Low Back Injury

Introduction

At some point in the fitness world, looking better became more important than feeling better.  With respect to chronic pain problems, anyone who has dealt with them knows the importance of living a pain free existence.  It’s easy to ignore for many of us, but not if you have pain constantly reminding you that you’re orthopedic health is suboptimal.  Lower back pain is, of course, one of the most common culprits.  Today I’d like to give you some background on lower back pain, and offer some tips to deal with it, thus improving quality of life and performance in the gym as well.

What Causes Low Back Injury?

In a more general sense, orthopedic pain is often caused by something called a directional susceptibility to movement (1).  In essence, this is when a joint has a tendency to move in a particular fashion whenever it is put to use, even if that’s not the joint articulation that was intended to occur.  Over time, this excessive motion in a particular direction repeatedly stresses the same tissues in the same way.  It’s like hanging a door improperly on it’s hinges, such that it sits at a slight angle and rubs the door jamb in a particular spot.  Even though you don’t want the door leaning into the door jamb every time it’s open and closed, it does so because it is misaligned and moves in an improper fashion.  Over time, this wears away at the door and door jamb where the rubbing occurs.  Now, imagine that the door is your knee, and the door jamb is some other tissue in your knee, such as the meniscus, or a ligament.  You can see how over time this could create an issue.  

Directional susceptibilities to movement occur from mobility deficits and poor motor control, and they should be avoided if at all possible.  Imagine yourself bending over to pick something up.  You have to flex your knees, hips, and spine to get low enough to pick up an object off the floor.  However, there is a certain amount of range of motion each of these joints should contribute to the movement.  Under a condition of poor motor control, one might bend the  lumbar spine far more than needed (Image 1 on the left).  Thus, the lumbar spine is showing a DSM into flexion, a tendency to move into flexion all the time.  This could even extend to movements where no lumbar spinal flexion is needed at all.

Image 1 - Left: Excessive spinal flexion / Right: Appropriate spinal flexion

Every tissue in the body has a failure tolerance.  At some point, if subjected to enough load, the tissue would be damaged.  However, as illustrated by the point I made above with the door jamb analogy, this doesn’t have to be one large load.  Although a very high load applied all at once can damage the tissue (e.g. a car accident), so can repeated low level loading over a long period of time (2).  How many people have you heard of injuring their back bending over to pick up a pencil, or turning to grab the phone?  Think about it: did bending over to grab the pencil really injure the person?  No, under normal circumstances the tissues subjected to load during this action should have been able to handle the stress just fine.  However, after repeated low level loading from poor movement, the failure tolerance for a tissue becomes drastically reduced (2).  This leads to a situation where it appears as though a straw broke the camel’s back all by itself.  In reality, there was a lot of low level tissue stress leading up to that.

It’s not just repeated motions that can create issue.  As well, sustained postures of virtually any kind can lead to injury over time through a phenomenon called tissue creep (2).  Although sitting all the time is a problem, sitting isn’t necessarily a bad thing if not performed to excess.  Even though white collar workers who spend the majority of the time sitting show increased risk of lower back injury, blue collars workers who are more physically active show reduced risk of injury if they increase the amount of sitting they do, suggesting that changing posture is more important than finding an ideal posture (2).  That said, with respect to lower back pain, positions of excessive lumbar flexion tend to be more dangerous because, as stated by Dr. Stuart McGill, they cause “myoelectric silence in the back extensors, strained posterior passive tissues, and high shearing forces on the lumbar spine. (3)”  Translation: deep flexion posture causes the muscles that extend the spine to shut down, increase stress on tissues on the rear part of the spine, and generate a lot of sliding forces on tissues in the lower back (Trust me, this is really bad).

Too Much Science... How Do I Get Better?!

Now to the good stuff.  I’m going to offer some general tips with respect to  reducing and preventing future incidents of lower back pain.  Notice the word general: these tips are not meant to replace medical intervention.  Not all back problems are the same, and they shouldn’t necessarily be treated as such.  However, you may find this information a very valuable adjunct to medical advice.

Stop Stretching Your Lumbar Spine!

The lumbar spine is an area of the body that is made for stability.  It is not designed for lots of range of motion, especially not rotation (1).  As stated previously, going too deep into flexion, even if the lumbar spine is capable of it, is a bad idea because it causes inactivity in muscles very important for dynamic support of the spine.  Yes, it may feel good at that moment, but that’s only because of the sensory input overpowering the sensory input of pain at the very moment.  In the long run, you are doing more harm than good.  Instead, a lot of the motion should come from either the hips or the thoracic spine, especially the hips during forward bending (1).

