Why this is the best exercise for low back pain

A while back I wrote a post mentioning exercises from Eric Goodman’s Foundation Training program for low back pain.

Besides the hip lunge exercise I described then, I started incorporating into my routine his most fundamental exercise that he calls the “Founder” exercise. I had had low back pain for years from too much sitting in my pre-OESH days, which seemed to be getting worse with all the lifting I was doing in the factory. In the past, I had tried a lot of different exercises for low back pain without much success and I thought I’d give the Founder exercise a try. From what I knew as a physiatrist, and from all the biomechanics research I’d done, the exercise made a lot of sense to me. For one thing, it looked to be a superior way to strengthen the gluteus maximus, a muscle that I don’t think has been emphasized enough in low back exercise programs, but which is vitally important to low back health.

The gluteus maximus runs from the top of your pelvis into your thigh. Its primary role is to stabilize the trunk against the thigh when we bend, lift, twist, dig, run, dance, climb, vacuum, play tennis, or just put on our underwear. By stabilizing the trunk against the thigh, it protects against excessive movement and stresses and strains through the joints in our low back. That’s a big job but the gluteus maximus is a big muscle. It’s not only the biggest muscle on your backside, it’s the biggest muscle in your body.

Basically, the gluteus maximus is designed such that it “has our back.” But unfortunately, in modern society, we sit on it a lot. So, it’s asleep and it doesn’t REALLY have our backs.

Sitting causes tightness in the hip flexors which triggers a muscle response called reciprocal inhibition that turns off the gluteus maximus and all the other muscles on your backside. When the gluteus is weak, compensations to stabilize the trunk must occur in the spine, which places a lot of stress through your spinal ligaments, discs, and facet joints—all the places that when excessively stressed, cause pain and injury.

Even though I’ve been physically active all my life, running every day, I also spent a lot of time sitting – in my former jobs in academic medicine and before that, as a student. The first time I had low back pain was when I was eight months pregnant, after some “nesting,“ prying off old siding from the house while perched on a ladder. The pain was intense for a couple days but within a week, it went away and didn’t come back until a couple years later when I moved a couch up three flights of stairs. Gradually, the triggers became less dramatic and the amount of time to recovery increased. Eventually, I’d have pain and not even know what triggered it.

I credit my friend and colleague in physical medicine and rehabilitation, Scott Nadler, whose life was cut short by cancer, for first identifying the role of the gluteus maximus in protecting the low back. Scott was a proponent of the importance of hip extensor strengthening and showed with preliminary studies in the early 2000’s an association in women athletes between impaired gluteus maximus strength and the development of low back pain. When a “core” strengthening program didn’t affect the development of low back pain in athletes in a prospective study, he thought it was because there wasn’t enough focus in the program on the hip extensors. To recognize and help continue his pioneering work, our field has developed a small research grant in his name. Meanwhile, I think Goodman’s Founder exercise answers Scott’s work for a program that emphasizes the gluteus maximus.

I know it’s hard when you’re busy to fit yet another exercise into your routine. But this one is worth it. I’ve been doing just a one-minute version of the Founder exercise once a day and then incorporating that movement into my daily routine and work in the factory. If I had time, I would do Goodman’s entire Foundation Training program which I highly recommend. But doing even just that one-minute Founder exercise, along with my two-minute yoga routine, I haven’t had low back pain, despite a lot of heavy lifting in the factory for over two years.

This is what I do. For 30 seconds, I hold the position that Kellyn (who is leaving for Yale tomorrow – bittersweet!) is demonstrating below, with weight centered on the heels of the foot (which is easier to do barefoot or in shoes that are completely flat like OESH), and butt sticking out back. It’s important to keep your knees only slightly bent so as to not to activate the quadriceps, which takes away from activating the hamstrings, which you’ll feel being stretched, especially if they are tight.

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Then I lift my arms up and hold that for another 30 seconds.

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I recommend you do the full Foundation Training program and/or work with your physician, therapist, trainer or coach to incorporate this exercise into your current regimen. And certainly you shouldn’t do it if it causes any back pain. If that’s the case for you, don’t give up…there are exercises you can do to build up to being able to do the Founder exercise properly without pain.

Why I think the Founder exercise works so well is that it activates the gluteus maximus in a natural way such that gains in strength can be carried over directly to the moments when you actually need trunk stabilization – like opening the bottom freezer drawer. In the second picture above you can see how the body weight force is in front of the hip. That creates a lever arm at the hip which has to be counteracted by the gluteus maximus. The longer the hip lever arm, the more the gluteus maximus needs to contract. Many exercises that attempt to “spot-train” or “tone” the gluteus maximus activate it in a rather non-functional way that doesn’t apply to every day movements. That’s because of a principle known as “specificity of training” that says strength gains apply specifically to the movement in which you trained.

The Founder exercise is similar to exercise maneuvers used by weight lifters called the “Good Morning” and the “Hip Hinge” in preparation for doing the “deadlift” and squats, but without weights. It’s also similar to the Utkatasana “Chair pose.” There are nuances in Goodman’s Founder exercise though, that I think make it the best way to strengthen not just the gluteus maximus, but a host of other muscles important for low back health.

Besides the gluteus maximus, the Founder activates muscles all along your backside known as the posterior chain muscles. These include, besides the gluteus maximus, your hamstrings (the muscles on the back of your thigh), the multifidus and the erector spinae (the small muscles running up and down the back of your spine) and your gastrocnemius-soleus (calf muscles). In a weight bearing position, the hamstrings function similarly to the gluteus maximus to stabilize your trunk. The erector spinae muscles help stabilize your spine between the individual spine segments. And the gastrocnemius-soleus provide the foundation. The exercise is engaging all these posterior chain muscles in a very functional manner so that gains in strength can be applied to when you actually need that strength to stabilize your back.

Another important part of the Founder exercise, I believe, is to make a conscious effort to incorporate it into your daily routine. I make an effort to incorporate the movement into my daily routine at home and at work. When I go to pick something up or to tie my shoelaces, I bend forward only at my hips, keeping my back straight. That kind of “hip hinging,” seems a little awkward at first, with your butt sticking out behind you, but gradually it will become more natural.

Changing one’s movement pattern can be difficult. For years, when I bent over, I bent forward through my low back, rounding it out like everyone I know. This is a learned movement that goes back to when we were little, watching and imitating the movement of our parents and peers. I’m not sure when as a society, we started rounding out our back as we bend forward but that movement stresses and strains the joints, ligaments, and discs in our back. Couple that with the fact that we spend too much time sitting, no wonder most of us have low back pain at some point in our lives. Fortunately, how we bend forward can be changed with some effort. I hope that as we increasingly appreciate and recognize the importance of the gluteus maximus and the rest of the posterior chain muscles to musculoskeletal health, that we can change what is considered the normal way to move.

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