The (Not So) Obvious Causes of Low Back Pain
Back pain is a bitch. There’s really no other way to describe it. It’s been said that 80% of Americans will experience it at one point or another, which, when you run the numbers, is like four out of five people. Yep, that’s what I like to call math.
Needless to say, back pain bites the big one and it’s easily the #1 cause for things like days missed from work, training days lost, not to mention the burden it places on health care costs.
The mechanisms for back pain are many, but can really be categorized into two camps:
1. One, massive, blunt force trauma: car accident, falling off a ladder, getting Terry Tated in your office for not refilling the coffee pot.
2. Repeated, low-grade, aberrant motor patterns which inevitably lead to something bad happening. Sitting at a desk all day comes to mind. In addition, we all know of someone who either bent over to tie his or her shoe or simply to pick up a pencil who ended up blowing out their back. The body is going to use the path of least resistance to get the job done, and unfortunately, because most people have the movement quality of a ham sandwich (poor hip mobility, poor t-spine mobility, etc), the lumbar spine, literally, gets eaten up.
While it’s a bit overkill, our spines can be thought of as a credit card. Bend it back and forth enough times, and eventually, it will break.
As a coach who works with elite athletes as well as people in the general population, I’ve seen my fair share of back issues, and I wholeheartedly feel that a structured strength training regimen geared towards improving movement quality, addressing any postural imbalances/dysfunctions, as well as “cementing” proper motor patterns is one of the best defenses in preventing low back pain in the first place.
Coaching someone how to achieve and maintain a neutral spine (something I wrote about HERE and HERE) would be high on the priority list.
Coaching someone how to properly perform a hip hinge or helping them clean up their squat pattern – utilizing the appropriate progressions (and regressions) – would also be kind of important.
And, of course, we can’t neglect staples like encouraging spinal endurance (planks), as well as placing a premium on proper lumbo-pelvic-hip control (core stability exercises like chops/lifts, Pallof Presses, and the like).
All of these things are great, and certainly will set people up for success, but there are many (MANY) less obvious components that often get over-looked.
Stealing an analogy from the great Dr. McGill – it’s the hammer and thumb paradox. Lightly tap your thumb with a hammer and not much will happen. No big deal, right? After a few thousand taps, however, you’ll be singing a different story.
Keeping this theme in mind, lets take the birddog exercise. Simple exercise, that many fitness professionals use with their clients to help improve dissociation of the lumber spine from the hips, and to teach co-contraction of the anterior core and erectors with little to no spinal loading.
Simple exercise, for sure, but not quite so simple in it’s execution. If you glance at the picture to the left, you’ll notice the concave shape of the back and see that she’s just hanging on her lumbar spine. Not exactly ideal execution.
If this were someone suffering from low back pain, would this alleviate their symptoms or make them worse? My guess would be the latter.
Taking it a step further, have you ever watched people foam roll? There’s no questioning it’s efficacy towards helping to improve tissue quality, and we have every one of our clients do it prior to their training session.
The thing to consider, though, is that when you’re dealing with someone with a history of low back pain – whether they’re currently symptomatic or not – you need to stay on top of them so that they’re not making the same mistake as above and hanging on their lumbar spine; essentially living in a constant state of extension.
Rather, what should happen is that they “brace” their core and maintain more of a neutral spinal position as they roll around (reference the fine looking gentleman to the right).
It’s borderline OCD, I know……..but I can’t stress enough how important it is to make the small things matter.
Take away the hammer.
Using an example that’s a bit more exciting, lets take the overhead press and break that down. Now, I have nothing against the overhead press – far from it. But when you actually watch a vast majority of people perform it, don’t be surprised if your eyes start bleeding. With a keen eye, what you’ll almost always witness is someone substituting excessive lumbar extension for shoulder flexion. But damn, it can look gooooooooooood at times.
When this happens, it’s usually beneficial to regress the exercise a bit and take some of the joints out of the equation, ALA the Gray Cook approach.
In the half kneeling position, I’m essentially taking my lower half out of the equation where I can now focus on pressing the weight over my head WITHOUT compensating with the lumber spine. The key here is to “dig” the rear toes into the ground and to squeeze the glute of the trailing leg, hard! As I press, I’m thinking “elbow to ear.”
Moving to a standing position, strength coach Dave Rak (he’s single, ladies) demonstrates a variation he showed me with one hip flexed:
Here, we’re still able to “lock” the lumbar spine in place and alleviate as much body english as possible. What’s more, there’s an awesome glute activation component in the trailing leg. Yes, I understand you won’t be able to use as much weight, but that’s not the point (yet). Once we can perfect the movement pattern, and take some of the burden off the lumbar spine, then we can load it and satiate our inner meathead.