Improve Mobility in the Hips and Thoracic Spine

To prevent unwanted motion of the lumbar spine, you need to be capable of generating the necessary range of motion somewhere else to perform normal activities.  The nearby structures of the hips and thoracic spine are the best places to start.  This certainly doesn’t mean mobility deficits elsewhere are unimportant, but these are common offenders.  In terms of rotation, much more rotation should occur at the thoracic spine relative to the lumbar spine, and bending over should happen primarily at the hips (1).  Once you regain this range of motion, make sure you implement it and be aware of excessive motion in your lumbar region.  Check out this video put out by Eric Cressey, a well respected strength coach and trainer in the industry, to get some ideas on drills that improve mobility in these areas.

Improve Stability in the Lumbar Region

Core work gets a lot of press these days.  However, most core work needs to be focused on preventing movement rather than creating it.  As indicated above, movements that typically occur where your lumbar spine is involved need more motion to come from either the hips or thoracic spine.  Well, not only should you make the path of least resistance easier by improving their mobility, but you should also make the path of least resistance more clear by making it harder to move the lumbar spine!  You can classify theses as anti extension, anti lateral flexion, and anti rotation.  Classic examples of anti extension and anti lateral flexion are the plank and side plank respectively.  However, anti rotation exercises tend to be implemented less often.  Here is a video showing some examples put out by Bret Contreras, another highly respected trainer in the industry.

Move Around!

As referenced earlier, sustained postures can be damaging to tissues similar to the way that poor movement patterns can be.  Thus, you would be wise to change your posture as often as possible.  Every 30-60 minutes stand up tall, stretch for a minute, or walk around the office.  One piece of advice I offer to clients of mine is to take all their phone calls at work standing up.  It’s an easy way to start incorporating a different posture into your daily routine at work.  As frequently as you can, reposition yourself to shift around tissue stress and stretch.  Just find something that insures you are regularly changing your posture; there is no right way to do this.

Avoid Spinal Flexion Early in the Morning

Upon rising, the spine is a more fragile structure.  The discs of the spine are hydrophilic, and as such, fill with water overnight.  The result is that when you first wake up the discs are more prone to injury (1).  Avoid any stretching routine that places your spine in deep flexion early in the morning, and avoid bending over as much as possible for the first 1-2 hours you’re awake.  If you’ve ever had back pain, this may sound intuitive to you.  A lot of people report that the pain is more pronounced when they first wake up, and diminishes as they move around and the day progresses.

Try the Golfer’s Lift

Another spine saver is the golfer’s lift.  This is a move that utilizes the back leg as a counterweight when bending over to avoid spine flexion and reduce spinal loading in general.  Image 2 below shows this alternative method of grabbing stuff low to the ground.

Image 2

Improve Glute Activation/Hip Extension

As a trainer, I see people move in a way that doesn’t maximize gluteal activation very often.  It’s something I take a look at in all my new clients.  If someone has a lot of spinal flexion when they bend over, it also means they need a lot of spinal extension when they stand back up.  This happens in lieu of much of the hip extension that would normally occur.  If you don’t understand what this means, the essence of the idea is that people stand up with compensation, using too much lower back musculature and not enough hip (e.g. glute) musculature to produce the motion.  There are plenty of rotational/lateral movements that should occur more from the hip that can cause issue if motion is produced from spinal musculature.  The bottom line is that you want to insure you’re using them properly.  Improper function of the glutes during daily activities is referred to as “gluteal amnesia,” and is implicated in back pain.  Check out this video for some ways to make sure your glutes are firing during some of the basic movement patterns.

A Synthesis of the Information

As stated before, the nature of any back problem cannot be assumed to be the same as another.  However, these general tips allow you to avoid sustained stress on the same tissues over and over again.  The bottom line is that improving the way you move, limiting extraneous stress on the spine, and providing a variety of movements and postures to your body will avoid overloading any one particular tissue.  This should help, to some extent, almost any back problem out there.  If you’re really diligent about creating a healthier environment for your spine, I bet you’ll be surprised at how much of a different it can make. This isn't just for people who have problems either; a lot of this information is also prophylactic in nature. So, go do your back a favor and try out these tips!

References

(1) Sahrmann, S., (2002). Diagnosis and treatment of movement impairment syndromes. St. Louis, MO: Mosby.

(2) McGill, S. (2002). Low back disorders evidence-based prevention and rehabilitation. Champaign, IL: Human Kinetics.

(3) McGill, S. (2006). Ultimate back fitness and performance. (3rd ed.). Ontario, Canada: Wabuno Publishers.