THE PROBLEM

Low back pain is globally pervasive.  60-70% of people experience low back pain at some point in their lives (World Health Organization).  Nearly 600 million people had low back pain in 2017 (Wu et al, 2020).  So why is low back pain so common?  Why do people have recurrent episodes of low back pain?  If there was a simple answer then we would already have a solution.  The causes of low back pain are diverse.  The obvious answer is the increased duration of sitting, driving, computer/desk work, and overall reduced activity level.  These sedentary changes lead to an increase in harmful spinal loading.  In addition to sitting, there are several non mechanical factors that drive back pain including stress, sleep, diet, and systemic inflammation.  Long story short, back pain is common and the drivers of pain are diverse.  

A common misconception is- the incident that lead to the start of back pain, is the cause of back pain.  For instance, you bent over and picked up a shoe and had sharp back pain.  It is not the single incident that caused the pain.  That incident was the boiling point where the tissues gave out. The process typically starts with repetitive poor movement and coordination.  Those repeated bouts of poor movement then lead to accumulative harmful load to the spine.  Lastly, there is one final incident (i.e. picking up the shoe) where the tissue can’t withstand the loads anymore and pain/injury develops.

Even though each case of low back pain is unique, we can really boil low back pain down to a few drivers.  These drivers of pain are common among all those with back issues.  What differs is which tissue eventually breaks down and causes pain, and the presentation of pain and symptoms.  But there are over arching dysfunctions of back pain in all individuals.  What we are going to discuss today are the pillars of dysfunction behind low back pain and how to address them.

THE PATTERN BEHIND ALL BACK PAIN

A simple explanation for low back pain is that the areas around your low back become stiff or restricted (thoracic spine and pelvis/hips) and the low back becomes weak.  Then when you load your spine (running, jumping, lifting weight, etc) the load is not evenly distributed to your system.  Instead the load all goes to you back.  You can get away with this for a while but eventually the lumbar spine (low back) will give.  

So what is the basic solution?  Improve mobility of your thoracic spine (mid back/ribs) and hips/pelvis.  Also, improve “core” strength.  Lastly, retrain common movement patterns (squat, walk, lift, carry) with the goal of even distribution of load to your system vs a spine dominated movement pattern.  

Seems simple right?  Often it can be.  Take away irritants (poor sitting or sleep posture, poor diet and stress) and address the above mentioned attributes.  If you follow these steps below and your pain persists that is where you reach out to a medical provider.  Capacity Performance Therapy would love to help.
FINDING YOUR DYSFUNCTIONS

TESTS and FIXES

MOBILITY

• Standing Toe Touch

  • Test

    • Stand with your feet together and attempt to touch your toes letting your neck and low back round

    • Keep knees straight and limit sticking your butt backwards

  • Goal: 

    • fingers to ground with no symptoms and symmetrical leg tension

  • Requirements

    • Ability for the back side (posterior chain) to lengthen

    • Ability for the front side (core/hip flexors) to pull the system downwards

  • The Fix:

    • Bottoms up (video below)

Thoracic or Mid Back Extension

• Test

  • Lye on your back with your knees bent

  • Can you raise both your arms over your head with elbows fully locked out having your hands touch the ground overhead

  • Can you do that without arching your low back or flaring your ribs up towards the ceiling

• The Fix

  • Hands and Knees Thoracic Extension (video below)

HIP AND CORE STABILITY

• Single leg bridge test

  • Here we are seeing if you can extend or lift up through your hip without your low back or hamstring compensating

  • Can you use your glutes vs your hamstring/spine to move your hips

  • Test

    • Start on back with both knees bent

    • Slowly lift butt up into air with both feet on the ground

    • Once at top of lift, raise one leg up into the air a few inches so you have to hold the position with only one leg

    • Can you hold 20-30sec without your hamstring cramping and without low back tension

    • Repeat on the other side

  • The Fix

    • 80/20 bridge hold with breathing (see video below)

Plank Test (Bunkie Test)

• Can you hold your body weight in a “neutral” position in all different planes of motion

• Do you have the ability to maintain a stacked and efficient system for prolong periods of time WHILE maintaining breathing through your nose

• Test

  • 30sec holds without losing alignment in all directions of a plank

  • Right side down side plank, left side down side plank, backwards plank facing the sealing, and face down plank

  • The goal would be to do all 4 position for 30sec on each leg (one legged)

• The Fix

  • The test and the fix are the same

MOVEMENT TRAINING

• Hip Hinge Training

  • Now that you have the basic mobility and stability, do you know how to move in a spine friendly manner

  • The hip hinge is the pillar of movement where you can create force from your strongest muscle (glute max) and limit spinal loading

  • Hip Hinge Training with Dowel (video below)

• Hip Hinge Posture Hold (video below)

WHAT TO AVOID

The general rule of thumb holds true of everything in moderation.  Sitting with bad posture isn’t harmful if done within moderation.  Having a stand up desk can actually be harmful if all you do is stand all day while working.  The goal is to find a balance.  The saying of the best posture is a variable posture is true.  But it is important to have some framework of efficient posture.  An efficient posture will unload tissues, promote recovery, and allow for proper mobility.  When we sit or stand for long durations with poor posture we develop inhibition, loss of motion, and overall inefficiency.  Long term these issues can lead to pain.

Check out this quick video on some basics for sitting posture education:

(video below)

HOW TO KNOW WHEN TO SEEK MEDICAL ASSISTANCE

I hope you got something out of this blog.  My goal was to help you appreciate that the lumbar spine pain is complex but the solution can often be simple.  Don’t overthink things.  Address basic mobility and strength, reduce negative stressors to the system, and keep moving.
If you follow this advice and issues still persist, seek some medical advice.  Capacity Performance Therapy in Bend, Oregon would love to help.  If you have pain going down the leg, vague pain that doesn’t change, or progressing pain then seek help.  These symptoms will not resolve with rest or a quick stretch.  There is a unique driver that needs to be addressed.

Reach out anytime with questions or concerns to nickh@capacitypt.com or 541-224-7485