Belly Breathing – The Right Way
One last point to consider, and this is something that I never even thought of until Bill Hartman pulled a Bill Hartman and made me realize how stupid I am, is the idea of belly breathing into the belt.
I’ve stated my opinion on weight belts in the past, and have always been told to PUSH OUT in order to increase intra-abdominal pressure (and thus, spinal stability).
As Bill demonstrates in this video, that’s not necessarily correct:
And there you have it: just a few more things to consider when discussing the topic of low back pain. Sometimes it’s not the quite so obvious things that are causing the issue(s).
Have your own ideas to share? I’d love to hear them below.
Comments for This Entry
Jessie StrangeInformative and FUNNY! I'd never seen the Terry Tate video before, it had me roflmao.
May 2, 2012 at 10:35 am |
DanielSweet post TG. Obviously there are numerous factors that can effect pain (those you mentioned, psychological, psychosocial, neural plasticity and a learned pain response in the brain etc), but what are thoughts on atrophy, weakness and just general dysfunction of the lumbar musculature as a predominant factor in the etiology of low back pain? There seems to be a plethora of evidence denoting that specific exercise for the lumbar extensors produces good results in the majority of low back pain cases.
May 2, 2012 at 10:36 am |
May 3, 2012 at 6:01 pm |
Ben BrunoNice post Tony. Since Dave is single, would you mind giving him my number and telling him to call me? What a hunk!
May 2, 2012 at 11:39 am |
TonyGentilcoreI'll have his people get in contact with your people......;o)
May 4, 2012 at 6:20 am |
Ron KafriAs always, great stuff
May 2, 2012 at 12:23 pm |
AlexWhile I'm sure the whole article is going to be excellent, let's be honest, the Terry Tate Office Linebacker reference is an automatic win.
May 2, 2012 at 12:34 pm |
deansomersetBeauty, right out of the box!! I've always found the hidden three have nothing to do with movement themselves. Drinking enough water, adequate recovery (sleep & recovery quality), and also wearing decent shoes that have ENOUGH cushioning to reduce the effects of ground reaction forces in daily walking all play a big role in low back pain, especially SI joint issues.
May 2, 2012 at 2:32 pm |
TonyGentilcoreSoooooo, considering I just emailed you about SI stuff, what you're trying to say is that I need to wear shoes with more cushioning......;o)
May 2, 2012 at 2:54 pm |
deansomersetProbably wouldn't be a bad idea.
May 2, 2012 at 3:59 pm |
Nick ChertockTony: I'm really glad to see your first example of the less obvious causes of low back pain. So often this pattern of behavior takes place. 1. Back pain becomes a problem 2. You decide to do something about it 3. You get advice on doing some kind of helpful looking exercise or stretch 4. You do something that you think is helping, but is actually making it worse 5. Get frustrated, start losing hope, decide to rely on pills and return to step 1 When you say "hanging on the lumbar spine" is this similar to someone in a half kneeling position with a lot of lumbar extension "hanging on their Y ligament" ( a term I recently heard Gray Cook use) ?
May 2, 2012 at 3:20 pm |
TonyGentilcoreNick - Thanks for the kind words, and glad to see you took some good bits of info from the post. As far as the "hanging on the spine" comment; exactly what I was referring. But in my case, I was referring to when someone is lying prone - like in a push-up position
May 4, 2012 at 6:21 am |
DanaSince so many people are affected by back pain (myself included - I'm about 10 weeks post discectomy for a herniated disc that ended my powerlifting career) I would love to see a lot more articles on the internets chock full of great exercises that don't load the lumbar spine. Squats and deads are dead for me, and I'm not even supposed to do chin-ups, or even push-ups anymore. That doesn't mean I want to sit around and twiddle my thumbs while the cool kids get to play with the great compound movements. I hope you'll consider adding some articles for us 80% from time to time.
May 3, 2012 at 9:54 am |
TonyGentilcoreDana - Really sorry to hear about this. Trust me, there are still PLENTY of options out there for you. I'm sure if you search around for guys like myself, Eric Cressey, Dean Somerset, Mike Robertson, Bret Contreras, etc......you'll find PLENTY of content. We've all written on low back pain. I'd HIGHLY suggest Mike Roberson's Bulletproof Knees and Low Back seminar set.
May 4, 2012 at 6:25 am |
johnHow can we correct APT?
May 3, 2012 at 10:03 am |
TonyGentilcoreShort answer: strengthen the glutes and external obliques. Stretch the hip flexors
May 4, 2012 at 6:26 am |
willHey Tony, great stuff as always. I have been using the Z press with my clients to great effect. Usually, they have the flexibility in the t-spine, but just can't activate the upper back for shit--EXCEPT if i force them to sit up in a Z press. Your thoughts, sensei...
