Extension Based Back Pain is a B****. And What To Do About It
Back Pain Is the Suck
It’s no secret that any form of back pain sucks. Looking at the statistics – it’s been said that 80% of Americans have experienced some form of lower back pain in their lifetime – it’s a safe bet that you know exactly what I’m talking about.
As such if you’re a coach, personal trainer, physical therapist, athletic trainer, a general fitness enthusiast, or, I don’t know, someone who trains bomb sniffing dolphins for a living, you’ve probably heard of the name Dr. Stuart McGill.
If not – and you better have a good reason for why not – for those unaware, Dr. McGill is essentially the world’s Don Corleaone of spine biomechanics and research. His two books, Low Back Disorders and Ultimate Back Fitness and Performance (now in it’s 4th or 5th edition), not to mention the endless array of studies he’s been involved in as well as his numerous other products have done more to expand the knowledge base with regards to assessment and program design not only for me, but for countless other health professionals than anyone else I can think of.
Note: this isn’t a slight against other “low back specialist” such as Dr. Craig Liebenson or that crazy witch-doctor-prisoner dude from The Dark Knight Rises who, after Bane pile-drived his knee into Batman’s back and more or less paralyzes him, healed Bruce Wayne’s spine with nothing more than some rope and some weird chanting………..in a matter of weeks.
Both of them are the bees knees, and I have without questionlearned a lot from them. But I’d be remiss if I didn’t say that Dr. McGill’s research has influenced me the most.
I’m not going to belabor the point here, but suffice is to say flexion based back pain tends to get most of the press – and rightfully so. As I noted, Dr. McGill’s research with regards to repeated flexion, and in particular loaded flexion, have very few detractors.
Ask anyone who spends the bulk of their day sitting in front of a computer screen in one massive ball of flexion or anyone who deadlifts like this……
…..and you’re bound to see they have a history of low back pain.
Which is why, when working with someone with (flexion based) low back pain, my main focus is to re-engrain “spine neutral,” help get people out of a constant state of flexion, and hammer core/spinal stability.
And to not deadlift like the asshat in the video above.
But even though this “anti-flexion” mentality has helped a vast amount of people, we’ve somehow managed to force feed people into thinking that ALL flexion is bad.
Lets be honest: people are scared of everything.
ObamaCare, increasing gas prices, zombies, Keanu Reeves movies, you name it….we’re scared of it. And now flexion is no different.
My buddy Dean Somerset wrote a fantastic post not too long ago titled Spinal Flexion is Important for Low Back Health and Strength which I felt did a bang-up job helping to bring the pendulum back to the middle.
Which serves as a nice segue into my topic today. Extension-based back pain.
We see this a lot in the athletic population – especially in extension-rotation dominate sports like baseball – but also in the meathead and trainer population too.
I wrote about this “phenomenon” (if you want to call it that) a while ago in a T-Nation article titled “Glue” Exercises Gone Wrong.
In it I talked about this concept of REVERSE POSTURING – or an extension dominate posture – that we were noticing in a lot of our clients at Cressey Performance.
Here’s a snidbit from the article:
A few months ago, we picked up on a repeating trend with some of our clients at Cressey Performance.
We started noticing a lot of extension-based back issues, particularly through the thoraco-lumbar (TL) junction. More specifically, we started to observe more of a gross extension dominant posture in many of our athletes and clients.
The chest up position, which we have been taught and have been preaching for the better part of the past decade, might have been an overreaction to the poor posture that many non-exercisers typically exhibit.
Much like what happened with the low fat craze in the 1990’s, the anti-stretching phase from a few years ago, low intensity steady state cardio vs. HIIT, and the never-ending debate over Jessica Alba vs. Jessica Biel, things often get blown out of proportion and taken to the extreme.
In discussing this matter with my colleague Mark Bubeck, a trainer in Ridgefield, CT, these extension-based types of pain from being locked in that position can be seen in all types of people, especially those with an over-exaggerated lower crossed posture (i.e., excessive anterior pelvic tilt).
The issue is that we’re starting to see this pattern in a lot of trained individuals too, and not just those who “pretend” to work out.
Those who’ve been training “correctly” for many years with what we thought were correct positions have seemingly developed the reverse posture of what we set out to correct in the first place!
Stating it succinctly, we know that the hunched over Neanderthal posture isn’t good, but the reverse (promoting chest way up with a huge rib flare and the movement coming solely from the TL junction) isn’t doing anyone any favors, either.
This, of course, isn’t to say that we shouldn’t still use the same cues as above – especially with those who do exhibit poor posture – but there’s something to be said for not taking things to the extreme.
To that end, here are a few updated cues with regards to the seated row:
- You still don’t need to be rounding your back. That’s just dumb.
- You still want to think about keeping the chest up, but also think “ribs down,” locking them onto the pelvis.
Confused? Check out this video to see what I mean:
In a nutshell: while not done intentionally, many fitness professionals, in an effort to correct faulty posture or flexion based back pain – cueing people to depress and retract their shoulders, over and over, and over again, for example – have helped contribute to the another issue altogether.
What About Those People Who Are in Extension-Based Back Pain!?!?!?
While not the most glamorous or elaborate assessment tool, one of the best ways to differentiate between flexion-based back pain and extension-based is to simply ask the person “do you have more pain while sitting or standing?”
If the former, you can probably ascertain that they lean more towards the flexion intolerant side of the spectrum.
If the latter, ding,ding, ding, you most likely have an extension intolerant candidate! Using myself as an example, I can tell that after having been coaching on my feet for 6-7 hours standing around on black matting, my lower back is oftentimes killing me.
