Back Clinic Lower Back Pain Chiropractic Team. More than 80% of the population suffers from back pain at some point in their lives. Most cases can be linked to the most common causes: muscle strain, injury, or overuse. But it can also be attributed to a specific condition of the spine: Herniated Disc, Degenerative Disc Disease, Spondylolisthesis, Spinal Stenosis, and Osteoarthritis. Less common conditions are sacroiliac joint dysfunction, spinal tumors, fibromyalgia, and piriformis syndrome.
Pain is caused by damage or injury to the muscles and ligaments of the back. Dr. Alex Jimenez compiled articles outline the importance of understanding the causes and effects of this uncomfortable symptom. Chiropractic focuses on restoring a person’s strength and flexibility to help improve symptoms of lower back pain.
Squat exercises are highly effective, as they strengthen the back and core muscles, helping the prevention of injury. They can be done anywhere with or without equipment like weights and resistance bands and can be part of an aerobic workout. Squatting requires following proper form and posture. Using the improper form, adding too much weight too soon, overdoing it without enough recovery time can cause soreness, back pain, and injury. Having muscle soreness after performing squats is expected; however, if symptoms like chronic soreness, tingling, numbness, or sharp aches that come and go, begin to appear, it is recommended to consult a medical trainer, chiropractor, doctor, or spine specialist to evaluate the symptoms, and if necessary develop a treatment plan, as well as a prevention plan to continue exercising safely.
Squat Exercises
Squatting is a highly beneficial form of exercise. Athletes, trainers, coaches, and individuals just staying healthy use the technique as a part of their training and workouts. This is because squatting increases core muscle strength, increasing body power. Squat exercises benefits include:
Increased Flexibility
Improved strength and a range of motion allow the body to move flawlessly in various directions with minimal effort.
Increased Core Strength
All major muscles work together during a squat.
This increases muscle stabilization, maintains body balance, increasing core strength.
Injury Prevention
Squats work all leg muscles simultaneously, synchronizing the body.
This increases body stability decreasing the risk of injury.
Back Pain and Potential Injury
The spine is exposed and unprotected during a squat. This is where back pain and injury can happen. Potential causes include:
Priming each muscle is recommended. This could be:
Starting with glute work.
Then planks to activate the core.
Finish off with stretching and range of motion exercises.
A personal trainer can assist in creating a customized workout routine.
Starting Position
The feet should always face forward to protect the hips and knees when beginning a squat.
If the feet face at an angle, the form can be impacted, leading to back pain or collapsing arches.
Spinal Alignment
Maintaining a straight-ahead or upward gaze, which increases center awareness during squat exercises, can prevent the body from leaning forward and placing stress on the spine.
Only squat as far as possible, making sure to feel in control and maintain the form.
Squatting too deep can cause muscle strain leading to pain.
Focus on form, as it is more important than depth.
Joint mobility
Ankle mobility and stability are essential to balance and control.
If the ankle is compromised, the feet could lift off the floor, forcing the body to compensate, leading to strain and potential injuries.
Barbell back squats are more advanced and, if done incorrectly, can cause injury.
A chiropractor or physical therapist will be able to evaluate spinal health, exercise form, and advise if there is an issue.
Body Composition
Achieve Health and Fitness Goals By Doing What You Enjoy
Don’t engage in workouts or fitness programs that make you miserable. Do workouts/activities that you enjoy and have fun doing. Exercise for the love of the body, keeping it healthy and in shape, not because there is a feeling of obligation.
Individuals who don’t like lifting weights try using resistance bands or bodyweight exercises.
The same goes for nutrition. Don’t base diet and supplement choices on misperceptions about health.
