Identifying The Cause Of Low Back Pain
Let me lead off by saying that I am not a Physical Therapist or Chiropractor, nor have any certifying credentials to state that I should be treating back issues. With every instant that I discuss, there should be certified professionals involved as well. But that is not the purpose of this article, rather instead to identify certain positions and deficiencies that I have found that typically lead to back issues. From there, I will cover some approaches I have taken with athletes I have coached with back pain that have led to decreased pain and/or occurrences of pain in my specific role as a coach in programming and movement quality.
First, there are the obvious cases where someone has significant form issues where either they cannot perform a proper hinge, and/or they have excessive lumbar extension in the squat or deadlift. Even someone with little to no experience in resistance training can spot these and know something isn’t right. That fix has an easy answer, and that is to take a big step back and teach them proper form. Those are the cases where they no longer have the privilege to continue to work with heavy weights until the can properly maintain positions and form with even the lightest of loads. But that’s the obvious scenario, and what I would like to focus on is the less obvious scenarios. While this may not cover every case, in my experience I have found three specific “less obvious” causes of back pain. Two of these lead back to an understanding of active versus passive stabilization, so lets cover that first. While this description could be more in depth, in a simplified form passive stabilization is stability when a joint rests at its end range of motion, with the joint creating the stability. So with the back, this would mean the end ranges of motion of flexion, extension, and lateral flexion of the spine. Active stabilization on the other hand is that middle range of motion where muscle is stabilizing the joint, or what you would consider a neutral spine position. Active stabilization is where we want to be. Passive stabilization is where injuries happen. And when it comes to back pain, the three less obvious causes are lumbar extension, lumbar lateral flexion, and bar path.
So the first case is lumbar extension. Lumbar flexion is the obvious cause where someone’s back looks like the St. Louis Arch, but lumbar extension can be just as much an issue, especially in the squat. While I have definitely seen cases of people over-extending in the deadlift, it is less common and also a much easier fix. In the squat though it is extremely common, where you see someone who tries to sit back, but instead just anteriorly rotates their pelvis, goes into lumbar extension, and is now using the end range motion of their spine to stabilize. In each person the degree to which this occurs varies, with some cases more obvious than others. The less obvious cases usually occur when someone actively stabilizes and keeps a neutral spine during the eccentric phase, but as soon as they initiate the concentric phase they going into an anterior pelvic tilt and lumbar extension. The degree to that varies, but I have seen even the smallest degree of lumbar extension can cause pain. Below is a video of an athlete of mine with her before and after squat. On the left you will see her go heavily into lumbar extension as she goes through the concentric phase, and on the right you will see the improve neutral spine position throughout.
The second case is when someone goes into lumbar lateral flexion due to a hip shift, which usually also entails some lateral movement and tilting of the pelvis as well. The typical thing I will see is during the concentric phase the lifter will pop their hip to one side and about half way up start to realign as they lockout, both on squat and deadlift. This specifically drives down on the QL (quadratus lumborum) of whichever side the person is shifting to. If you are not familiar with the QL, become acquainted with it, as I find that to be the most common culprit of back pain. If someone comes to me and says they suffer from lower back pain, but it is not diagnosed and they are pretty confident it is not a structural issue with the spine, 9 times out of 10 its the QL.
Lastly is a bar path issue. Bar path is dictated by the actual movement pattern, but if you watch the bar path it can tell you a lot. And for lower back pain, if the bar path during the concentric phase of the squat and deadlift moves forward of your midline at any point, it means you are putting extra and unneeded pressure on the lower back. Typically this issue also coincides with someone who shoots their hips back and chest falls in the squat, or someone on deadlift who either sets up with their shoulders too far in front of the bar or straightens their legs too early. Either way, as that bar moves over your toes instead of the midfoot, tension transfers away from the hamstrings and glutes and now goes to the lower back. Below is a link to 3 videos, the first showing an example of the bar path issue, and the second two showing examples of the aforementioned lateral flexion.
So you’ve identified the cause of the low back pain, now what? I am not enough of an expert to give a detailed and perfect plan, nor do I think that is even possible, as each individual case will be different. But what I can tell you is that three things need to happen:
- Regress the weight.
- Slow the movement down.
- Repattern the movement
Whether the issue be lumbar extension, lateral flexion, or a bar path issue, you need to back off the weight and slow the movement down to where you can achieve proper form. For squats, this may mean adding a tempo to the eccentric and maybe even the concentric as well. For deadlifts, I wouldn’t recommend a concentric tempo, but you will need to regress the weight to a point where you can keep in a proper movement pattern. Something that probably needs to be included for many is improved bracing mechanics, as the issue could be that you are not bracing your core correctly through these movements. I’m sure you wanted an easy fix, but it doesn’t exist, and having a knowledgeable Chiro or PT than can help guide in this process is extremely beneficial. The two things I will leave you with is this QL lacrosse ball stretch that I posted on my Instagram a while back that has relieved the back pain of many people I know, so this is always worth a shot for a short term fix. The other is my go to for teaching breathing and bracing mechanics, and if you find that you have a lot of trouble performing this, it is probably safe to assume bracing is one of the components leading to your back pain.