Build a Bulletproof Lower Back

When I was in my undergraduate exercise science studies, I had a professor who said something I'll never forget. He said, "You don't throw your back out doing deadlifts. You throw it out picking up your panties."

If you've ever thrown your back out, you know exactly what I mean. I'm Seth, I'm an ER physician and former special ops guy, and today I'm going to show you how to build a bulletproof lower back so this doesn't become your story.

Low back pain is one of the single most common complaints I see in the ER, and here's a secret for you. Most ER docs actually hate picking up patients with this complaint because it is genuinely very difficult to. There are honestly no really good medications to treat it, so we are often sending home a patient who still is in pain.

Multiple studies have shown that even opiate medications are not very effective for low back pain, and because recovery can take weeks or even months, there is a very real risk of addiction with opiates. So, we resort to things like muscle relaxants and ibuprofen or Tylenol, which are meager at best.

This is the sad reality of low back pain, and maybe you know exactly what I'm talking about from personal experience, and I know that I do because I've thrown my back out exactly three times in my life, and I remember each one vividly. And hey now, this is not an old man thing, all right?

The first time I threw it out, I was only 22 years old. I was leaning over to grab something out of the glove box in my truck, and I felt something in my lower back just give, and I realized I was stuck in that position for like the next 5 minutes, and spent the next 2 weeks genuinely regretting getting something out of my glove box. The second time, I was picking up a 10-lb dog. Embarrassing. And the most recent one, I had just woken up in the morning and was putting on my shoes while I was still half asleep. Each time confirming exactly what my professor had said years ago, picking up your panties.

So, let's get into why this happens, what to do if you're currently dealing with this, and how to build a back that never does this again. Why does picking up something that weighs basically nothing cause the kind of pain that has you walking like an old man for 2 weeks? It's not because you're weak, it's not because you're getting old, although I know some of you immediately went there and I see you. It's because there is a specific muscle sitting right at the very base of the spine where it connects to your pelvis that is almost certainly not doing its job. It's called the multifidus. Most people have never heard of it, which is one of the problems itself.

The multifidus runs the entire length of your spine, but it's most important right at the bottom, that lumbar sacral junction around L4, L5, S1, right there where the spine meets the pelvis, right there where most people feel that twinge of pain which puts them out of business for the next 2 weeks. Its job is not to generate power. Its job is to stabilize each and every individual vertebra of your spine as it moves. Every time you bend or twist or reach or lift something, the multifidus is supposed to pre-activate and protect that junction before any of the load arrives. Think about it kind of like a bouncer at a door of your lower back. When it's working, nothing gets through. When it's asleep on the job, everything can walk right in and just wreck the bar.

But here's where it gets interesting. Research shows that even after one episode of low back pain kind of we're talking about, the multifidus at that level, very bottom level, starts to atrophy. It basically shrinks and it gets replaced with fatty tissue. And unlike most muscles, it doesn't automatically come back when the pain goes away. So, here's what happens to most people. They throw their back out. They rest for 2 weeks. Pain goes away. They go back to their life thinking everything is fine, but the multifidus never came back the way it was. It's not as strong. It's much weaker. It activates later than it should, if at all. And the next time they reach into the glove box, same spot, same pain, same story, more couch time. This isn't bad luck. This is a structural weakness that the person did not address.

And it's not just people who have already been injured. If you sit at a desk all day, which statistically most of you do, your multifidus is being systematically ignored. Sitting doesn't train it. Standard gym work mostly misses it. Squats, dead lifts, rows, great movements, but they train the large muscles around the spine. The multifidus is deep, very deep. You can't even feel it. It's small and specific. It's why when most people come to the emergency department with low back pain and they're saying it hurts right down here and I push, I can't make the pain re reproduce because it's so deep inside in those stabilizer muscles. So, it needs specific work, which I'm going to show you.

But first, if you're currently dealing with back pain right now, I have something for you. And if you're not, don't skip this part because it explains what not to do when this eventually happens to you anyways. If you're in pain right now, first thing, do not stop moving. I know every instinct is telling you to lie on the couch and not breathe too hard, but complete rest is one of the worst things that you can do for low back injury. The research is very clear on this. Prolonged bed rest leads to more stiffness, slower recovery, and a much higher chance of this becoming a chronic problem. So, keep moving. Short walks, knees to chest when you're lying down, cat cow yoga thing on all fours when you get some chance, you know, gentle movement daily.

For medication, ibuprofen or naproxen are your best options. Take them with food because they can upset the the stomach lining. Muscle relaxants can help with spasms in the short term and despite what you may have been offered, opioids are not significantly more effective than ibuprofen for this kind of pain. Multiple studies back that up and given recovery takes weeks, the dependency of you getting hooked on opioids is very, very real. So, I don't prescribe this for them. Most ER doctors don't prescribe anymore as well. Time, movement, anti-inflammatories, that's the honest answer.

Now, let's try to make sure that this doesn't happen to you again. All right, here's where most lower back videos are going to tell you to do things like dead lifts and planks and bridges and just call it a day. And those are good, but they're missing something. Remember the multifidus that we talked about earlier? The little muscle at the base of the spine that basically nobody trains.

