A few months after I had abdominal surgery last year I started having low back pain. My activity level was coming back slowly, but surely, but so many things seemed to aggravate my lower back, which sometimes radiated into my hip flexors. I was incredibly frustrated because I knew I hadn’t done anything to injure my back… no pain running down my legs, none of many other symptoms people often ask about when asking about where and when someone’s lower back hurts.
I suspected it was some sort of indirect issue related to weeks/months of a rather sedentary lifestyle since after the surgery I’d developed a serious infection that wiped me out for months. But again, I’d gone back to weight training, and nothing I was doing there was aggravating it (or hurting it when I’d do an exercise). So I asked my primary doc for PT orders and plead not to see a specialist until I’d had a good PT evaluation/assessment, and if things didn’t improve within six weeks, or if they got worse, I would see a specialist. He obliged, thankfully. I’m not saying everyone should go that route, but for me, prior to the surgery, I’d not had any problems, so I thought it was a safe, conservative route to go.
Within ten minutes of my first PT appt., we determined my core was incredibly weak, and I’d likely been guarding it since recovery from surgery and the infection. So whenever I did any exercise, instead of engaging my core, I was overcompensating with my back and other muscles. The PT gave me some great core-strengthening exercises, as well as stretches, and within two weeks I was feeling an improvement. I continued to see her weekly for about five weeks, and I couldn’t believe the difference - the lower back pain was gone. But it took a LOT of concentration to relearn some of the activities/exercises I’d been doing all along, but improperly. Doing core exercises is a lot more than just some crunches and pelvic tilts. You have to have your core engaged while doing them and I’ve found that very few people can really observe you and and tell if you’re doing the exercise correctly or not - if you’re doing it incorrectly, it not only doesn’t help, but will make it worse. I remember at one session, she was telling me about three or four different things to do at once (head up, chin tucked in, shoulders down, pelvic tilt and push out the upper abdomen). I stopped after the fourth one and laughed at her, “OK, you get to pick three things you want me to do at once. This is all too much coordination for me to be learning at once.” So she laughed, and we backed off, and concentrated on a couple of things for me to be focused on regarding my posture, etc., and the next week we added on as the other things became more intuitive and automatic. But it was a lot more thinking work than I expected!
BTW… one of the first things my PT told me to do was stop yoga (I’d been doing a restorative yoga class twice a week) for many of the reasons listed above, but specifically for what BB said - yoga instructors do not have the time or eyes to watch every move that every class participant is doing and give feedback; this is even more true if you’re having issues. I always thought, if I wanted to go back to yoga, I would only do it with private classes until I was sure I was over the back issues. My PT did recommend Pilates, though - I know around here, you can’t take a Pilates class unless you’ve had several private lessons with an instructor. And once you are in the class, there’s a limit of four per class. I don’t know if other places operate with the same protocol, but it seems to be a safety measure built in that most yoga classes don’t offer. I had a private Pilates lesson last winter with the wife of someone H works with, and I was completely impressed with her attentiveness to how every muscle was functioning as I was doing a movement… very hands on, on her part, too, making sure I was engaging the right muscles. It really made a difference for me.