The Fastest Way to Alleviate Low Back Pain
So people with low back pain come into your clinic all the time. Explain to me how you can use MOBO to address and alleviate low back pain?
I like prepping with the ROLLO first. I would do broad based foam roll. You can be on your back in what we call “hook lying” position, where your knees are bent comfortably, and then you can roll from T-spine all the way down to the lumbar spine.
The big thing about the lumbar spine is that you don’t want to encourage a ton of extension there; meaning bending backwards. But at the same time you have very big muscle bellies that are along the spinal column.
The quadratus lumborum is often referred to as the QL. It is most commonly associated with pain in the back as the QL is located in the lower part of your back on either side of your spine. Your QL and your paraspinals are big muscle groups in the lower back, which can handle pressure, but not a lot of extension.
So you have to find a happy medium where you’re not encouraging a ton of extension, because part of the population that will be using this, who have low back pain, will have pathologies like stenosis; which you would not want to allow extension – or spinal stress fractures, called spondylolysis; which you do not want to allow extension.
And then, if you have any kind of, what we call sacralization or genetic anomalies that make your spine very rigid, you do not want to necessarily allow much extension.
You have to be careful if you use the DUO, that there’s not too much extension in the lumbar spine.
PRO TIP – You don’t want to be on a big foam roller or the ROLLO and do a lot of extension of the lumbar spine if you don’t know what pathology is causing your back pain. If you have pain, go to your general practitioner, physical therapist or chiropractor before starting a rolling program.
Okay, now that being said, the most common pathology for back pain is disc herniation; which you do not want to be in flexion for, so extension is good. But if you don’t know that, and you have not been diagnosed with one of these issues, in particular, then you don’t know which way you need to go.
So, with MOBO, that’s why I would say you stick with the basic ROLLO roll, gently across the back with minor extension or you use the DUO and just get in and around the thoracic spine, avoiding the spinous processes – the bony extensions of the spine. Where they are most pronounced is in the low back. Then also avoid the bony structure of the sacrum so that you’re not on the tail bone in any sort of way.
So, on the lower back, in the past what I’ve done is roll, starting with the upper T-spine, all the way down to my glutes. I may actually do some flexion to kind of work through the scapular area, but then I stop completely and flatten out when I get below the ribcage.
Now, once you get to the pelvic crest, you probably shouldn’t put any pressure on the crest itself, right?
Right, you do not.
Okay, so basically you get up to that point you can kind of feel that crest there, hop over it, and then right there is where your sacrum is. You should feel your tailbone right between the two balls of the DUO, right? And then, you can roll all the way through the glutes then.
You can do that, yes. You just don’t want to be right on the bony part of the sacrum. You don’t want to put that kind of pressure on the sacral joints. So, when you reach the sacrum area, then you just either move the two balls over to the thick glute muscle on either side of the sacrum, or you take the balls of the DUO and you use one ball at a time if you want to get into glutes more precisely.
Another option is to put the Long WAND together, stand up against a wall and tackle the glutes from the vertical direction as well.
I’ve also taken the DUO and just widened it out so that the sit bone sits in between the balls and just pivot around the actual hip bone itself.
Right. That is your ischial tubercle, and that’s part of your pelvis.
Okay, so, your pelvis. Okay so I’ll put it around that bony area because it seems you don’t wanna have too much pressure right on the bone itself.
Yeah you don’t want to be right on it.
So I go around it, sort of.
Yes, you want to be careful, but it is a very good area to attack with the DUO, since the hamstrings insert to it. Also, you can tackle glutes from from the side again with the WAND or the DUO or a single ball, and then later you can move into the hamstring muscle bellies just below that sit bone, the ischial tubercle.
It is really effective to get into the hamstring this way, using DUO by adjusting the gap between the balls – going wider or closer, because you have multiple muscle bellies for the hamstring; actually three big giant muscle bellies.
Again, we can mobilize around the sacrum, as long as we make sure that it doesn’t actually put any pressure directly on the sacrum, right?
There is the sciatic notch that’s just below the tip of the sacrum/tailbone, and again, any kind of nervy stuff you don’t want to be feeling. Even when you’re working in the glutes, if you feel tingling, burning, any kind of weird sensation that travels anywhere, then you need to move the ball off of that, because that means you are interfering now with a nerve supply; which in that area is gonna be the sciatic nerve.
Okay so lower back, so you would say the best things to prep, so if I had, let’s just say i had lower back pain, first of all go see your doctor. Find out why. Now if it’s just, you know, I sit a lot and it’s not lower back pain. Maybe let’s call it lower back soreness, or tiredness, fatigue. That’s different than like acute pain, right?
Yes, because spondylolysis causes sharp pain and discs cause nerve pain, and usually that radiates into the butt, or down into the back of the thigh.
But really for most people what we want to have them do is do things for their lower back so they don’t get in a position where they have acute pain.
So the best way to do that is definitely hit T-spine first, right.
