How to REALLY Fight Low Back Pain

Let’s call her Joy, but in truth she was far from happy.  She sat in the chair across from me and shared that several times a day she would experience 10/10 pain shooting from her lower back down her leg.  The low back pain was so severe that it would drop her to her knees at times.  Joy’s pain was a daily experience for over 15 years.  It lead to her undergoing spinal surgery six months ago, but her symptoms persisted.  Her initial functional goals were as simple as the ability to get up from a chair as well as go up and down stairs without low back pain.  She came to physical therapy to learn how to get out of low back pain, but she also taught me a deeper appreciation for the functional benefits of the Ultimate Sandbag and DVRT…

In the world of DVRT social media, it is unlikely that a week will go by without the mention of “real world strength” or true “functional training.”    These concepts are what attracted me to the world of DVRT and why it has remained the linchpin of my own training.

It is not uncommon to see DVRT Master Instructor Cory Cripe demonstrating the real world benefits of moving through multiple planes of motion while utilizing a Burly size bag loaded with enough sand to fill a small sandbox.

Another day, DVRT Master Instructor Larisa Lotz, is demonstrating creative movement flows that enable her triathletes to develop mobility in conjunction with core activation.

https://www.instagram.com/p/BuKjxdXHjrd/

 As a physical therapist, functional training through the lens of DVRT often looks like the concepts that are presented in the DVRT Restoration course or the equally valuable Pelvic Control Program.  For example, a patient being seen following a knee surgery might be instructed in dead bug and bridge progressions.  Utilizing the principles of engaging the ground and creating tension in the lats by pulling the bag apart, we can tap into the sling systems of the body.   Coordinating these concepts with resisting and moving through multiple planes of motion helps enhance stability to develop a more functional gait pattern.

 The gait pattern can then be strengthened utilizing ARES sled drags. The ARES is an especially helpful tool in the clinic when full squats or lunges are still not comfortable.  I have found it a great way to build strength as well as improve work capacity. A dynamic plank that trains more than the “chest” or what most would see in a standing press exercise. Such movements help us create stability of our pelvis which goes a long way in helping low back pain concepts.

With Joy, functional training took a different path.  The first two visits were focused on breathing, pain education, and positioning movements to enable her to move with less pain.  On her third visit, she said that her low back pain was significantly improved and no longer went down her leg. Unfortunately, picking something up from the floor still bothered her.  She also said she was frightened while climbing stairs because of her balance.

First, I spent time coaching her through bending forward in ways that did not provoke pain.  When she had this down, it was time to take out the 30 pound power bag. I chose this size because it was her 30 pound granddaughter that she was most anxious to be able to lift. With the bag elevated, we worked on engaging the ground and hinging the hips so she could grab the neutral grip handles and pull them apart to activate the lats.  After she was able to grip the bag without pain, we worked on her lifting it.  She was able to do this with good form and no pain, so we moved it to the floor.  Throughout this process she was learning the proper way to perform this functional movement pattern, but equally important she was learning to let go of her fear of moving.

“There’s just one problem, your granddaughter doesn’t come with handles.  Let’s look at another way to pick up this bag.”

Because of the versatility of the Ultimate Sandbag, she was able to practice cleaning the bag into the bear hug position. With practice, she was also able to lift into this position pain-free.

We then moved on to the stairs.  It didn’t take her long to become confident that she could go up and down them pain-free and without losing her balance.  Joy was expecting another grandchild any day, so I had her hold the 10 pound Core USB in the front hold position. Though I didn’t have her pull in hard to engage the lats, it was supposed to represent a baby after all!   The bag was then shifted into a suitcase hold to represent a bag of groceries. She was challenging her stability by changing her holding positions, but just as important, she was learning that she could move pain-free in functional tasks that were uncomfortable just a week before.

When Joy returned for the next visit, it was evident that much had changed.  Her disposition was reflecting her name, as her low back pain diminished and her freedom increased.

Massive multi-planar movements, training triathletes, or teaching 64 year-old grandmothers to move pain free, functional training can look very different.  While function can wear many faces in the world of DVRT, they are all turned toward strategies that enhance strength and movement efficiency in “real world” situations.