, and so we didn't set one up in our new room. And so we, I decided to do some from the office, but also there's a gardener that comes there a lot. And, and then I decided to do it for my house, but then we got a puppy. And so this puppy is, uh, she decides to cooperate or not. And I'm thankful she cooperated for at least 75% of this podcast here. Um, but anyways, not everybody has the same starting point. Um, just find your low hanging fruit. If you're looking for help, there will be someone out there to help you. If you can't find anybody, let us help you. Okay. Or, um, there's going to be a link in the description where you can contact us. Now, um, some people say, well, you're, I'm in Kentucky. You can't help me. We might know someone in Kentucky. Okay. All we're, all we're, we're willing to help. We have a, we have a nice staff. Um, we love to see that people find the right solution for their problem. Even if we're not it reach out to us. We'd love to start that conversation with you, but you got to start with us first. So subscribe to the podcast. We have other really great topics coming. Uh, the next one's going to be, why is my lower back crooked?

The next one's going to be, why does my lower back pain only come in the morning? Uh, then why is, uh, uh, why my low back spine, low, my low back spine MRI is normal, but I have pain failed low back surgery and how to recover anterior and posterior pelvic tilt. Is it bad or good posture? Could it be creating your pain? Here's how. And the last one is spinal stenosis, uh, non-surgical treatment options that may work for you. So, um, we're going to cover a lot over the next year. Um, we love spine, low, low spine, hips, sciatica, hip impingements, tight muscles in the area. Uh, those ones are ones where like our bread and butter, like it's, it's something that we specialize very much in. Uh, we can see people with knees and ankles and feet and shoulders and shoulder blade and so on, but it's, uh, we really love treating the low spine and the, and the hip area. It's, it's our, it's our expertise. So, um, subscribe to the channel or the show. And then you'll see all these as they, geez, I feel like I'm doing the YouTube channel now, by the way, we have a YouTube channel if you guys haven't seen it yet. So, um, yeah, subscribe to the podcast. You'll get all these as they come out. I'll see you guys next time.