Lower Back Pain
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Lower Back Pain
I am often told by patients that they have “a bad back” and therefore cannot train heavily or have to avoid certain exercises at the gym. Worse still is hearing from patients that every time they train squats or deadlifts they always come away flared up or at the very least irritable in the lower back and therefore have avoid those exercises. These beliefs and experiences are quite common, but they are unfortunately often based on fear rather than science. The science is in: exercise is good for backs!
When is it potentially more than a little back pain?
With that being said it is important to differentiate between lower back pain and serious back pathology. In some cases, more concern is warranted and these cases are usually associated with additional symptoms than just pain to the lower back. These include any of the following:
- Commencement of pain after a traumatic event such as a motor vehicle accident or fall
- Pain at night or in resting states
- Has associated tingling, numbness, “pins and needles” around the bottom, genitals, down the legs or feet
- If you are experiencing loss or decreased bowel or bladder control
If this is you, then you should seek advice from a health professional straight away prior to continuing to exercise.
Lower Back Pain Causes
Pain in the lower back can come from many, and a combination of sources. Back pain does not necessarily mean that you have “slipped” a disc but rather that the structures in the area have been overworked, overstretched or compressed to a level that they want you to know about it and change what you are doing. These structures include the joints between your vertebrae, the multitude of muscles that attach to your pelvis, spine and ribs, as well as the connective tissues in between. If you have challenged[CP1] any of these structures is a dysfunctional way, especially under load, they can become irritable or damaged.
The first rule for all back training then is to always train in a functional way, avoiding dysfunctional patterns that can cause injury. Functional lift for most people can be achieved by starting in the right position and training your body to stay in the right position under load.
So what is this positioning?
Neutral spine: Often argued about thoroughly by Physios, PTs, and a range of “Bro Scientists” found at the gym, this term refers to the position of the spine where it can maintain its highest level of patency. The spine naturally has 3 curves in it and when lifting, the main way to avoid back pain is to maintain these curves. The most common mistakes lifters make are either arching their back clenching the lower back muscles and hip flexors or flattening their back by scooping their hips under. Both positions will lead to pain from a loss of ability to control the pelvic muscles effectively.
Pelvic control: If the spine loses its correct position the pelvis will also be forced into a non-optimal position. The problem with this is that most of the muscles required to perform a lift attach to the pelvis and when out of position, muscles like the glutes and abdominals will not be able to activate effectively. By maintaining a stable pelvis and not letting it roll forward or tuck under when you lift, those glute and core muscles will be able to activate better rather than forcing the back muscles to take over.
Foot and knee position:Too narrow, too wide, bow or buckled knees, unstable or shaky. If your foundation is rubbish your lift will be as well. The force of the lift has to go somewhere, if it’s not passing from your feet into the floor it has to pass through you. Unfortunately, this force usually goes through the least stable part of your body, and if you are struggling with the above points, this will be your hips or your back. Get your foundation right to avoid this!
Putting all this together can get complex. You may feel you need to have eyes in the back of your head to be able to see and correct all these things. Turns out this is what the mirrors in the gym are actually for. But without an extra set of eyes using these simple rules will help you to squat or deadlift pain free and start training that back to become stronger.
The fix – 6 rules
- Slight toe out (glute)– parallel feet are instinctively where most people start the squat. A slight adjustment turning the feet out (think 11 o’clock and 1 o’clock) will facilitated better glute recruitment
- Press knees out (glutes) – like the foot turn out, changing the knee position changes the recruitment of the glutes. If they buckle in, glutes turn off. Alternatively angling the knees slightly out will improve glute activation.
- Deeper squat (glutes)– the glutes function best at the first 15 degrees of hip flexion and anywhere past 90’. If you are only squatting to mid-range you will never recruit the glutes at the lower portion, so try to access them at a lower depth
- Heel lift (preventing restricted Range of Motion (ROM))– Having trouble getting deeper in the squat? You may be inflexible through the ankles. Lift your heels by standing on a small weights plate or step (3-5cms) this will open your ankles and prevent them from restricting your range.
- Feet wider (preventing restricted ROM)– Tight hips stopping your depth? Widen your stance a little (sumo stance, or wide leg deadlift) this will open your hips up and give a little extra space to approach those deeper positions.
- Start light!– This cannot be overstated! If your technique is imperfect and you overload your body, there is going to be pain. Lighten your load to allow yourself to practice and perfect squatting and deadlifting. You will be surprised how quickly you can add that weight back on without a drop of pain to the lower back.
The main thing to remember in all of this is there is no such thing as a “bad back”. If you are sore you are either injured or not fully rehabbed. The fix for both is incremental improvements to stability and strength. If you still feel like you need that second set of eyes to identify what you may be doing wrong in the gym, the team at City Physio is here to help you out.
Jordan Pink