References
Calatayud, Joaquín et al. “Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain.” International journal of environmental research and public health vol. 16,19 3509. 20 Sep. 2019, doi:10.3390/ijerph16193509
Clark, Dave R et al. “Muscle activation in the loaded free barbell squat: a brief review.” Journal of strength and conditioning research vol. 26,4 (2012): 1169-78. doi:10.1519/JSC.0b013e31822d533d
Cortell-Tormo, Juan M et al. “Effects of functional resistance training on fitness and quality of life in females with chronic nonspecific low-back pain.” Journal of back and musculoskeletal rehabilitation vol. 31,1 (2018): 95-105. doi:10.3233/BMR-169684
Donnelly, David V et al. “The effect of the direction of gaze on the kinematics of the squat exercise.” Journal of strength and conditioning research vol. 20,1 (2006): 145-50. doi:10.1519/R-16434.1
Zawadka, Magdalena et al. “Altered squat movement pattern in patients with chronic low back pain.” Annals of agricultural and environmental medicine: AAEM vol. 28,1 (2021): 158-162. doi:10.26444/aaem/117708
Today, more than ever, individuals are less physically active and sitting down for more extended periods causing the gluteus muscles to be used less and weaken. Weak, inactive, or tightening glutes can cause instability in the lower spine, the hips, and the pelvis to shift out of alignment. This leads to low back and buttock pain. The pain is constantly dull, aching, pulsating, then when moving, getting up, it throbs and stings. Gluteal strengthening exercises can strengthen the muscles and alleviate the pain.
Gluteal Strengthening
Every individual has a unique physiology. The body develops asymmetrically as the individual favors one side or area of the body over another. This can cause imbalances in the muscular system, leading to awkward positioning that causes pain. The muscle groups that support the lower back consist of the:
Core muscles
The gluteal muscle group includes:
Gluteus Maximus
Gluteus medius
Gluteus minimus
Pelvis muscles
Hamstrings
Quadriceps
In some cases, the development or lack of level of an individual’s upper back strength can also affect the amount of strain on the lower back.
Gluteal Strengthening Difference
Many joints connect in this area that can have functional problems. The muscles within the lower back need:
Stretching allows the body to enhance the limits of its flexibility and mobility. Most of the stretches are involve the hip joint, as this is one of the most effective ways to loosen the gluteal regions. It’s essential to warm the muscles slightly with a light activity while stretching them to elongate naturally.
Seated Figure 4 Stretch
Sitting in a chair.
Cross the right leg over the left.
With the right ankle resting on the left knee.
It should resemble the number 4.
Bend forward at the hip, placing slight pressure onto the left leg.
Hold this stretch for ten-twenty seconds.
Stretch the other side.
Placing the left foot on the right knee.
Repeat this three times.
Downward Dog
This yoga pose engages all the muscles along the back. With the glutes at the top in this position, it forces them to activate, allowing them to stretch fully.
Hold this pose and focus the attention on the glutes.
Squats naturally engage the glutes. This is a variation on a squat that focuses on developing gluteal strength.
Stand with the back facing the wall.
Place a Swiss stability ball between the wall and the back.
Lean back into the ball for balance.
Lower the torso until the knees reach 90 degrees.
Return to standing.
Repeat for ten reps.
Do three sets.
Body Composition
Analysis An Effective Tool
Opportunities to increase physical activity lead individuals in a positive direction. The most common reason for reducing and stopping healthy changes is a lack of motivation and feedback. Strategies that provide immediate feedback are essential to:
Monitor progress for establishing a baseline.
Set appropriate and attainable goals.
Track changes over time.
Ensure success.
Monitoring changes with a simple weight scale or Body Mass Index calculator provides limited ability to accurately track changes that only highlight weight changes and not track progress in muscle gain or fat loss. In less than 45 seconds, the InBody Test provides doctors, trainers, and physical therapists with easy-to-understand, accurate and objective measurements to evaluate body composition that includes:
Assessing muscle distribution.
Target areas weakened by condition or injury.
Identify muscle and fat imbalances in each area of the body.
Monitor changes to determine the efficacy of the treatment plan, exercise program, and diet plan to ensure long-term success.
References
Akuthota, Venu et al. “Core stability exercise principles.” Current sports medicine reports vol. 7,1 (2008): 39-44. doi:10.1097/01.CSMR.0000308663.13278.69
Distefano, Lindsay J et al. “Gluteal muscle activation during common therapeutic exercises.” The Journal of orthopedic and sports physical therapy vol. 39,7 (2009): 532-40. doi:10.2519/jospt.2009.2796
Glaviano, Neal R et al. “Gluteal muscle inhibition: Consequences of patellofemoral pain?.” Medical hypotheses vol. 126 (2019): 9-14. doi:10.1016/j.mehy.2019.02.046
Jeong, Ui-Cheol et al. “The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.” Journal of physical therapy science vol. 27,12 (2015): 3813-6. doi:10.1589/jpts.27.3813
Macadam, Paul et al. “AN EXAMINATION OF THE GLUTEAL MUSCLE ACTIVITY ASSOCIATED WITH DYNAMIC HIP ABDUCTION AND HIP EXTERNAL ROTATION EXERCISE: A SYSTEMATIC REVIEW.” International Journal of sports physical therapy vol. 10,5 (2015): 573-91.