May 3, 2012 at 12:02 pm |
TonyGentilcoreI'm sad (or maybe even embarrassed) to say that I'm not familiar with the Z press. Care to share a link?
May 4, 2012 at 6:32 am |
willOh jeez, now I'm embarrassed. Probably super common, called something else (Savickas press?), and I'm an ignoramus. Here are some links: http://www.beyondstrengthperformance.com/one-arm-dumbbell-z-presshttp://www.youtube.com/watch?v=r7IroJAYao4 (the music is especially calming in this one...) Basically, sit in a tall-L position without back support, vertical press. I've found it really helps for me to feel a locked lumbar position.
May 7, 2012 at 4:38 pm |
:)2 things: http://triggerpointbook.com/ http://www.healingbackpain.com/
May 3, 2012 at 1:44 pm |
RobertSo I got myself into the half-kneeling position to try the db shoulder-press. Anyone have insight as to what my issue(s) is if I am then unable to bring my elbow up to my ear (as in, forearm folded back in, just raising elbow straight up in an arc towards my ear). Lack of thoracic spine mobility, too tight lats / triceps? I'm all ears as this is a problem I'd like to begin to address. Any insight or suggestions would be much appreciated!
May 3, 2012 at 10:37 pm |
TonyGentilcoreI should have been a little more clear - your elbow doesn't necessarily HAVE to touch your ear. Rather, I just want to make sure that people "press" in that general direction so that their elbow is LINE with the ear. Hopefully that clarifies. My bad.
May 4, 2012 at 6:34 am |
Dan PopeFreaking Bill Hartman making us all look bad. Nice article Tony, that anterior tilt is super common in the push/split jerk especially after a bunch of repetitions in the crossfit population
May 4, 2012 at 11:51 am |
GuestYou might enjoy this website/article: http://experiencelife.com/article/the-web-of-life/
May 10, 2012 at 4:45 pm |
Inspired Fit Strong – Най-интересните статии, които прочетох тази седмица:05/12/12[...] The Not So Obvious Causes of Low Back Pain [...]
May 11, 2012 at 7:07 pm |
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May 28, 2012 at 12:20 pm |
A Few Updates | CrossFit Locus[...] Tony Gentilcore on The (not so) Obvious Causes of Low Back Pain. May sound similar to the stuff I always repeat- learning good squat, hip hinge and movement [...]
June 6, 2012 at 5:30 pm |
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July 3, 2012 at 7:30 pm |
Saturday Good Reads: Edition 1 | LaVack Fitness[...] – John Izzo Just Because A Doctor Said It – A Response – Tony Gentilcore The (Not So) Obvious Causes of Low Back Pain – Tony Gentilcore Are the Psoas and Iliacus the Only Hip Flexors Above 90 Degrees – Greg Lehman Coaching Cues: [...]
November 27, 2012 at 2:51 pm |
joGreat article. But I think you meant to say borderline OCD, not ADD - not to get all OCD over this.
January 28, 2013 at 11:32 pm |
TonyGentilcorehaha. Dually noted.
January 29, 2013 at 9:37 am |
Saturday Good Reads: Edition 1[…] – John Izzo Just Because A Doctor Said It – A Response – Tony Gentilcore The (Not So) Obvious Causes of Low Back Pain – Tony Gentilcore Are the Psoas and Iliacus the Only Hip Flexors Above 90 Degrees – Greg Lehman Coaching Cues: […]
September 12, 2013 at 9:53 pm |
theoldbeerbellyTony, Been reading a lot of your stuff lately, I appreciate you sharing your wisdom. Could you point me in the right direction of some useful SI Joint literature? I've been dealing with intermittent pain in my lower back left side after a deadlift injury 3 months ago. Any advice or direction would be much appreciated. Thanks again for the great reads!
March 29, 2014 at 1:24 pm |
TonyGentilcoreDean Somerset has written on SI joint pain a lot in the past. http://deansomerset.com/stuff-you-should-read-si-joint-edition/ http://www.mikereinold.com/2012/03/assessing-the-sacroiliac-joint-the-best-tests-for-si-joint-pain.html
March 31, 2014 at 7:38 am |
theoldbeerbellyThank you good sir...
March 31, 2014 at 7:44 am |
Sandness PeakMy back definitely begins to hurt after sitting at my desk all day. Surprisingly my neck, back and legs begin to hurt and feel sore. I probably need to move more throughout the day and stretch my legs and back.
May 23, 2016 at 2:41 am |