Original article in German: Muskuläre Dysbalance – 23 Übungen gegen Hohlkreuz, Rundrücken und Geierhals
Some time ago, I was forced to take sick leave from work because of my lower back pain.
Six different doctors had already examined my lower back. That day, I drove to the seventh and last doctor. I felt weak and vulnerable, and I was extremely annoyed. The doctor took an x-ray of my lumbar spine.
Diagnosis: ‘Lumbago’, which is just another word for low back pain.
Well, I knew that already! The last doctor couldn’t help me either. He prescribed the typical: Painkillers, physical therapy, and rest. After a few days, the pain was gone, but only for a while…
A Strong Back Doesn’t Feel Pain, Right?
I experienced back pain for the first time in 2006. At that time, American football, wrestling, and weight training were my priorities.
It started off with little aches in the lower back. In the beginning I thought it was nothing serious and that it would go away by itself. But instead, it got worse!
My sleep wasn’t very good, and was getting worse. Sitting became uncomfortable, and when I moved without thinking, a sharp pain shot through my back. The pain and discomfort usually came in spurts, and lasted for 1-2 weeks. The pain would go away for a little while, and I would forgot about it until the next time it appeared.
I didn’t understand what was happening. I was eating healthy, and exercising almost every day. According to the doctors my back was fine – or was it?
While this was going on I remember seeing an old marketing slogan from a German company called Kieser Training: “A Strong Back Doesn’t Feel Pain”. Anyone who has ever experienced back pain will agree, that statement is bullshit!
I still believed it, though. I was deadlifting, rowing and doing pull ups on top of wrestling and football. My back was strong … and it ached…
This went on for several long and painful years.
After the seventh doctor’s visit and a break from training, my pain disappeared as usual, so I started training again. This time, I trained harder than ever.
Insanity: doing the same thing, over and over, and expecting a different result. – Albert Einstein (likely)
It didn’t take long before I felt lower back pain again. It happened one evening at wrestling practice, and it was so bad, I had to stop training. My coach came over and asked what was wrong, so I told him about the troubles with my back.
- Coach: “You arch your back too much.”
- Me: “Yes, I have a slight hollow back.”
- Coach: “No, you MAKE a hollow back, because you’ve gotten used to a wrong posture.”
- Me: “Okay?”
- Coach: “So, you have to get used to a correct posture!”
- I was skeptical. Nevertheless, I asked what he meant, and how I would be able to correct that.
- Coach: “Just stand straight.” Then he corrected my posture and said: “This is how your back should be. Do you also train your abs when you work out?”
- Me: “No.”
- Coach: You probably have a muscle imbalance. Wrestling stresses your back muscles. On top of that, you do a lot of deadlifting. Your back is strong and your abs are weak!
- Me: Why are they weak? I have a six-pack *smile*…
- Coach: That’s because you are slim…
Stronger abs and better posture will eliminate my back pain? That sounded too easy to be true. But, I was willing to try anything at that point!
In addition, my coach recommended some books on this topic, which I went out and bought right away.
I took another break from practice and used the time to read my books, and make a better workout plan.
After 2 weeks, I was pain free! When I started wrestling and American football again, I waited for the next wave of lower back pain – but it never came. I haven’t had severe lower back pain since!
In this article I will explain what methods I used to get rid of my back pain, and what I do now with my clients who also suffer from lower back pain.
Muscle Imbalances = Bad Posture = Pain?
Your muscles can only contract. If you want to stretch or lengthen them, they need an ‘antagonist’. which is something that pulls them from the other side.
The antagonist of the biceps is your triceps, and vice versa. If you do a biceps curl, your bicep contracts and your tricep lengthens. When you do tricep extensions, the opposite happens.
A muscular imbalance is an imbalance between agonist and antagonist.
The picture explains it quite well:
Left: Muscle A and B are relaxed and in balance.
Middle: Muscle B is shortened.
Right: Muscle A is weaker than Muscle B.
How are muscle imbalances related to Lumbar Lordosis?
Vladimir Janda came up with the upper and lower cross syndrome, and the prototype of muscle imbalances. He explained bad posture as being a result of muscle imbalances that he called ‘cross syndrome’.
Seen from the side, you can connect the muscles with diagonal lines, which results in two crosses: The upper cross and the lower cross.
- Upper Cross: Head, neck, shoulders and chest.