Individuals believe that maintaining a straight/flat back is healthy. However, the back is made up of natural curves that allow flexibility and optimal movement. If there is a lack of these curves, it can lead to spine issues, discomfort, and pain. A common problem to develop from a spine lacking natural curvature is abnormal kyphosis. This is when the natural curve in the thoracic spine – mid-back or lumbar spine – low back disappears, which results in a flat back. Restoring the curvature can be challenging, as flatback syndrome requires chiropractic adjustments to gently shift and realign the spine back into a healthy curve and re-train the spine to maintain the curve.
Causes of Flat Back Syndrome
Flatback syndrome is usually a result of muscle tightness in the lower back muscles, specifically in the psoas muscle. Or it could be degenerative disc disease, where the cartilage supporting the spine begins to weaken. Other causes include arthritis and osteoporosis. Practicing unhealthy posture habits can worsen these conditions, speeding up the loss of the spine’s curvature. Loss of spinal curvature does not occur rapidly, as the body will begin to present with symptoms. The following symptoms could be an indication:
Fatigue when trying to stand upright
Balance problems
Restricted mobility
Muscle spasms
Chronic low back pain
Thigh pain
Groin pain
Disc herniation
Back pain and problems with balance are the earliest warning signs of flatback syndrome.
Symptoms
Flatback symptoms usually get worse as the day progresses, with a sense of fatigue and increasing difficulty to stand upright. Individuals tend to flex or bend their hips and knees to get into an upright position. This can become an exhausting process as the day progresses. Individuals can also have symptoms of sciatica and/or spinal stenosis with leg pain and weakness that gets worse when walking. Neck and upper back pain can begin to present while straining to align themselves. The symptoms become disabling, often requiring pain medications that limit the individual’s ability to perform daily activities.
Realignment Treatment
A chiropractor must determine the severity of the deviation through a thorough assessment and examination. This shows the loss of curvature to help a chiropractor plan a realignment/remodeling adjustment schedule. Restoring a natural kyphosis is done through a combination of adjustments and bracing. Scheduled spinal adjustments will realign and shift the vertebrae back to neutral, while a back brace supports to prevent any deviation. Stretching and exercising relevant muscle groups is also part of a chiropractic treatment plan. An example is core exercises for strengthening the muscles supporting the spine.
Body Composition
Personalized Nutrition
Because the body is so complex and dynamic, there is no perfect fit when it comes to diet, exercise, or a combination. Fad diets typically recommend that individuals adhere to the same eating guidelines, indicating they will reach an expected result like fat loss. These diets work because they focus on a simple reduction in calorie intake, especially processed and fast foods. The problem is that some of these fad diets can restrict critical nutrients that negatively affect an individual’s health. More information about an individual’s body and how it works is an excellent resource in improving body composition and overall health. Personalized nutrition is an innovative and favorable approach to preventing and treating obesity and related conditions. This approach identifies:
Genetic markers
Dietary patterns
Environment
Metabolism
Educated recommendations can be made based on these factors.
References
Drabsch, Theresa, and Christina Holzapfel. “A Scientific Perspective of Personalised Gene-Based Dietary Recommendations for Weight Management.” Nutrients vol. 11,3 617. 14 Mar. 2019, doi:10.3390/nu11030617
Farcy, J P, and F J Schwab. “Management of flatback and related kyphotic decompensation syndromes.” Spine vol. 22,20 (1997): 2452-7. doi:10.1097/00007632-199710150-00025
Lee, Chang-Hyun, et al. “‘Lumbar Degenerative Kyphosis’ Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception.” Journal of Korean Neurosurgical Society vol. 60,2 (2017): 125-129. doi:10.3340/jkns.2016.0607.001
Lu, Daniel C, and Dean Chou. “Flatback syndrome.” Neurosurgery clinics of North America vol. 18,2 (2007): 289-94. doi:10.1016/j.nec.2007.01.007
Wiggins, Gregory C et al. “Management of iatrogenic flat-back syndrome.” Neurosurgical focus vol. 15,3 E8. 15 Sep. 2003, doi:10.3171/foc.2003.15.3.8
The pelvic floor is essentially the spine, and when pain presents, it can be mistaken for back pain. However, these two conditions are frequently linked. The National Institutes of Health- NIH reported that a quarter of women are impacted by pelvic floor disorders and up to 16% of men. The pelvic floor is made up of muscles. If the muscles begin to spasm, they can spread pain upwards and even downwards. This is where the misdiagnosis of lower back pain comes in.
