Low Back Pain Exercises - Glutes the Missing Link

By: Yuri Elkaim, BPHE, CK, RHN


Looking for low back pain exercises? Well, the answers may not be as obvious as you think. In this article, I'm going to show how by training your glutes (and NOT doing sit ups or crunches), you can prevent low back pain.

As more and more people develop lower back problems one cannot help but question the type and quality of their exercise, if in fact they exercise at all. Low back pain can arise for a number of different reasons from prolonged sitting, poor core stability, and even poor lifting mechanics in the gym.

Whatever the cause, a recurring theme is noticed in individuals with low back pain – inhibition of the gluteal (buttocks) muscles. Traditionally, core-stability programs tend to focus on the trunk muscles (transversus, multifidus, obliques and paraspinals); however, the glute (bum) muscles are also very important for core stability and preventing low back pain.


Anatomy and Mechanics of the Glutes

The glutes are comprised of the gluteus maximus (the largest muscle in the body), and the gluteus medius and minimus. The gluteals play a dual role - not only do they act as mobilizers (to create movement) but they also act as stabilizers. For instance, as mobilizers, the gluteus maximus initiates hip extension (pulls the leg back), meaning that it is involved in movements such as the push phase in running or jumping, whereas, the gluteus medius and minimus abduct the hip (move the leg sideways out from the body).

From a stability perspective, during running for instance, the gluteus maximus acts to maintain upright posture and stabilize the sacroiliac joint. The gluteus medius and minimus work to maintain a level pelvis when weight-bearing on one leg, preventing the free side from dropping down.

The problem that I notice most often is that many individuals train body parts and not movements. They opt for the “vanity” workout instead of the functional full body workout. At the same time, these same people are very often the sporty type engaging in activities such as running, cycling, tennis, and team sports. And this is where the problem arises. The body is being trained to look good and not necessarily to perform well and/or prevent injuries.


To Squat or Not to Squat?

Here’s an example of a functional movement that many gym-goers incorporate into their “vanity” workouts – the squat. The squat is a great functional movement that mimics many daily and sporting movements patterns.

But here’s the problem – it has been shown that individuals with poor core stability, inhibited gluteals, or pre-existing low back pain DO NOT activate their glute muscles properly , when performing exercises such as the squat. What’s happening here is that the hamstrings are firing first to extend the hip, followed by the lower back, and then (and sometimes not all) the glutes fire.

This pattern of activation leads to tremendous stress on the lower back as the load is directly transferred from the hamstrings onto the lower back via sacraltuberous and dorsalsacral ligaments, thus, totally bypassing the “supposed” prime mover – the gluteus maximus! Thus, the load is dangerously placed on the passive structures (ie. ligaments and joints) rather than the active structures (ie. muscles).


Weak Glutes and Knee Pain in Runneres

Here’s another example of how weak gluteals can even lead to other problems. Many runners often complain about knee pain due to the repetitive high stress nature of running. These runners often turn to buying new shoes, orthotics, or medicating themselves to mask the symptoms. Although these methods may have there place, preventing knee pain (and back pain) for that matter can often boil down to having functionally trained, endurant gluteal muscles, especially the gluteus medius. Any time I come across someone complaining of knee pain, one of the first things I assess is their gluteus medius. And guess what? It is often inhibited, misfires, or weak!

Therefore, to improve muscle function, it is easier to think in terms of the mobiliser/stabiliser system as it guides us into using exercises that will be more functional. The system tells us that stabiliser muscles need to switch on easily at low-load levels, they need to be able to maintain joint position and they need to have good endurance. Stabiliser muscles tend to become inhibited and are not active enough for sufficient duration.

Therefore to train stabiliser muscles correctly, exercises should involve positions that mirror your daily activities or athletic movements, they should be trained with light loads and many repetitions or made to hold the correct position for a prolonged period. In so doing, you will strengthen your lumbo-pelvic stabilty and help prevent muscle imbalances resulting from biased training. The end result – better core/pelvic stability, proper muscle activation timing, better energy transfer, and less chance of developing low back problems.


7 Awesome Glute and Lower Back Exercises to Prevent Low Back Pain

The following are several excellent functional exercises for developing better glute activation, lumbopelvic stability, and eventually improved back health. They start very basic and progress in difficulty.

Equipment needed:
• Floor mat
• Rubber tubing
• Step
• 1 dumbbell (5-15% of your body weight)

1. Clams - Lying on your side with both legs bent, ensure that your feet are still in line with your torso. Then, open legs (like a clam shell) apart while ensuring that your feet remain together. Only raise the leg to about 45°. You should feel this in the glute of the working leg. Perform 15-20 reps per leg.

2. Hip Hikers - With one foot on step and both legs locked, drop unsupported leg towards floor so that hip drops. Hike hip back up while keeping both legs locked at knee. You should feel this in the glute of the supported leg (on step). Perform 15-20 per leg.

3. Bridge - Level 1
Lie on your back with knees bent. Brace your abdominals and squeeze your bum cheeks together as if holding a $100 bill between them. Curl the bum off the floor, lifting the hips until the knees, hips and chest are in line. Hold this position, purposefully squeezing the glutes to support the bridge position. Start with 10 x 10 seconds, building up to 2 x 60 seconds. If you feel a strong contraction in the hamstrings or the lower back is straining, then you are not using your glutes strongly enough. Focus on them to ensure they do the work.

Level 2
Same as above, but once the bridge is achieved lift one knee up in the air and support the bridge on one leg only. Hold for a count of two and then swap sides. Maintain for 60 seconds. Build up to 3 minutes. Again, ensure the pelvis remains level and your abdominals are braced.. If you feel a strong contraction in the hamstrings then you are not using your glutes enough.

4. Side Bridge with Lateral Leg Raise – Lying on your side, raise your hips off the floor while supporting your body weight on one forearm and the knee closest to floor, and keeping your top leg straight. While holding this position, focus on activating the glute of the straight leg and perform 15-20 leg raises. Rest for 30 sec and switch sides.

5. Walking with Unilateral Load - Research has shown that carrying a weight on the contralateral side while executing a closed chain exercise in stance phase optimally develops the gluteus medius/minimus complex (GMM). In other words, if you walk with a weight in one hand (equal to about 5-15% body weight) in one hand, you will strengthen the opposite GMM.

6. Single Leg Squats - Stand on one leg in front of the mirror. Ensure your head is up and your shoulders are back, with your abdominals braced for support. Squat down with your bum going back and your knee staying over your laces. Keep the free-leg knee next to the stance knee (or extended behind) to ensure you stay aligned. Keep your pelis level and square as you squat down. Stand back up, ensuring everything remains aligned. Build up to completing 3 sets of 10 each leg.

7. Squats with Abduction – SECRET SQUAT TECHNIQUE
In a standing position with your feet shoulder width apart and rubber tubing (or theraband) placed around your knees, brace your abdominals and descend into a squat (no lower than 90°) while activating your glutes so that you lightly adbduct your knees causing the rubber tubing to stretch. Ensure that your knees remain in line with your toes. Squeeze your glutes and push back up into a standing position while allowing the rubber tubing to relax. Perform 20 reps with little or no weight. You should feel a great deal of activation in your glutes.


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