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These are two issues I see commonly with people I start working with whether they are golfers or not. Sometimes they are linked, and other times they are not. How I go helping people with these issues is the exact same though: ASSESS.
SKIP TO PAGE 2 if you do not care how the sausage is made and just want to see some cool drills. I do think the assessment is the most important component of this and we at Oak would love to help provide you with that in person or online!
The first step in anything assessment when it comes to pain is to check the severity. This is easy because it just involved asking, “How bad?” “Where?” “When and while doing what movements?” and “For how long?”
Depending on those answers I can determine if this is something I can help with, or if I need to refer them out to a chiro (Dr Juan) or physical therapy.
Lets assume i can help this imaginary person.
Next we would do an actual movement assessment.
I always do these 3 drills
Toe Touch
What Im Looking For
Hip External Rotation(ER)/Internal Rotation(IR) (Open, Closed, Passive)
What Im Looking For
Overhead Reach on Wall
What Im Looking For
Why these?
These 3 drills will give a pretty good analysis of movement at the pelvis and the hips. I will also do just a static posture assessment to check for pelvic and spine position at standing; which in combination with these assessments gives a great picture of what is going on movement wise. I also do a gait analysis which will give me some more info on what may be going on and confirm or counter whatever I saw in the movement assessment.
Most of the time I will see something going on during the assessment that gives us a jumping off point. However, I usually like to do some stability assessments as well to get an idea of how well they are able to balance and stabilize of the pelvis.
These stability assessment depend on the results of the previous, however, they usually look something like: single leg balance, split squat hold, glute bridge hold, etc…
Why do we do these?
These assessments will give us a greater understanding of how these move and stabilize the body with or without their movement limitations. It will also gives us a better idea of what muscle activation they can achieve and if it is “right” or not.
Quick example of this would be if someone is lacking right hip external rotation (ER) that can sometimes lead to less glute max activation on that right side. If we do a split squat hold and they fatigue in their low back and hamstring/calf, then that would suggest that might be the case. If we then did a glute bridge hold and the right glute max couldn’t activate as much or at all, then I will feel very confident that the right glute is playing a major role in the low back pain.
Okay so now our assessments are done, we have a better understanding of what the heck is going on. Now what?
Now we do whatever is best for the situation, see if it works, and progress if it does and alter it if it doesn't.
Regardless, I always start off with breathing correctives to bring everything back to “neutral” so to speak.
We start with these breathing correctives for 2 reasons. First, they do bring our body and nervous system into a place where making changes is easier and pain is normally lessened. Second, I use them as another assessment. How you breathe and what part of your trunk you breathe into is important.
Common weird breathing things I see are: lifting your neck while relaxed breathing, exclusively breathing into the left side, breathing only into your belly, and not being able to breathe into your posterior ribcage. There are others, but these are super common.
So when we start with breathing corrective, I look to overcome these breathing asymmetries. The easiest way to do that is to learn how to breathe into the posterior ribcage and depress your anterior lower ribcage.
Things like quadruped (on all fours) breathing works really well for this.
Then we would do another breathing corrective that would be supine (on your back) and make you actively depress lower ribcage.
From there, it is dependent on the assessments what we would do next.
For Mobility Limitations
We would stretches and drills targeted at the limitation.
For something like a limited toe touch, we would do weighted pikes with a foam roller between the legs.
We might also do a neural flossing drill which would be holding the toe touch position and extending and flexing the head. This will increase and decrease the tension put on the spinal cord and nerves down the leg which will lead to a greater stretch effect.
Lastly, we would focus on anterior compression around the pelvis and hip flexor strength.
For Stability Limitations
We would alter the positions we perform certain exercises in to make sure we get proper muscle activation, or we would do a drill that would get the right muscle activation and then perform the stability drill again to see progress.
If we use the right glute example again, we would try a variety of exercises to get that right glute max to fire. Once we were able to find one that works, we would perform the glute bridge again. However, this time we would put our back on a bench and feet on the floor. This will decrease the need for hip extension past a certain point and gives us more room to work with in order to activate that right glute max.
Please keep in mind that I know this long post is kinda vague. I have a hard time talking about things generally because every person is handled on a case by case basis. What I can say though is that for most people, the process I set out today works.
Find out how you move.
Find out what muscles are being used more and less than they should.
Learn how to breathe better.
Experiment and progress.
The key to any low back or sciatica pain is to know what is going on AROUND the pain. If we can find a limitation somewhere and attempt to fix it, we can normally relieve some of the pain and find variations of exercises that can keep you training while we fix the problem.
The main takeaway for anyone dealing with low back pain is to not stop training if you can. There are cases where severe intervention needs to be taken, however, these are rare. 9 times out of 10 you can just do variations of exercises that you can tolerate to keep training and keep progressing.
Never stop moving!
Yours in strength,
Nate
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