The Pelvic Floor
The pelvic floor is comprised of muscles and connective tissue, known as fascia. The muscles and fascia intertwine, creating a support system for the pelvic organs. The pelvic floor muscles act as a spring system that supports the organs. When downward pressure is applied, and the spring system is working correctly, they push back up to support the muscles. These muscles create the base known as the core. The core muscles support the abdomen, diaphragm, and back muscles, supporting the spine. This is why back, pelvic pain is prevalent as these muscles are interconnected.
Pelvic Floor Dysfunction and Back Pain
If there is pelvic floor dysfunction, there is an inability to control the muscles. There can be too much or insufficient tension, resulting in urinary incontinence or inability to complete bowel movements. It can also be mistaken for back pain or contributes to pelvic and low back pain. The core muscles support the torso and promote stabilization during movement. If they are not working correctly, the torso and pelvis become unstable. The SI – sacroiliac joints linked with the pelvis and the lower spine can begin to present with posterior pelvic and back pain.
Symptoms
Dysfunction can present in several ways, including:
Vaginal dryness by a lack of estrogen during menopause.
Tight inner thigh muscles.
Back pain itself can cause dysfunction.
Women make up the majority of cases that result from:
Pregnancy
Childbirth
Endometriosis – a condition in which uterine tissue grows outside the uterus.
Men can also develop problems. As a man’s body ages, prostate problems can cause urinary leakage and frequency problems. It can develop from activities like bicycling. The seat can compress the pudendal nerve, causing pain and dysfunction.
Retraining the Muscles
The dysfunction can be helped by reactivating and strengthening the pelvic and core muscles. Training the pelvic floor and the core muscles will help boost support for the spine and alleviate discomfort and pain. First, it is recommended to get a physical evaluation by a chiropractor or physical therapist to determine if the pelvic floor muscles are too tight or weak. The objective is to improve the strength of the pelvic floor muscles or relax them if they are too tight. A chiropractor and physical therapist can work on the muscles, educate on stretches, exercises, nutrition, and offer additional help and support.
Body Composition
Muscle Adaptation
The point of resistance training is to get the muscles to function more effectively. It begins with the contractile proteins that control muscle shortening and lengthening. Resistance exercise can cause some of the proteins to get pulled apart. The stress the muscles experience is the stimulus for the muscles to rebuild bigger, stronger, or more powerful. After resistance exercise, the muscle synthesizes proteins helped by nutritional stimuli and protein consumption. Satellite cellsalso activate to help build up the broken-down muscle. Resistance exercise causes activation.
Smith, Christopher P. “Male chronic pelvic pain: An update.” Indian journal of urology: IJU: journal of the Urological Society of India vol. 32,1 (2016): 34-9. doi:10.4103/0970-1591.173105
The body is a connected whole and more than just separate parts and regions. When back pain presents, it might not be the back muscles or spine but could be tense, tight hips, and hamstrings causing low back pain. How it happens, how to stretch and loosen up, and target these areas could help alleviate the pain.
The Hips and Hamstrings
When the hip flexors and hamstrings become tense, the tightness can alter the pelvic alignment. This affects spinal alignment leading to discomfort and low back pain. The hip flexors are a group of muscles around the front of the hips, and they activate when moving the leg and knee upward. The hamstrings are the muscles in the back of the thighs that allow for flexion of the knees and hip extension. Muscle tightness in the hips and/or hip joint stiffness can also contribute to low back pain. Not being able to rotate, flex, or extend the hip forward or backward can affect:
Walking
Running
Swinging
Twisting movements
This increases mechanical strain on the lower back.
