When working the lower back muscles we want to increase core strength and mobilitywithout causing pain or dysfunction. So many of my patients come to me with low backand neck pain as a result of working out improperly in the gym, or doing yoga or pilatesimproperly.

Core strengthening is very important as it helps to keep the center of gravity stable andcan also help to level the pelvis, the foundation of the spine. However, not all corestrengthening is safe, depending on the muscle imbalance already present. Every lower back patient I have seen for the last 30 years has muscle imbalance which causespelvic instability, pain and spinal dysfunction. This muscle imbalance then causes anunstable pelvis. When not corrected it then causes compensation throughout the rest ofthe spine and can result in problems like herniated discs, degenerative disc disease,osteoarthritis causing stenosis, scoliosis, sciatica, etc.

The muscle imbalance which is consistently seen to cause back pain is either a tightright iliopsoas muscle (which tends to get tighter when doing pilates), a tight leftquadratus lumborum muscle, or both. Sometimes you will also see a tight piriformismuscle which frequently gets overused due to it compensating for an unstable pelvis.The twisted pelvis (and unleveled foundation) then causes abnormal side bending androtation which causes the spinal joints to become dysfunctional. This joint dysfunctionthen causes muscle spasm and muscle weaknesses throughout the rest of the spine,potentially up to the neck. Even though we see muscle imbalance all the way up thespine, it is important to understand that the right iliopsoas and left quadratus lumborummuscles caused the original problem by causing the pelvis to go into an uneven,unstable position. The other muscle imbalances we see are usually compensations forthe uneven pelvis.

There is one more muscle that I would like to talk about that can make an alreadyunstable pelvis worse. It is the latissimus dorsi muscle (or lats, see above). If the core muscles arenot strong and the pelvis is unstable using the lats can cause increased instability asthey attach to the top of the pelvis (via the thoraco-lumbar fascia) and can pull the pelvisinto a more uneven position. I have seen many patients cause their low back pain as aresult of strengthening their lats.

So, what is the best lower back work outs?

1) Strengthen the rectus and transverse abdominus, internal and external obliques(without shortening the iliopsoas), the hip abductors and adductors, and the threegluteus muscles.

2) Stretch the right iliopsoas and left quadratus lumborum muscles. Sometimes thepiriformis muscle also needs to be stretched, but only secondary to the abovemuscles.

3) Stay away from using the latissimus dorsi muscles. If you need to use these musclesfor activities of daily living and you have low back pain you will probably need to workwith a physical therapist who understands pelvic dysfunctions well.

The latissimus dorsi muscles are used when you swim. SWIMMING ISCONTRAINDICATED IF YOU HAVE LOW BACK PAIN because it uses the lats whichthen pull the pelvis into a more unstable position. Other sports that use the lats arekayaking, surfing and mountain/rock climbing. The lats are also used when you do pull-ups/chin-ups, triceps dips, rowing and lat pull downs.One needs to avoid theseexercises until you have stabilized your pelvis, strengthened your core and learned howto keep your pelvis stable.

One needs to strengthen the muscles that hold your spine in alignment and stretch themuscles that pull your spine out of alignment.

The videos in, “The Missing Link to Neck and Back Pain Relief” shows you how to do your lower back workout safely.