The Truth Behind Low Back Pain

Author / Matthew Zanis

5-7 minute read

If you’ve ever had low back pain, raise your hand. Go ahead. If you didn’t raise your hand, you may be part of that lucky 10% of the population who have never had the joy of lower back issues. Or maybe you can’t because it hurts your back to raise your hand, but you just won’t admit it. Or, maybe you just haven’t trained hard enough to where you get the occasional aches and pains. But, if you’re reading this article, then there’s a good chance you enjoy banging heavy weights, and have likely tweaked your back from time to time in the process. 

Follow up question! How many times have you been told that your “weak core” is the cause of this back pain? 

Well, if a “weak core” were really the smoking gun, then every powerlifter, olympic weightlifter, and gymnast should be in the clear. Yet, the incidence of back pain is still on the rise with these populations of athletes included. 

We need to change our way of thinking when it comes to low back pain; there are no amount of sit-ups, planks, or deadlifts that can “strengthen your core” , despite what Finsta tells you. In reality, it’s more about teaching your body how to find center in every movement pattern, plane of motion, on two legs, and one…in a consistent and unconsciously competent manner. In this article we are going to shift your perspective surrounding low back pain, and help you understand that reducing the risk of pain and injury to the lumbar spine is more about listening to what your body needs and how it is receiving information from your environment through your feet. 

Lifting and Low Back Pain

You are probably familiar with the common logic of lifting with your legs or keeping the weight as close to your body as possible, to prevent hurting your back. Looking at a lift through the lens of physics and mechanics, this makes a lot of sense. The closer the weight is to your body, the less shear force is directed to your spine. Less shear force means less potential for injury.

But, what happens when the object you are trying to lift is oddly shaped, or positioned in a place that forces you to lean forward or twist to pick up? If you were on Field Strong this year, you would’ve completed the “Denser” cycle, which revolved around using a Sandbag. In fact, it’s not uncommon to find odd object lifting in many of our Power Athlete programs. Wouldn’t you like to have the capacity to successfully crush this task when it rears its head?

Good news, this CAN be accomplished! 

There is no bad movement, only a lack of preparation. 

With a logically designed program, you can progressively overload patterns that allow your body to adapt to lifting in these odd positions safely. Personally, this is why I encourage lifting with a rounded back for my clients, utilizing movements like the Jefferson Curl, and incorporating twisting movements that help you explore boundaries outside the comfort bubble many of us build for ourselves by only training standard barbell movements. 

But going a step further, what if I told you that the underlying issue with your training could actually be how you carry your center of mass in response to gravity? Yep, that imaginary force pulling down on us every day is often poorly managed by even the strongest athletes out there today. This is partly due to our environment and the comfort world we have built around us to make life easier. However, another contributing variable is our over-reliance on external resistance (ex a barbell)in our daily training. Many of us never take the time to truly explore and discover how to manage our joints against gravity, without a piece of iron in our hands, through their fullest range potential. 

No bigger example can be found of this issue than looking just below the belt at the hips. When the hips lose “mobility” from wearing shoe prisons, sitting the majority of the day, and only squatting heavy weight in partial ranges, another area of the body needs to take up the slack – cue up the low back. The lumbar spine will compensate with over-extension to make up for limited hip extension and engage more Quadratus Lumborum (QL) to make up for limited hip internal rotation…one sided low back pain anyone?

“Mass? Never Heard of Her”

Your center of mass is located just below your belly button and coincides with the intervertebral space of the 4th and 5th lumbar vertebrae. Coincidentally enough, this joint space is the most common site of low back pain. Interesting, no? 

Each day, one of your brain’s main priorities is maintaining your center of mass over your base of support; it normally sits between your two feet on two legs, and the area around your foot while moving on one leg. 

So, if we are constantly trying to “stabilize” and maintain a “neutral” spine in our training with heavy doses of two-legged exercises, how can we ever expose our brain and body to other stimuli that challenge maintaining our center of mass over our base of support, in preparation for the unknown and unknowable of life and sport? 

Your Back Problem is Really a Foot Problem

We can train the body out of “alignment” problems in the gym. We can put some meat armor on athletes that makes their body more durable. We can condition athletes so that they don’t fatigue prematurely and break down in their technique. We can remove the shoe prisons from restricting our athletes and encourage them to perform more barefoot work. Despite all of these means of reducing the risk of low back pain, this is still a reactive, not proactive model of addressing the issue at hand. 

We still need to understand how the feet impact the low back. Remember, it’s not about training barefoot, nor the exercise selection; it’s about the INTENTION behind the movement. 

