Photo Credit: Engin Akyrut, unsplash.com (edited)
Low back pain (LBP), especially one-sided, is often a result of asymmetry. In the world of dancing, the ability to perform & look the same on both sides of the body is essential. The reality is, though, that the body is not designed symmetrically (read more in my post on Asymmetry).
Forcing symmetry on an asymmetrical body requires compensation – think over-stretching, joint strain, and malalignment to name a few. This results in pain. In dancers, it is common for this compensation to occur in the SI joint, pelvis, and lumbar spine, often on one side, but can also affect both sides.
Our natural asymmetry makes it especially difficult to control the position of the pelvis. The left pelvis will tend to tip forward & flare outward, orienting the pelvis and lumbar spine to the right of center. This puts an asymmetrical pull on the muscles attached to the pelvis and spine. It also creates a compression of the left SI joint and gapping of the right SI joint.
Visual of common pelvis position due to natural human asymmetry
Increased Lordosis (arched back) in Single Leg Balance
Asymmetry helps explain why this study of collegiate dancers found that those with low back pain had excessive “measurement of lumbar lordosis during functional dance positions, particularly those requiring single leg stances”. Attempting to balance our asymmetrical bodies is an extreme challenge, often not overcome — though we manage to fake it.
Increased tip of pelvis & arch of back in single leg positions like the one above has been linked to increased tendency for Low Back Pain in dancers. (Photo Credit: Yogendra Singh, unsplash.com)
The more a pelvis tips forward (lordosis), the less we can access the hip & abdominal muscles needed to stabilize us on one leg. How do we manage to balance on one leg? By tipping the pelvis even MORE forward. A forward tipped pelvis “locks” up the hip & lumbar spine, creating “stability”, but at a cost. What a cycle!
Example of how we use excess lordosis to create “fake stability” (Photo Credit: www.scoliosissos.com – edited)
Lumbar Spine Rotation
In addition to lordosis, there was a subtle trend found in pre-professional & professional female dancers with LBP. The study found the dancers with LBP had decreased segmental rotation in the lower lumbar spine when walking versus those dancers without history of LBP. Rotation mobility was increased at the lower thoracic spine, as well. These differences in mobility were unique to rotation and no significant differences were noted in lumbar spine lateral movements or forward/back (flexion/extension) movements.
One thing that is very common is a misunderstanding of lumbar rotation exercises. Below are some examples of what people usually think of when told to work on their lumbar rotation:
Photo: greatofficechair.com Photo: centerforspineandortho.com
Photo Credit: hqpt.com
The issue with the exercises above is that they are not isolating the lumbar spine.
The key to lumbar rotation is shifting the pelvis and hip. The lumbar spine follows the sacrum when it comes to rotation. See the diagram of the asymmetrical pelvis above.
This version is MUCH BETTER! The difference seems subtle, but it is oh, so huge. For examples of rotating the lumbar spine in isolation via pelvis rotation/hip shifting, see recommended exercises at the end of this post.
Quadratus Lumborum Muscle
Another common cause of LBP, especially right-sided, is the Quadratus Lumborum (QL). This tends to cause pain at the “flank” area. The QL runs from the lower ribs to the back rim of the pelvis, and is highly involved in single leg stability. It is often tight & overactive on the right side due to our natural increased ability to exhale on the right side of our bodies (and struggle to inhale here). In addition, the right QL becomes short & overactive when the spine orients to the right.
Photo Credit: www.oomphosteopathy.com.au
Simply stretching the QL will not solve this problem. Correcting the spine orientation & promoting more inhalation on the right side of the body is the ultimate solution. See right QL Inhibition exercise below!
What Can You Do to Prevent LBP and SI Joint Pain as a Dancer?
Using what I know about natural asymmetry & the trends found in dancers with LBP, I recommend 3 key concepts to focus on:
- Improve your ability to rotate the pelvis to the left – appropriately!
2. Improve rotation at low lumbar spine
3. Minimize excess lordosis with single leg activities
If you tend to have lower back pain and SI joint pain, suspect that human asymmetry is playing a major factor. Choose at least one exercise per category and do it ONLY AS SHOWN… no reversing it for the other side, except for the reciprocal activity (2b.). Stick with them daily for 2-4 wks. If you don’t notice improvement, consider seeing your doctor or physical therapist in person.