- Lower Cross: Abs, lower back, hip flexors and thighs, and glutes.
You have a lower cross syndrome if your lower back muscles (thoracolumbar extensors) are shortened, and the abdominal muscles are weak. In addition, your thigh and hip flexor are shortened, (rectus femoris and iliopsoas) and your glutes are weak.
This puts your pelvis into an anterior tilt, and causes Lumbar Lordosis.
Do exercises help against muscle imbalances?
Yes. By performing certain exercises that stretch, strengthen or massage, you can balance your musculature or ‘agonist and antagonist’. To counteract the lower cross syndrome, you need to stretch your lower back, thighs, and hip flexor, and also strengthen your abs and glutes.
Are muscle imbalances really that bad?
It depends on the severity of the imbalance, and the activities that you want to do. I know of cases in which a muscle imbalance was the cause of an injury. I also know people who have very strong imbalances, but are just fine.
However, muscle imbalances will increase the chance of an injury, and they can make it harder for you to get into a “good” posture. That’s why it makes sense to counteract these imbalances.
If you have lower back pain in combination with a lower cross syndrome – correct the imbalance!
Do I automatically have a good posture when my muscles are balanced?
No.
A good posture also includes good habits, in addition to a balanced musculature.
For example, if you have a habit of sitting in front of your computer for 8 hours with your back bent, then you’ve developed a “bad posture”.
If you don’t break the “bad-posture-habit”, then it doesn’t matter if the agonist and antagonist are balanced. A well-balanced musculature doesn’t automatically change your habits.
Moreover, the cross syndrome theory lacks some evidence. Paul Ingraham, for example, claims that it’s not “muscle imbalance that makes people slump and hurt — it’s a brain thing.”
Here is a guest article that focuses more on posture and habits: Improving your body posture (coming soon).
Does a good posture and a balanced musculature help against pain?
Yes and no.
Posture, pain and muscle imbalances may correlate, but correlation isn’t causation.
There are people with bad posture who don’t have any back pain. And, there are people with a good posture and a balanced musculature that are in pain.
On top of that, we have many “experts” with different opinions. Esther Gokhale blames posture and John E. Sarno blames tension and stress for lower back pain.
I don’t know for sure if my back pain was caused by a muscle imbalance, my unawareness of my bad posture, or just tension that came from negative stress. It could also be a combination of all of these factors.
However, the following are facts:
Before
- I had a strong back that I used in wrestling and American football. I did not deliberately train my abs.
- My weight training consisted mainly of squats, deadlifts, and bench presses and rowing.
- I hardly did any stretching.
- I had Lumbar Lordosis and I was unaware of it.
- I slept on my belly.
- I had severe back pain for more than half a decade.
After
- After every training session (football and wrestling) I did the hollow body position *see below.
- With every strength training, I also trained my abs.
- I stretched my lower back and hip flexors several times a week.
- I made sure not to arch my back all the time.
- I rarely sleep on my belly.
- I have not had severe back pain since!
Your situation might be similar, or completely different.
If you are walking around like a duck (belly and butt hanging out) then you might be unaware of your posture. If you sit a lot and never train your abs and your glutes, you might have a muscle imbalance in your hip region – a lower cross syndrome.
In both of these cases I recommend the exercises below. There is no risk in doing them, and the rewards could be a reduction or elimination of frustrating pain!
4 Exercises for Lumbar Lordosis (and Lower Back Pain)
There are tons of exercises that we could do, but let’s keep it simple and focus on 4. These are the ones that helped me the most. Do them every day for at least 30 days straight.
- Strengthen Abdominals – Hollow Body Position
- Strengthen Glutes – Band Walks
- Stretch Hip Flexors – Kneeling Hip Flexor Stretch
- Stretch Lower Back – Seated Figure 4 Stretch
Program
A1: Strengthen Abdominals – Hollow Body Position
A2: Strengthen Glutes – Band Walks
B1: Stretch Hip Flexors – Kneeling Hip Flexor Stretch
B2: Stretch Lower Back – Seated Figure 4 Stretch
A is the first cycle. That means you will jump back and forth between exercise A1 and A2. The same goes for B. Breaks are not necessary. Do 3 sets of each cycle.
1. Strengthen Abdominals – Hollow Body Position
I mainly trained my abdominal muscles with the hollow body position. It was the most important exercise for me in the fight against back pain. That’s why I will give you 4 progressions.
