Today’s PrimalMed Prescription…. “Don’t be Stupid!!!”
BACK ATTACK!!!… look SOUTH to your GLUTES. A cautionary tale of “Twist and Shout.”
Patient: “Hey Doc, it hurts when I do THIS.”
Doc: “Don’t do THAT!”
In WHAT UNIVERSE would I even consider that attempting this move, affectionately known as the “breakdancer kick through” be a smart idea? And WHY would I do it on a hard slick floor?
Back in the day, I did about 20 of these on each side for core strength and mobility. Back in THAT day. New day. I’m an AARP-vaark now so I have renamed this move the “Twist and Shout!” I was down in the MRI suite at the hospital, reviewing a lumbar spine MRI, and displaying to one of the techs, a full body core move to strengthen the core and AVOID having back pain.
So of course, a twist, a twinge, and now MY back is a barking! IDIOT! Can I please have those 30 seconds back?
So on that note, our first musical selection.
Surely you remember the post of October 25, 2022. Almost a year ago. Wonky knees? Look NORTH to the glutes!
Back to today:
Those damn glutes really are important. Good glute strength and control is the root cause of leg issues AND as we will see, BACK issues. BACK issues? Look SOUTH to the glutes!
Who amongst us mortals hasn’t had a back tweak or two. You know, getting out of the car with a twist and lift. Grabbing a bundle and forgetting to tighten your abs and bend the knees and engage the glutes. It happens. People who sit a lot. Runners who don’t train their Posterior Chain and have dead butt syndrome or lazy glute syndrome. Everyone’s gotta lazy bum!
The Glute Maximus and Minimus but most importantly the Glute Medius are KEY stabilizers of our hips and core. It’s not just superficial 6 pack rectus muscles. There are DEEP muscles of the core that need to be strong. Namely, the Transverse Abdominus. Lie on your back, knees up and exhale and press the small of your back down. That’s called a pelvic tilt. Feel the sides of your abs tensing. That’s your TA or Transverse Abdominus. NO NEED TO CRUNCH. Just do those pelvic tilts and tighten the TA. Atta boy!
Now I’m gonna throw 2 more muscles at you that are key for back strength:
The Piriformis and The Quadratus Lumborum, or the QL.
The Piriformis is your deep butt muscle. It stabilizes your sacrum, which is the base of your spine and connects to the outer hip. The sciatic nerve runs adjacent or through it. Tight piriformis or knots here can cause pain.
The QL is a deep muscle in your lower back that connects the spine and pelvis to the lowest ribs. Make a fist and place it around your back under the ribs and next to the spine but above your bony pelvis. That’s your QL.
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Had enough? Want one more? There’s a little guy called the Multifidus, that runs along the back of the spine. It’s a thin tiny muscle that stabilizes the spine when you bend and twist.
Oh wait. I forgot the front of the spine and pelvis! You got the Psoas, Iliacus, and they blend in to become the Iliopsoas which you can feel if you put your hand on top of the inner hip, tighten your core and raise your hip. It’s the major hip flexor.
The point of this anatomy lesson? RELAX! There will be NO QUIZ. It’s to stress that your BACK health depends on many other muscles. We all know about the booty but there are other actors in this play!
I’ve been reading lumbar spine MRIs for 30 years. Yep, that’s right, 30 years as a Radiologist. I see A LOT of herniated discs. Some patients have back pain, some don’t. Some have surgery. Sometimes the patients have relief. Sometimes they develop scar tissue and are worse. That’s called “Failed Back.” Guess what? We need to move past the old paradigm of the herniated disc as the lone villain and get to the root cause of back pain!
Just like the meniscus tear isn’t always the root cause of knee pain, I suspect that when your back goes out, or tweaks, or locks up or even if you have butt pain and leg pain or even numbness and tingling down the leg to your toes, it MAY be the disc hitting a nerve, but it MAY, and dare I say MORE LIKELY, be an issue with the supporting soft tissues being weak and non-balanced. If the core can’t support your spine and the load on your discs and nerves, well then they may bark at you and “doth protest too much!”
And one more concept: The FASCIA! Oh yeah, how could I forget about the fascia. I like to refer to the fascia as the duct tape or saran wrap that surrounds your muscles and ligaments and joints. It is long sinewy matrix made mostly of collagen and other proteins. Lots of little unnamed nerves and capillaries run through the fascia. Healthy fascia means your muscles can move and glide and stabilize! A happy fascia means a HYDRATED fascia. Say NO to STICKY FASCIA!
Try to visualize a crusty old sponge in your kitchen sink. Dried out and stiff. That’s your fascia after you had 5 cups of coffee and no water and electrolytes! Here’s a diagram below. See how large sheets of fascia envelope the body. A stiff left neck or trapezius can irritate downstream nerve endings and cause hip and back pain on the other side! Gotta keep the fascia loose and mobile!
So what’s the TL;DR? How can we go from KNOWING to DOING?
Being PrimalMed approved means KNOWING your limits. Don’t be an idiot and try to bust a move only a 20 year old gymnast should do. Stick with your PrimalMed planks, squats and pushups for 80% of your gains. Sprint or do something fast occasionally. WALK! Walk some hills! Run or bike, swim or row, or pickleball to your hearts content.
When you have a tweak, take a few days off. DON”T STRETCH an injured muscle. You’ll prolong the injury. Let it heal with gentle and consistent dynamic movement. Don’t sit for too long. Did I say walk? HYDRATE to keep your fascia loose and happy.
Speak to a qualified physical therapist. I CANNOT stress this enough. A good PT can identify those muscular imbalances, and find knots and trigger points and can release those tight and tender muscles.
Whassup PrimalMed? No specific corrective exercises in this post? NO. Not today. I’m not a PT. Please DO NOT go willy nilly down the YouTube rabbit hole. It’s a great way to injure yourself. I have my opinions of course, but each case is different. At the very least, consider addressing the TRIGGER POINTS in the above discussed core muscles with your therapist. It makes sense to loosen and release tight tissue rather than stretching tight and weak tissue. Think about gently foam rolling the FASCIA to loosen up those cranky knots and adhesions.
Craft a personalized REHAB and then a PREHAB plan AFTER an appropriate evaluation by a licensed professional.
THEN, you can work on strengthening the deep core, back, GLUTES and hip muscles and spine stabilizers with exercises so YOUR fortress is ready for your next attempt at being a RubberBand Man. Now how ‘bout a little Motown! Let’s go back to 1976!
Here’s something new!!!
PrimalMed PIX submitted from our readers! PrimalMed approved !!!
Here are two happy PrimalMed subscribers who spotted the official PrimalMed mobile at an undisclosed location.
And one of our most enthusiastic subscribers, when he is not modelling the PrimalMed squat or pushup in earlier posts, was hiking in the Grand Tetons in Wyoming last week and of course brought some PrimalMed swag to impress the locals on the Dutton Ranch. Give Rip and Beth a pen!
Perfect article as Alan just pulled his piriformis muscle…
Happy bday on the 19th
We’ll make sure to bring our PrimalMed pens on all vacations for now on.