Low Back Pain - Types and How to Fix it

Low back health is an item of particular concern for men and women of all ages. According to work done by Maher and Underwood, “Pain in the low back is second only to foot problems in order of incidence in humans throughout their life span.” All humans are at risk of developing low back pain due to a plethora of reasons that range from genetically inherited to chronically developed. Congenital issues include scoliosis, incomplete closure of the neural arch, and spondylolisthesis. These inherited issues can lead to aggravation of biomechanical complications. For example, one may not know that they have spondylolisthesis, besides a small low back postural distortion. However, this condition becomes apparent when a twist or blow to the low back causes the issue to present itself through rapid vertebra displacement. Biomechanical issues that develop over time are due to repeated stressors such as muscle imbalances or repeated strains or sprains within the lumbar spine region. Traumatic low back stressors can also cause these muscular imbalances and range from strains and sprains to fractures and contusions. The best way to sustainably overcome these issues in the long term is to develop a training program that integrates activity and proper strengthening and lengthening of the right muscles surrounding the low back.

When considering training and fitness prescription for individuals with low back pain, many ideas must be considered. First and foremost, the activity level of the client must be understood. According to Principles of Athletic Training by William Prentice, obesity is one of the main causes of low back pain. Activity levels are a major part of the low back pain equation. In a study done by Hans Haneweer and colleagues, it was discovered that there is a U-shaped correlation between low back pain and activity levels. This means that at the lowest ends and highest ends of activity level, there was substantial low back pain. As a practitioner, it is important to understand the role that activity levels play in low back pain.

Second, it is important to understand muscular imbalances and their role within the low back pain epidemic. Stretching and strengthening both play a role in healing the low back, however these techniques cannot be applied indiscriminately. There are advantages and disadvantages to both pathways. For example, constant lengthening of the anterior portion of the core can lead to a lack of stability throughout the core which leads to increased back pain. These anterior core muscles include the transverse abdominis, rectus abdominis, and hip flexors. However, specific muscles can be chronically tight and need to be lengthened. Examples of this may include the hamstrings and the muscles of the low back such as the extensors which may be chronically tight due to long-term sitting. In contrast, the gluteus maximus and the abdominals may become chronically lengthened due to sitting and need to be strengthened to restore proper muscle balance. Overall, it is valuable to understand the length of the muscles that surround the core within a particular individual. This knowledge is achieved through testing and repeated observation by a practitioner. This allows one to determine which muscles need to be lengthened and which need to be strengthened.

To simplify, in Principles of Athletic Training by William Prentice, a blunt guideline is put forth. According to this text, back extension exercises that strengthen the back extensors should be used when back pain is less when the client is lying down than when the client is sitting. This strategy should be used when back bending occurs with diminished pain, but pain is increased with forward bending. According to this text, lumbar flexion movements that build the strength of the abdominals should be used with the client has more pain while sitting than lying down or standing. This strategy is also particularly useful when the client has poor core stabilization and strength. Overall, testing is helpful, and often necessary, in understanding when to employ these strategies. However, one can essentially guarantee less low back pain when core musculature is strengthened at a dynamic level through movements like bracing and balancing with emphasis on core strength.

In my own work, I first ensure that no known congenital or structural issues are present. Once I know that the issue is muscular, I always ensure that testing is done that allows me to understand where muscular imbalances may be taking place. For example, an overhead squat assessment can highlight issues throughout the body that indicate postural distortions. Once specific distortions are highlighted, I will then design a program that helps to fix these distortions. For example, in the swimmers that I train, a common issue in this region of the body tends to be low back hyper flexibility. This is due to repeated movements such as the butterfly kick and breaststroke kick. These movements lead to an overall lack of stability in the core and a general predisposition towards low back pain due to muscular strains, stress fractures, and other related issues. The way that I prevent these injuries with these athletes is by isometrically strengthening their core whenever possible. This can include movements such as the low plank, any of the McGill Big Three movements, heavy loaded carries, and other isometric strengthening movements such as bracing and breathing techniques. Any movement that promotes core stability and awareness of muscular control within the core is beneficial in low back injury prevention.

In conclusion, most low back pain is fixable. Most low back pain is due to mechanical defects. According to Principles of Athletic Training by William Prentice, these defects are caused by, “faulty posture, obesity and faulty body mechanics.” All these issues can be fixed with a regular training and postural correction routine. For congenital and structural issues, one must see a doctor who can accurately diagnose and correct the issue. However, the patient still needs to understand that long term low back health only comes about through postural correction and dynamic core stabilization. One does not have to live with and suffer through low back pain. Corrective exercise done right can fix most of the low back issues that a huge percentage of our population chooses to simply live with.

Maher C, Underwood M: Non-specific low back pain, The Lancet 389(10070):736–47, 2017.

Heneweer, Hans, et al. “Physical Activity and Low Back Pain: A U-Shaped Relation?” Pain, vol. 143, no. 1, 2009, pp. 21–25., https://doi.org/10.1016/j.pain.2008.12.033.

Prentice, William. Principles of Athletic Training: A Guide to Evidence-Based Clinical Practice (p. 821). McGraw-Hill Higher Education. Kindle Edition.