Losing the ability to function through the entire length of motion can also indicate muscle weakness and a lack of joint movement where the joint around the muscle becomes stiff. This can be caused by:
A lack of movement
Arthritis
Age-related changes
Stretching and Treatment
Stretching exercises can be the first line of treatment. It is recommended to start with gentle stretches targeting these areas. What works best for the individual is the stretch they are comfortable repeating enough to make a difference. Warming up the muscles first will generate the best results. An easy place to begin is a gentle forward fold stretch.
Stand up straight, or sit with the legs extended out in front.
Then, reach with the fingers toward the toes. Don’t worry if you can’t reach them.
If the stretching does not bring relief, it is recommended to progress to a personalized treatment and stretching program with a chiropractor or physical therapist. Chiropractic and physical therapy can relieve the problems without medication, injections, or surgery and provide lifelong techniques for maintaining optimal flexibility, mobility, and strength. The hands-on treatment loosens and relieves the tense tightness, reinforcing the flexibility and range of motion. Treatment includes:
Joint mobilization to the hips and spine.
Soft tissue mobilization.
A personalized strengthening program with stretches and exercises that target the specific muscles.
Health coaching.
Anti-inflammatory diet recommendations.
Body Composition
Monounsaturated Fats
Monounsaturated fat is considered healthy fat. This type of fat makes up a significant component of the Mediterranean diet. Studies have shown monounsaturated fats like extra-virgin olive oil can help prevent adverse events related to cardiovascular disease. A meta-analysis evaluating diets high in monounsaturated fats indicated a significant reduction in:
Triglycerides
Bodyweight
Systolic blood pressure in individuals with type II diabetes.
A significant increase in HDL or good cholesterol.
Another study showed the protective effects of monounsaturated fatty acids reduced the risk factors associated with metabolic syndrome and cardiovascular disease. Monounsaturated fats can have a positive impact on overall health. Monounsaturated fat sources include:
Olive, peanut, and canola oil
Avocados
Almonds
Pecans
Hazelnuts
Sesame and pumpkin seeds
References
Estruch, Ramón et al. “Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90.” The New England journal of medicine vol. 378,25 (2018): 2441-2442. doi:10.1056/NEJMc1806491
Gillingham, Leah G et al. “Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors.” Lipids vol. 46,3 (2011): 209-28. doi:10.1007/s11745-010-3524-y
The low back is made up of five vertebrae, L1 to L5. Pain in the low back is common, specifically because of all the sitting at work, school, and home. Individuals dealing with low back pain know how difficult it can be to sit without discomfort and have found that a low back support pillow can help.
Low Back Support Pillow
A lumbar pillow is a pillow that supports the low back region of the spine. Different types include:
Specially shaped pillows made from materials like memory foam.
Lumbar pillows can be used on any chair at the office or home.
They are also helpful for travel with small-sized versions that can be packed and easy to carry.
How Lumbar Pillows Help
According to the CDC, the average adult spends around 6.5 and 8 hours a day sitting. Constant sitting hurts the body, specifically the spine and the back muscles, and is a significant cause of muscle stress. Properly supporting the low back helps remove the stress and strain. A low back support pillow can help correct sitting posture.
Pillow Options
There are plenty of options for low-back support pillow shapes, sizes, fillings, and materials. These include:
Some look like a half-cylinder in shape, rectangular, and curved.
Personal preference and comfort are different for everybody, and it could take some trial and error to find the right lumbar pillow. Some pillows are customizable, allowing the ability to add or remove filling as needed. Talking with a spine specialist, orthopedist or chiropractor can help in figuring out what type is best. Pillows come in various price ranges, with some at $10-15, while others can cost $100 or more. However, any pillow that provides enough support for the low spine’s natural curvature can work. It is important to be comfortable and supported to prevent pain and injury no matter where you sit.
Body Composition
Fermentable and Nonfermentable Fiber
The entire body can host trillions of beneficial bacteria. The majority live in the intestines and are referred to as the gut microbiome. Also known as the forgotten organ, these bacteria have a say in the body’s composition and overall health. The beneficial bacteria thrive on fermentable fiber, and fermentation in the gut produces short-chain fatty acids like:
“Association Between Sitting Time and Cardiometabolic Risk Factors After Adjustment for Cardiorespiratory Fitness, Cooper Center Longitudinal Study, 2010–2013.” Centers for Disease Control, Atlanta, GA. December 2016. www.cdc.gov/pcd/issues/2016/16_0263.htm
“Workplace sitting is associated with self-reported general health and back/neck pain: a cross-sectional analysis in 44,978 employees.” BMC Public Health, London, UK. May 2021. pubmed.ncbi.nlm.nih.gov/33957889/
Kettlebell training for the back muscles and back pain prevention can be part of a recommended treatment plan. When experiencing low back pain, many sports medicine experts recommend kettlebell exercise to strengthen the core and posterior chain. However, if not used correctly, kettlebell exercises can worsen back pain.
