Low back pain and problems exist in a variety of forms, and diagnosis is critical to knowing what the best exercise is to create the best outcome. After diagnosis, there is still a skill in knowing what to prescribe and why to prescribe it.
After establishing that there is no “best” universal exercise to prescribe for a lower back problem in my last article, I’ve received a lot of questions about kettle bell swings and their use in low back rehab. This article will examine the swing in detail, and why I find it highly effective in rehabilitating the lower back – but only for the right athlete, and at the right time.
Force Application for Rehabilitation
Lifting weights comes at a cost on the lumbar spine that can be understood in terms of spinal compression, when the force is produced down the spine, and shear, when the force is applied across it. One of the most important factors in later stage low back rehabilitation is building lumbar spine musculature endurance. The aim is to create lumbar spine neutral control endurance while increasing these compression and shear force loads.
The ideal kettlebell swing here creates a hip-hinge deadlift style pattern, with an un-negotiable vertical tibia decreasing the joint movement at the ankle and knee. I don’t want a squat-style-swing where the knee and ankle movement will decrease spinal sheer and compression forces. The patient will be tolerant to those at this point, so it becomes about building strength endurance.
A Step-By-Step Implementation
Knowing if the patient would benefit from a kettlebell swing prescription takes a strong understanding of their goals and sport requirements. Swings can be programmed for most people, but is not the choice of exercise to use in an acute disc injury, for example, as pain fundamentally alters movement. The kettlebell swing should be used only when pain has been abolished and the rehabilitation path is aimed at restoring athletic performance. If you have read my previous articles, you will already know that I don’t consider an athlete restored to function unless they can flex their lumbar spine painlessly, and under a load that relates to tasks their sports require.
I've treated a few surfers over the years. In all cases, swing work was the moment their progress leaped forwards.
The first step is confirming the patient can tolerate spinal compression without pain, then applying manual shear force to the spine to ensure that the shear forces are also painless. At this stage of rehabilitation, I’m focussing on neutral spine control and optimisation. The patient must pass these tests to move on to the swing. This is not negotiable.
When rehabilitation commences, I begin with a deadlift-based technique. This is in line withclear research evidence that hip dominant flexion patterns are safer than lumbar dominant ones. I teach the hip hinge as a preferred movement pattern. If necessary, I will have done significant work to produce an excellent hip hinge by this point with a variety of hip hinge patterning and neutral spine hip hinged deadlifting.
I start with kettlebell deadlifting before barbell deadlifting, as this brings the mass closer to the patient’s centre of gravity. This would begin in sumo stance before proceeding to conventional form. To progress to the swing, it is critical that the patient demonstrates excellent deadlift technique beforehand.