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 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.