Posterior Chain Exercises for Prevention and Treatment of Low Back Pain

Abstract

INTRODUCTIONLow back pain (LBP) is common, costly, and disabling across all ages, functional levels, athletic groups, and occupations (10). Exercise has been shown as an effective prevention and treatment approach for this disorder in terms of reducing pain and disability and improving quality of life and physical function (1,10). Numerous exercise approaches are available for LBP and none have been exhibited as distinctly superior (10). Regardless of the exercise approach, optimizing function of the posterior chain muscles, specifically the glutes and lumbar extensors, is crucial for prevention and treatment of LBP (10). A healthy posterior chain is required to counteract forces, sudden movements, and physical demands and is fundamental in physical performance, prevention of injuries, and physique development (7). A healthy posterior chain also enables good posture and motor control throughout various body positions, activities, and movements and supports optimal flexibility, endurance, strength, and muscular development (7). Abnormal glute function is linked to performance deficits, injuries, LBP, and development of a less than desirable physique (4,7,15). Lumbar muscle strength and endurance loss, atrophy, fatty infiltration, and poor motor control also are associated with LBP (5,13). These deficits can be overcome through appropriate training of the posterior chain muscles. The safety and effectiveness of posterior chain exercises for individuals with LBP, healthy individuals, and high-risk workers such as firefighters and military personnel have been demonstrated by our group (6,8,9,12).Photos courtesy of Charity Lane and John Mayer, 2017.A healthy posterior chain is required to counteract forces, sudden movements, and physical demands and is fundamental in physical performance, prevention of injuries, and physique development (7). A healthy posterior chain also enables good posture and motor control throughout various body positions, activities, and movements and supports optimal flexibility, endurance, strength, and muscular development (7). EXERCISE STRATEGIES Glutes Many people have great difficulty in properly engaging the glutes during common exercises (7). Thus, supervision by qualified fitness professionals who are adept in glute activation strongly is advised. Proper hip movement and training, including good form, appropriate contraction, isolation, and goal-oriented repetition range, are paramount. Equipment specifically designed for training the glutes is minimal, which further emphasizes the need for supervision. We recommend the hip thruster and squat for effective glute activation and training. Resistance for the hip thruster and squat can be increased by using a plate-loaded barbell, dumbbells, or incorporating resistance bands. The hip thruster is gaining momentum as a foundational exercise for glute training, because it is user-friendly and results in higher glute activation than squats and dead lifts (3). Although the squat has many benefits in terms of overall muscular strength development (14), its use specifically for glute activation is challenging unless movement patterns are focused on this goal (2).Lumbar Extensors Lumbar extensor training should focus on isolating these muscles and selectively activating the lumbar multifidus (11). Back extension exercises on Roman chairs and selectorized machines serve this purpose if certain movement patterns are encouraged (11). We recommend Roman chairs, machines (e.g., dynamometers), free-weight movements (e.g., dead lifts), and core stability exercises for lumbar extensor activation and training (11). The best exercise training approach for the lumbar extensors is dependent upon several factors, such as available equipment (e.g., machines, free weights), available resources (e.g., access to trainers, fitness centers), and the client’s specific goals (e.g., muscular strength, endurance, motor control) (11).The best exercise training approach for the lumbar extensors is dependent upon several factors, such as available equipment (e.g., machines, free weights), available resources (e.g., access to trainers, fitness centers), and the client’s specific goals (e.g., muscular strength, endurance, motor control) (11). RECOMMENDATIONS For prevention and treatment of LBP, we recommend the following approaches for fitness professionals (7): Implement posterior chain exercises, such as those delineated previously, that encourage proper hip and lumbosacral movement and specifically target the glute and lumbar muscles. Base posterior chain exercise programs on scientific evidence and the client’s specific needs, goals, and preferences, in combination with the expertise of the fitness professional. Closely supervise performance of posterior chain exercises. These muscles are very difficult to activate and can be trained on many of the same pieces of equipment with a simple alteration of form. SUMMARY Properly functioning glute and lumbar extensor muscles are essential for maintaining a healthy posterior chain. For the management of LBP, fitness professionals should incorporate progressive resistance exercises for these muscles to reduce pain and disability, prevent injury, improve quality of life, enhance physique, and optimize physical function.