Low back pain redux

This week’s post is a follow on to last week’s post with some basic information about low-back pain, covering some slightly different topics and getting into a bit more detail.

The post will primarily address whether and how much we should bend, extend and rotate our backs.

Dr. McGill has lectured and written extensively on why flexion is bad for our backs, and yet what exercise does your physical therapist give you to address your low back pain? Crunches! Somehow in the last 20 years it has become a universal truth that situps are bad but crunches are good. Take a look at these two photos.

Back flexion during a sit up
Back flexion during a crunch

One is a crunch and the other is a situp. Do you see much difference in flexion? I don’t.

Some people would argue that we need to flex in training because there are some sports, such as mixed martial arts (MMA), where athletes need to perform in a flexed position. So we should really train the muscles that help us flex. But here’s the thing: the flexor muscles (rectus abdominus, obliques and multifidus) use more force in other exercises like planks, stability ball rollouts and bird dogs than they do in crunches or situps. Should you train your flexor muscles? Absolutely! Just don’t do it in a flexed position.

Another movement that can cause problems in the low back is extension – or more accurately hyper-extension. Frequent hyperextension of the back can cause spondylolisthesis, which is a stress fracture of the pars (part of the vertebral column). Spondylolisthesis is common in cricket bowlers and gymnasts who require repeated extensions to perform their sport. The training concept here is similar to the approach for flexion: work the muscles without straining the structure. Think about exercises that strengthen your extensors without hyper-extending them: glute bridges, bird dogs and even back extensions; just take a look at your back position periodically to make sure you are not extending too much.

This “anti-movement” approach does not stop with flexion and extension; it also applies to rotation. Think of a golfer or tennis player. There is a lot of potential rotation in every swing or stroke. These athletes need to train the muscles responsible for rotation, but in a friendly “anti-rotation” way. There are several great options for this including

  • Cable push/pull

  • Cable anti-rotation press

  • Landmine twists

I mentioned “potential” rotation for golfers and tennis because ideally these athletes will have enough hip mobility to provide all of the rotational movement for their swing or stroke. In fact hip mobility is an important variable in preventing and managing low back pain for everyone.

The reason this is important is that limited mobility in the hips usually results in the back being recruited to take over. For golfers or tennis players, the problem is often lack of hip rotation. If you are unable to properly rotate through the hips, then your spine will need to absorb the forces from your swing. And how many times in a tennis match do you swing your racket? That is a lot of rotations!

Now think about sprinting. Your hips flex as you lift your knee up to start the stride, then the foot pushes into the ground and then extends as you finish your stride. A certain amount of hip flexion and extension is required just to run, but if you do not have that mobility, the movement will come from somewhere else: your back.

Try this experiment: Stand facing a wall with your arms straight and hands on the wall; Lean forward slightly and take one hand and put it on your lower back to feel its position. Adjust to make sure your back is neutral. Now lift one knee up as if in the start of a sprint stride. What happens to your back as you do this? Does it round a bit? For many people, this simple movement causes back flexion. Now extend the same leg back and away from you as if finishing a stride. Do you feel your back extending? Think about how many times you do these two movements when you run or play a game of soccer or baseball? That’s a lot of flexions and extensions!

Guess what else can force you into unnecessary back flexion and extension? Tight pants. Try the experiment above but with tight pants on and see how much additional back movement you need just to move.

The solution? Work on your hip mobility! This can be achieved in a variety of ways, and the best approach will partly depend on your specific body and condition, but here are a few suggestions. Make sure you can do a “hip hinge”, which essentially means that you can bend forward at the hips without having to flex your spine. There are many daily activities, like bending forward to brush your teeth, that should be done by hip hinging instead of back flexing. A good exercise to train this pattern is to do a Romanian deadlift with a dowel touching your head, shoulders and buttocks (see the photos below for beginning and end of this exercise.

Bodyweight Romanian deadlift start position
Bodyweight Romanian deadlift end position

Stretching the hip flexors with a variation of a lunge stretch is another good idea, as is strengthening your external hip rotators (glute medius) which you can do in many ways, including mini-band clamshells.

The conclusion? You can go a long way toward preventing and reducing back pain by strengthening your back with anti-movement exercises, and by increasing your hip mobility with both stretching and strengthening exercises.

7 thoughts on “Low back pain redux”

  1. I’d just like to say thanks on behalf of everyone who may of read this artical. I would like to add that I have made a recovery it has been a long road but I’d also like to add that there was not a whole lot of help from the professionals the help that I got was like pulling teeth anyways keep up the good work And to all you people with low back pain don’t give up and if you read this artical your on the proper path, also look into the press up and recovery position. Peace and God bless

  2. Thanks for the pointers, Els. I’ve been adding these to my workouts for about a week. We’ll see what results I get when I get back on the field in the spring. :)

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