Every exercise that I'm about to show you specifically targets that area along with the glutes and the deep core because all three have to work together to protect that lumbosacral junction. Think of this kind of like a three-legged stool, multifidus, glutes, and deep core. And kick one of the legs out, the whole thing falls.

So, exercise number one is the reverse hyperextension. And this is the one almost nobody does and it is arguably the most direct exercise for the multifidus at the L4, L5, and L5 S1 junctions. This is the one that I go to to strengthen my lower back. Right at that junction, I literally do this a few times a week, so I'm not just preaching and not practicing. This is actually what I do. Lie face down on a table or a bench or a countertop. I use my cold plunge outside and I lay over the top of it with my legs hanging off. Basically, uh right at the hips, you let your legs hang off. Hold the sides of it for stability. And from there, keeping your legs together, lift them up until they're parallel to the floor and slowly lower them back down. And then do that. That's one rep and you're going to continue to do that. What you'll feel is a very specific contraction right at the very base of your spine. Not in your upper back, not in your mid back, not in your hamstrings, right there at that junction. And that is where that multifidus is firing, probably for the first time in a very long time for most of you who sit at a desk. So, start with about three sets of 10. Go slow on the way down. This is how you strengthen it over time, okay?

The next thing is the glute bridge, which I already mentioned. The glute bridge are primary movers of your hips. They're also critical stabilizers for the entire pelvis. And when the pelvis is stable, the lumbar spine has less work to try to do and to support. So, weak glutes or butt cheeks means that your lower back picks up the slack every time that you extend your hip, which is every time you walk and stand up and climb stairs and pick something up off the floor. So, it adds up pretty fast. Basically, just lie on your back, feet flat on the floor, knees bent, drive through your heels, and lift your hips up until your body forms a straight line from your knees to your shoulders. Squeeze the glutes hard at the top, hold for about 2 seconds, and then lower slowly. When that gets too easy, start doing it with one leg at a time, single leg glute bridges. One foot flat, one foot extended. If your hip drops to one side when you pick up, that's your weak glute, and that's the one that has been letting your lower back do most of the job. About three sets of 12, single leg when you're ready.

All right, exercise three, the dead bug. This focuses mostly on the deep core, specifically the transversus abdominis. It is the front half of the same stabilization system. The multifidus is the back half of it. They basically work together to stabilize it, almost like you have a back brace on. Um you can have one without the other. Lie on your back, arms straight up toward the ceiling, knees at 90° toward the ceiling. Press your lower back flat into the floor. Now slowly lower one arm overhead and the opposite leg toward the floor simultaneously. Lower back stays flat the entire time. If it lifts lifts off the floor, that means you've gone too far. The lower back staying flat is the whole point. That is the deep core doing its job and tightening everything and stabilizing it. You're going to go back and forth, each leg, each arm. Uh three sets, eight per side. Be very slow, very deliberately. This is embarrassingly unsexy and incredibly effective.

And exercise number four, the bird dog. Same stabilization demand as the dead bug, but opposite position. You're going to be on all fours, hands and knees. Hands under your shoulders, knees under your hips. Extend one arm forward and the opposite leg back simultaneously. Hold that for 2 seconds, return without letting your hips rotate or your lower back sag. The moment your hips start rotating, the multifidus has disengaged. Keep them square, keep that spine neutral, and that's the whole exercise. Research using ultrasound imaging shows that the bird dog produces significant activation of both the multifidus and the deep core simultaneously. It's one of the most efficient movements that you can do for spinal stability. Three exercises, eight per side.

And exercise five, McGill's side plank, named after Dr. Stuart McGill, probably the most respected spine researcher in the world. On your side, elbow under your shoulder, feet stacked staggering for stability, and let your hip lift your hips up off the floor until your body forms a straight line, and hold it. This trains the lateral chain, the quadratus lumborum, the obliques, the gluteus medius, the muscles that stabilize the spine against a side-to-side or rotational forces, and the ones that get absolutely never tension in most programs. Most lower back injuries involve some degree of rotational or lateral load, and this is the exercise that basically prepares you for that. Three sets 20 to 30 seconds per side, build up to about 45 seconds for three sets.

So, if we put it all together, it's five exercises three to four times per week, 30 minutes max. And I don't even think it would take that long, to be honest. I usually do these as a warm-up before my actual workouts, and all together with my mobility workout, it usually takes me about 10 minutes to warm up total, including these exercises. So, we have the reverse hyperextension, three sets of 10, glute bridge or single leg glute bridge, three sets of 12, dead bug, three sets of eight per side, and bird dog, three sets of eight per side, and the McGill side plank, three sets of 30 seconds per side. Now, if you're doing these multiple times per week, you can probably get away with just like one or two sets each, and that's probably just fine.

Do this consistently for eight weeks, and you will feel a difference you can't really explain until you understand what you've just built. The muscle at the base of your spine has been absent from the conversation for most of your life, and will finally be doing its job. And so, the next time you reach into your glove box, you just get the damn thing out of the glove box that you needed, which is exactly what should have happened the first time.

I'll put the full plan in the description so that you can save it and start today. And if you want help putting together a complete program, training, nutrition, recovery, all of it built around a specific situation, check the links below for ways to work with me directly. Please don't forget to subscribe. It helps the channel a lot. Watch this video next. And until next time, keep moving.