Another simple “test” would be to have him or her perform a standing toe touch. People who are extension intolerant will typically have more pain on the way UP.
All of this to say that those with extension intolerant backs typically (not always) have something going down in the facet joints or may have end plate issues (fractures, spondy, etc).
So what are some strategies we can implement to help address the issue?
Glad you asked!
1. It sounds borderline silly, but being more cognizant of rib position is a huge deal.
Walking around in a “flared” rib position in concert with an excessive anterior pelvic tilt is a one-way ticket to Mybackfuckinghatesmeville, USA.
Case in point, here’s an example of what I mean:
In the first picture my ribcage is flared out and the (imaginary) line between my nipples and belly button is long. Conversely, in the bottom picture my abs are braced and the line between my nipples and belly button is shorter. This is the position I’d ideally like to stay in for most of the day, and especially while exercising.
Now, I’m am NOT insinuating you need to walk around all day “checking” yourself, making sure your abs and glutes are engaged, but I am saying it’s something that should enter the equation.
We all know the saying that we have one hour to “fix” things in the weightroom and 23 more hours in the day to f-things up. Well, this is part of those 23 hours.
The point above coincides very well with the section above on seated rows. Incidentally it also bodes well for just above everything with regards to lifting heavy things.
Learning to “own your rib position” when squatting and deadlifting can pay huge dividends with how your back feels in the long run.
I wrote an entire article on the topic HERE. (<—- Read It! Gosh!)
Even something as trivial as how we perform a standard lunge can have an effect.
We’ve always cued people to perform their lunges with their shoulder up and retracted and they chest up:
It’s not inherently wrong, but for those with extension-based back pain doing lunges this way can be murder.
Instead, I like to cue a slightly more forward lean and to think about the shoulders going over the knees rather than the hips.
This way not only is the lower back able to flatten slightly, but more of the load is placed on the hips rather than the lower back itself.
2. Stop Doing Things Which Cause More Extension
We all know that benching with an arched lower back is one of the keys to hoisting up big numbers. Powerlifters live by this creed and it’s for good reason. A good arch means less distance the bar has to travel.
I’m not one of those people who feels that benching with an arched lower back is bad. The lumbar spine has a natural lordotic curve and benching with an arch isn’t the end of the world.
Benching with an excessive arch (in addition to the butt coming off the bench……RED LIGHT!!!), well, that’s another story.
For those who do exhibit extension-based back pain, however, it may be in their best interests to nix the (excessive) arching – at least for now – and bench with a flatter spine.
Don’t worry, I promise you won’t turn into a Jersey bodybuilder. I think.
Likewise if you’re someone who performs their chest supported rows like this:
Is it any wonder why your back is flipping you the middle finger????
Jesus – just stop it!!!!
It may make more sense to do more row variations which won’t allow you to crank through your lower back. Stricte(r) seated row, half kneeling 1-arm cable rows, and the like would be money here.
3. Wear Shoes With More Cushioning
Eric Cressey touched on this topic HERE, but I wanted to chime in on it as well.
I get it: You wear Vibrams everywhere you go – even at the mall – so that everyone within a two-mile radius knows just how hardcore you are.
First off all, you’re a douche.
Secondly, wearing shoes which offer a bit more cushioning may be more advantageous for those with extension-based back pain as it helps serve as a bit more of a shock absorber.
I walk around on hard black, rubber matting all day when I’m coaching and it can be unforgiving on my back. Upon the recommendation of Mike Reinold, I switched to a shoe that offered a bit more cushioning and I could instantly feel a difference in how my back felt at the end of each day.
If you’re someone who has to stand for long periods of time throughout the day, this subtle tip could be a game changer.
4. Learn to Breath
The people over at the Postural Restoration Institute (PRI for those in the know) have been around for well over two decades, but it’s only been within the last 2-3 years that their “stuff” has gotten a bit more exposure.
While even Gandalf would have a hard time understanding their entire philosophy, I can tell you that one of the major “umbrella themes” is to understand that, based off our anatomy, the human body will never by symmetrical.
Taking things a step further, it’s recognizing that we’re inherently designed in such a way where asymmetry is inevitable, and that how we breath plays a major role in that.
PRI tries to teach people how to breath more efficiently, which in turn, in conjunction with their corrective modalities, will help attempt to bring them back to neutral.
People who exhibit more extension-based back pain tend to have an over-active or dominate Posterior Extensor Chain (PEC Posture), and as weird as it sounds, (unloaded) flexion is one of the best ways to help them.
Tossing in some dedicated breathing drills which help teach people to “breath into their back” can make a world of difference.
These are drills we’ll tack onto an extended warm-up with our athletes and clients before they actually pick up a barbell.
They take all of maybe 2-4 minutes to complete (depending on how many we include), and then it’s off to go crush some weights.
All Fours Belly Breathing
Deep Squat Belly Breathing w/ Lat Stretch
Here I’m going into a “deep squat,” and using the front of my thighs as a guide to keep my rib cage down. I then take a deep breath through my nose trying to drive me “sternum to the back wall,” which helps turn my upper back into a dome.
I then forcefully exhale all my air which will help to engage my diaphragm to a higher degree.
With both drills I’ll shoot for anywhere from 5-10 breaths, or until someone blacks out. Hahahahaha. Just kidding.**
And that’s just the tip of the iceberg. This post in no way encompasses an all-inclusive list of stuff that can be worked on, but hopefully it gave some food for thought with regards to how to approach back pain from a different viewpoint.
** = or am I?