Kettlebell
They are made of cast iron or steel and are named for resembling a tea kettle with an oversized handle. They can be used in one and two-handed movements.
Exercises and Movements for Back Pain
For individuals that are not experiencing back pain, kettlebell training can be excellent for maintenance and injury prevention. They strengthen the core and back muscles.
The kettlebell swing is an essential exercise and is one of the most important exercises when dealing with back pain issues.
A kettlebell is placed on the floor about 12 inches in front while standing with the feet a little wider than hip-distance.
The hips become the hinge.
Extend the arms down to the bell and grip it.
Begin swinging it up and down through the legs and then upward and outward to chest level.
The shoulders are to stay relaxed.
The hips are used to thrust and create momentum to swing the kettlebell.
Keep the spine neutral throughout the exercise to prevent injury.
The arms are to hold the bell only.
Don’t swing with the arms or shoulders, but push through with the hips.
The exercise can be swung up over the head but is not recommended for those with back pain.
Benefits
They are portable and don’t require a lot of space.
With kettlebells, an individual can train more easily than with barbells.
Kettlebell workouts provide strength training and cardiovascular fitness.
Once the proper technique is learned, individuals can set up a regular regimen at home.
Proper Form and Mistakes
Proper form is crucial. The primary movement most individuals have difficulty with is getting the proper hinging motion at the hip. Most individuals flex at the lower back and place increased pressure on the discs. Proper hip hinge motion means:
Keeping the low back straight
Flexing at the hip
Pushing back out with the buttocks when performing the swing motion.
When done correctly, an individual should be able to stop at any stage and hold that position.
Posture Form Tips
Form issues with kettlebells include:
Hip Hinge
When picking up the kettlebell, remember to hip hinge instead of squatting to maintain the back in a neutral position.
Drive the hips back in the same way when sitting down on a low chair.
Arching the back
If the pelvis is tilted too far forward, the back arches a lot.
This can narrow where the nerves leave the spine in the low back.
Keep the abdominals tight to prevent the pelvis from tilting forward.
Using the incorrect weight can also cause problems; this could be going too heavy or too light.
Too heavy increases the risk of straining the body and back.
A kettlebell that is too light does not provide the correct resistance to strengthen the muscles.
Another common mistake is overtraining. Specifically, individuals over 50 whose bodies don’t recover as quickly.
Individuals over 50 are recommended to spread out the workout days with more than one rest day.
Common Injuries
Proper training before working with kettlebells is highly recommended, especially for those already dealing with back pain. Individuals are encouraged to work with a physical therapist, sports chiropractor, or personal trainer who can teach proper techniques and specific exercises, observe the individual’s process, and make corrections. Improper technique can lead to:
Muscle strains.
Muscle spasms.
Compressed or pinched nerves.
Added stress to pre-existing low back conditions.
Impact injuries to the wrist and forearm.
Body Composition
Exercise Ball Pikes
Exercise ball pikes are an advanced total body workout. Muscle groups worked out include:
Deep abdominals
Hip abductors
Quadriceps
Deltoids
Scapula stabilizers
Pectoralis major/minor
To do the exercise:
Start in a pushup position with the arms on the floor in front.
Lift the legs, so the tops of the feet rest on the exercise/stability ball.
Knees should be bent to start the movement.
Extend the legs out as straight as possible.
Hold the position for a few seconds.
Return to the starting position.
References
Common Injuries Associated with Kettlebells: ACSM’s Health & Fitness Journal (March/April 2017) “Managing Risks of Training with Kettlebells to Achieve Optimum Benefits.” journals.lww.com/acsm healthfitness/Fulltext/2017/03000/MANAGING_RISKS_OF_TRAINING_WITH_KETTLEBELLS_TO.6.aspx
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