For example, we see a lot of coaches utilizing the cue of “drive your knees out” in a squat in fear of their athlete’s pronating. In reality though, this pronation is necessary and useful. The problem shows up when we can’t move OUT of pronation. Pronation, or flattening of the arch, allows the tibia and femur to spin inward, leading to a pelvis that dumps forward and results in arching of the low back. This is necessary to expand the body and pull yourself into a good squat position. However, you can see how staying “stuck” here throughout the day could leave your low back overly sensitized and tensioned with the lumbar vertebrae in a closed position, and the lumbar erector muscles in a shortened state. 

In other words, when you pronate, which is also necessary for landing from a jump and decelerating the body, an adequate stretch of the anti-pronators, including your gluteus maximus and biceps femoris (lateral hamstring), is necessary to decelerate that motion. Most athletes actually have very little posterior chain strength because they never achieve this lengthening state in order to facilitate a “good glute contraction.” In response to a lack of adequate internal rotation and deceleration, the force bleeds up from the hip to the lumbar spine. You can now see how your low back problem can stem from your feet.

Knowledge is Power

As you can see, many postures, positions, patterns, and movements are not nearly as dangerous as they seem. The truth is that low back pain is complex. The spine is built to be both a solid pillar AND mobile. We run into problems when we minimize movement and place ourselves within a “right and wrong” movement box. Sure, it makes logical sense to maintain a rigid spine when picking a heavy barbell off the floor. Setting yourself up in a stiff position is mechanically advantageous for lifting the most weight, which is our goal in the gym. However, rounding the back like in a Jefferson Curl movement shouldn’t be feared. 

I want you to visualize the world of sport. Do all athletes always maintain a flat back while moving up and down the court and field? How about those who work on a farm? Do you think they keep a “neutral spine” while bending over to pick the fruits of their labor? 

The truth is that the prevalence of low back pain wouldn’t be minimized if people suddenly attempted to remove lumbar flexion (rounding of the spine) during daily life and athletics. In fact, the fear and anxiety associated with maintaining a specific position might even increase the prevalence of back pain episodes.

At the end of the day, digesting more information around low back pain and understanding it’s complexities will actually lower your pain sensitivity and likelihood of experiencing debilitating low back pain episodes. 

So, here are some quick take home points you should know:

  • A “neutral” spine that is often demonstrated with squats and deadlifts is associated with a more hip dominant movement strategy. This is definitely important for performance – creating more power, strength, and speed. However, it should be noted that spinal flexion, even with a “neutral” spine is unavoidable. We can see up to 40 degrees of segmental spinal flexion in these activities! 
  • NEUTRAL IS A RANGE and varies between individuals. 
  • Your disc is so strongly attached between your vertebrae that it can never “slip.” Disc herniation is only associated with 2-5% of low back pain, and damage shown in MRI’s and X-Rays is POORLY associated with pain. 
  • The body ADAPTS…even to lumbar flexion. Each person’s rate of adaptability and tolerance to load varies.
  • Repeated flexion and extension may be a positive benefit for the spine according to recent literature – serving as a protective mechanism by reducing the brain’s pain response to such activities. 

In the end, YOUR goals and current state of activity should direct your movement selection. I want you to imagine you were educated about how YOUR own body moves, identifying limiting factors, and taught how to manage your center of mass in sport and daily life. That’s why we developed the Low Back Health Course. This course will take you deeper into all the concepts discussed in this article AND give you the tools necessary to self-assess and work through any low back pain problem. 

Related Content

EDU: The Back Health Course

BLOG: Training Foot Health – Kinetic Chain by Matthew Zanis

PODCAST: PA Radio Episode 492 – Spine Rounding, Jefferson Curls, and Back Pain Programming

BLOG: Pain – This Shit is Complicated by Matthew Zanis

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AUTHOR

Matthew Zanis

PT, DPT, FAAOMPT, OCS, ATC, CSCS Former baseball catcher and an avid outdoorsman. Worked with Division 1 basketball, football, and track and field at the University of Pittsburgh, along with the Pittsburgh Pirates and Arizona Cardinals organizations. Received a Bachelors in Athletic Training from the University of Pittsburgh in 2011 and a Doctorate in Physical Therapy from Duke University in 2014. Is board certified in Orthopedics and a Fellow through the American Academy of Orthopedic Manual Physical Therapists. Is a PT with the United States Olympic Committee and USA Shooting. Currently operates his performance therapy practice in Scottsdale, AZ with Dr. Tom Incledon of Causenta Wellness, and became a Power Athlete Block One Coach in September of 2017.

Dr. Zanis utilizes the Power Athlete Methodology to optimize performance, reduce injury risk, and rehab his clients and athletes through movement assessment, coaching, and individualized program design.

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