The KISS principle of lower back pain is a helpful guiding principle for which exercises to start with when treating lower back problems. In theory, if you simply use your knowledge of Good vs. Bad Changes in Symptoms (found here) and follow the Traffic Light Analogy (described here) then you should be able to determine the effectiveness of ANY exercise. However, it’s helpful to have a starting point. This is what the KISS principle provides.
To find out about the KISS principle watch the video below, or if you prefer a written explanation keep reading.
KISS stands for: Keep It Saggital Stupid.
Saggital movement in the lower back moves either forwards (like reaching for your toes) or backwards (like a cobra pose in yoga). This is different from the coronal plane, which is side to side movement, or transverse movement, which is back rotation.
How is this applied?
Central or Symmetrical Symptoms
If your lower back problems are causing your central or symmetrical symptoms then you will always stay in the sagittal plane of movement. Central symptoms mean that you have pain or stiffness in the center of your lower back, right around your spine. Symmetrical symptoms means that your radiating pain is equal on both sides of your spine.
Examples of symmetrical symptoms are: sciatic pain down both legs to the bottom of both feet; pain equally across both sides of your lower back; radiating pain from the back to your knees on both sides.
Staying in the sagittal plane means that if you try an exercise which does not change your symptoms, stay in the same plane of motion and try the next exercise progression in that plane of motion. If you exhaust all of the exercises in the lower back extension direction without success, then you should proceed to the lower back flexion exercises.
If your symptoms stay central or symmetrical, Keep It Sagittal Stupid.
Pain and Symptoms Primarily on One Side of the Spine
If you lower back problem produces pain and symptoms which are NOT central or symmetrical, you should STILL start in the sagittal plane. But, if the sagittal plane is not successful, you do not have to stay in the sagittal plane.
Examples of symptoms primarily on one side of the spine include: Left lower back pain only; Pain in the center of the spine AND to the left; sciatic pain going down only one leg.
If this is you, start with the extension progression of exercises. This is because the majority (70% or so) will still get better with the extension progression of exercises even though the symptoms are primarily on one side. But keep in mind that If you’re going through the progression and your symptoms worsen, then try the diagonal extension progression. If still no luck then do lateral (side to side) lower back exercises.
The Only Time to Start with Side to Side Lower Back Exercises
The only and very rare time when it’s best to begin with side to side, or lateral, exercises is when you have a moderate to major lateral shift in your spine. In addition, the lateral shift must have began at the same time as your back problems to be considered related. What does a moderate to major lateral shift in the spine look like? See below.
Synopsis of KISS Principle
Keep it sagittal stupid. Everyone, with few exceptions, should begin in the forwards and backwards plane. More specifically, they should start with the lower back extension progression of exercises. If your symptoms are symmetrical or central then ONLY do exercises in the extension or flexion direction (no diagonal, lateral, or rotation). If your symptoms are primarily on one side of the spine more than the other then there is a small chance (around 30%) that you will need to complete diagonal or lateral exercises.
What questions do you have about the KISS Principle of lower back pain?
Dr. Charles Baldi
Ortho and spine specialist
Doctor of physical therapy
Baldi Movement Group LLC
www.baldimovementgroup.com
ContactUs@baldimovementgroup.com
(610) 484-4487