The hollow body position is divided into four steps or positions. When you reach the point that Each time you’re able to hold one position for 60 seconds, you move on to the next.
Here is an example: Let’s say you can hold Step 1 | Bent Legs at 90° and your set looks like this:
- Set 1 – 30 seconds
- Set 2 – 25 seconds
- Set 3 – 20 seconds
As you get stronger, your holding time will increase:
- Set 1 – 55 seconds
- Set 2 – 49 seconds
- Set 3 – 41 seconds
Until you can hold 3 sets for 60 seconds.
- Set 1 – 60 seconds
- Set 2 – 60 seconds
- Set 3 – 60 seconds
Then you start with Step 2 | Legs at an angle, and repeat this until you hit 60 seconds again.
The most important thing in the hollow body position is the posture of your lower back. When you arch, the exercise becomes ineffective. You have to press your lower back into the ground.
Right (✓):
Wrong (✗):
Take your time, and perfect each exercise before you take the next step.
Step 1 | Bent Legs at 90°
Lay on your back. Bring your legs to a 90º angle. Drop your shoulders down and towards your hips. Press your lower back into the ground and brace your abs.
Step 2 | Straight legs at an angle
If you have completed Step 1, then you can straighten your legs in the second step. Make sure your back stays pressed into the ground.
Step 3 | Legs almost parallel to the floor
In the third step, lower your legs further down to the ground.
Step 4 | The hollow body position
Finally, raise your arms over your head. Even though it is called “hollow body position” you do not arch your back. The lower back remains pressed into the ground.
2. Strengthen Glutes – Band Walks
There was a time when I hardly trained my glutes, but I made sure to activate them throughout the day, (especially while standing) and when I was doing exercises (like the deadlift). At the time, it seemed good enough for me. In retrospect, I think I should have done more glute activation exercises to speed up the process.
I recommend band walks. Do 10 steps forward, backward, lateral left and lateral right, no breaks in-between. Get a heavier band if you can do more than 20 steps per set.
Forward / Backward
Lateral
If you don’t have access to bands right now you can do glute bridges and frog pumps for 10-20 reps each.
3. Stretch Hip Flexors – Kneeling Hip Flexor Stretch
You should feel the stretch mainly in your hip and perhaps a little in your thighs. Don’t arch your back! Keep your hip neutral or tuck your tail bone in (posterior pelvic tilt).
Move in and out of the stretch for 10 reps. Then hold the stretch for 20-30 seconds per side. Every time you breathe out, try to sink deeper into the stretch.
Right (✓):
Wrong (✗):
Check out this YouTube video for a more detailed demonstration:
4. Stretch Lower Back – Seated Figure 4 Stretch
The lower back has several different muscles and fascia that you can move and stretch in various ways. I preferred this stretch simply because I could do it at work (back then I worked in a cubicle-like office).
Cross one leg on top of the other and lean forward. You should feel the stretch in your lower back, and in your glutes.
Move in and out of the stretch for 10 reps. Then, hold the stretch for 20-30 seconds per side. Every time you breathe out, try to sink deeper into the stretch.
If you don’t feel it, I recommend the stretch in this YouTube video at minute 0:20-0:30.
Find a stretch that you feel in your lower back, and that you can do often, not just once a week when you have access to a yoga mat.
Will this help me get rid of lower back pain forever?
There are several factors that can cause lower back pain and I cannot make any false promises, like a snake oil salesman. There is never just one solution for a problem with multiple causes.
Many of my clients who performed these exercises felt less back pain, and sometimes even instant relief. But that doesn’t mean that these specific exercises are the only reason for it. Maybe, their back just needed movement. Maybe this is a placebo effect. Or, maybe their body was telling them that it needed to relax, and the exercises did just that.
That’s why I recommend that you take notes (something I should have done back then). It will help you pinpoint the main problem. I added 3 columns for sleep, water and negative stress, (1 is low, 10 is high) because they can affect your lower back pain as well.
Step 1: Get a sheet of paper or print this document where you can record your progress.
Step 2: Do all 4 exercises for at least 30 days. If you don’t already move a lot, add my 5-minute-full-body-routine to your exercises. You can get access below.
Additional Resources you might like: Two books. Esther Gokhale – 8 Steps to a Pain-Free Back and John E. Sarno – Healing Back Pain. They both have a different point of view. One blames posture, the other blames tension and stress for lower back pain – Understand and try both approaches.