Which exercise caused low back pain?

I recently had a client mention he has had some low back tightness on one side after his last couple of workouts. I found this out after he finished a really nice set of deadlifts, to which I asked about adding more weight. His response was that his back has been bugging him so he wants to not push the deadlift. I can certainly agree with that.

Given that response, however, I gave extra attention to form on his next set, in case I had missed something. I didn’t; or at least I still couldn’t see anything wrong. Note that this is not someone with a history of low back pain. I asked if he felt it during the workout or after, and he replied that he felt it later. I also asked if anything had changed in his life – overtime, stress, sleep or nutrition changes. He answered that all was normal.

Hmm. The deadlift is the obvious culprit, but it really looked good. In fact I had recently switched him from a straight bar deadlift to a trap bar deadlift, which had a positive effect on his form (he tended toward a low hip deadlift which to me is a sign that the trap bar may be a better choice). The reason this change struck me as relevant is that the soreness had been for the past few sessions yet he switched from straight bar to trap bar before his last session. Logically it seemed unlikely that both versions would yield the same back tightness. He also mentioned that it was one side only. His deadlift is square: No shifts to the side, no one hip higher than the other, no bulging spinal erectors on one side. So how would this yield (or contribute to) low back soreness on one side?

I took a closer look at his workout sheet to see if something else could be involved. The single leg glute bridges and half kneeling band Pallof press both caught my attention. Both are great exercises that can contribute to a happy back by strengthening the muscles that support it. But both also could yield movements that disrupt the low back if his brain chooses that path.

The single leg glute bridge, when done with a rib flare (not desired), or with too much range of motion, can be driven by lumbar extension instead of hip extension. Even though glute bridges are often used as an exercise to help someone with low back pain, if form is off, it can contribute. The fact that he was doing the single leg glute bridge (versus a two leg one) makes more sense as a contributor to unilateral back discomfort than does the bilateral deadlift. As I thought about it, I remembered that he had previously mentioned having a hard time feeling glute bridges in his glutes.

I watched his form carefully when he got to the single leg glute bridges and noticed that he was exploding up and his ribcage was flaring a bit in the process. Bingo? I cued him to bring the ribcage to the pelvis, and to slow down. I then watched him struggle with my ribcage to pelvis cue, so I asked him to engage his abs. This cue worked perfectly, and the rib flare in his glute bridge decreased. He also slowed the pace down. I can’t recall his exact reaction, but it was something along the lines of ‘huh’.

During his next set, I ask him to finish a bit lower this time. This cue often helps for those who extend the back during a glute bridge as it is often the point at which hip extension ROM runs out that they take over with lumbar extension. Reduce the range and they don’t need to use the lumbar end range. This worked to get rid of the extra back extension that remained with the previous cue. I also asked him to hold for a second at the top. Often when people have a hard time feeling their glutes in an exercise, just giving it an extra hold can make all the difference.

At this point I was fairly sure it was the glute bridge that was the culprit in his back tightness, but I knew the half kneeling band Pallof press had the potential for this as well.

Like the single leg glute bridge, the half-kneel band Pallof press (really all variations of Pallof press) is a great exercise. It is typically considered a lateral core exercise, meaning it works primarily the muslces on the side of your core, or the obliques.

The problem with Pallof presses is that, depending on the individual doing them, it might not be working the lateral core. In the past couple of years I’ve become aware that many people do not work their lateral core when doing lateral core exercises. A lot of people feel Pallof presses in their back. If you have never asked clients where they feel Pallof presses (or chops, lifts, or side planks…), you really should. I suspect you will be surprised how many are not feeling it where you think they do. In some cases putting fingers on their side can help them to fire these muscles, while in others this simply gives you confirmation that these lateral core muscles are not doing much.

After his set of the half-kneeling band Pallof press, I asked my client where he felt it. He said his abs, so I asked side or front, noting ideally he’d feel it in one side. He said both (abs and side). I watched his next set and it looked good. Since it looked good and he did not feel it in his back, I crossed it off the suspect list.

At the end of that session I felt relatively confident that the tightness he had been feeling in his back was from his single leg glute bridges, but I maintained a degree of uncertainty until I heard back from him two days later with confirmation that his back was not tight.

It makes sense if you think about it. Every muscle in the body has multiple functions. Given that, how can we be sure that every brain is going to pick the muscles you think it should to perform an exercise? The brain has a collection of personal experience and unique anatomic features to consider when choosing what muscles to tap for a given task. In the case of the Pallof press, that may or may not include obliques; and in the case of single leg glute bridges that may include a larger contribution from spinal erectors than glutes.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa, Canada, who was an engineer in a previous career and thus loves any opportunity to assess (and ideally solve) a problem.

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