Hit T-spine first, and then – here’s the secret – technically, if you really want to handle low back pain, you go to the front. The secret? – – – You must tackle your hip flexors! That is what creates most of the low back pain that is not associated with any of the pathologies I just listed.
Okay right, so hip flexors. I would mobilize the T-spine first, and then I would come to the front. Mobilize the front of the pelvis, because sitting is causing hip flexors to shorten and become dominant. That pulls the low back or the lumbar spine forward.
It literally rocks the pelvis forward, out of a strong neutral position. That’s what creates all that tightness, stiffness, tension, weakness, pressure, that is not related to those really bad low back pathologies.
So if you can tackle the lower back pain from the front, even better results will occur than you just rolling the musculature in the back.
Okay, so mobilizing the hip flexor – what you’ve said before is that the area to address – it’s below the underwear line, right. You do not go anywhere where the underwear on the front side, meaning bikini underwear. On the front side, in the bikini swimsuit, in the triangle region, right. Because the side you can pretty much go hit anything on the side of that triangle, right.
Yes, you can hit anything not in that triangle. You can get your TFL over there, you can hit some quad, and you can hit the rest of the glutes.
So if you’re mobilizing the hip flexor, I’ve seen you pull back with the leg, away from the wall. Kind of at side angles. Just kind of get all the way around it. So how close to the groin can you kind of go?
Here’s the thing about the hip flexor. Hip flexor is a catch-all term. Okay, it’s four total muscles, right. You have your psoas major and minor; which all start in the lumbar spine. They attach to the lumbar spine through the belly.
Do not, I repeat do not, go in there and try to get the psoas because you also have an abdominal aorta and all of your intestines. That requires a medical practitioner to get to.
Then you have what’s called the iliacus. It comes right off of the pelvis. Now that is in an area that could be exposed which you could get with the WAND, right. But you have to turn yourself at a slight angle; which we could go over one time. And then the fourth hip flexor is actually one of the quadricep muscles. It comes from the thigh, crosses the pelvis, that’s your rectus femoris.
So if you feel your bone in the front, that pelvic bone, and follow that inside, just tuck your fingers around it that’s gonna be the iliacus and where the rectus come in. Those are the two muscles for the hip flexors that you could actually target with MOBO and make a difference for low back pain.
We have to be real specific where you go with that, because again and if you just even go one thumb widths in towards the groin, you’re gonna be in a big vascular and neurological zone called the femoral triangle.
That you do not want to be in with any mobility device. You’ll usually know though, you’ll get into some squishy stuff or you’ll notice it’s really uncomfortable. Not muscle tendon uncomfortable, but like – ‘ooh that feels funny’. It is zingy, tingly, whatever.
And so I usually use the MOBO WAND with the END CAPS for those parts because you can, in this area especially, if you transform it into the MINI-WAND, you have a lot more control to get into those areas and then just do little cross frictions across the rectus.
Because, remember that tendon comes straight up and inserts into that area, where that bone is located.
Go just slightly inside of it so you can add cross friction. You can also foam roll with ROLLO, or take the DUO and work the upper quads that way. All of that also helps with the lower back too, because, remember you need to open the pelvis because usually we’ve been sitting all day; which means our legs are at 90 degrees way too long.
I’ve had some lower back pain that was due to playing sports, my hamstring was really tight. So would it be a good idea to first prep the entire thigh and then go into the hip flexor area?
Yes for sure, because think about the quad: I mean that’s a big muscle belly that you can mobilize from the front, then tackle the hamstrings from the back. It is great to get into those muscle bellies which relieve a lot of the tension that’s associated with their insertions, by getting the muscle bellies to release. Or vice versa, like with the neck, if you tackle the muscle insertion area you can get the muscle belly to release.
So you can’t really get to the insertions very easily if the quads and the hamstrings are tight, because they attach to that sit bone or the ischial tubercle. And they attach inside the pelvis, so again, you’re in sort of the zone you don’t want to get.
So mobilizing the muscle bellies first, before mobilizing the muscle insertion areas, might be an even better idea, and then see what happens with your low back. Because the low back shouldn’t need a lot of targeted attention. It’s the bigger muscles that are influencing what’s happening to the lumbar spine, which is your low back. Those bigger muscles are the key.
So if mobilizing the Hip Flexor is a secret to low back health, I guess the T-spine is the other secret, right?
Your T-spine is the other key, because what happens is people sit all day, so the t-spine lacks extension; which means then you have to go somewhere else in the body to get it, and it’s typically the lumbar spine and that is exactly what we don’t want.
We don’t want a lot of that extension coming from the lumbar spine. We don’t want a lot of the movement coming from the low back. We want it to be shared throughout the spine. The T-spine does a little bit of its job, then the lumbar spine does a little bit of its job, the cervical spine does a little bit of its job, instead of the cervical spine, the neck, and the low back doing all of the work because the t-spine is locked up.
So if you can get the T-spine to move freely, a lot of things up the chain and down the chain improve dramatically. So the T-spine is a big area to target for low back pain and for neck pain. If you can mobilize the T-spine, you can indirectly influence those two body parts, right.
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