Causing and preventing lower back pain
by Dusty Feldman, CPT · May 27, 2009

Approximately 80 percent of Americans will suffer from lower back pain during the course of their lives, and roughly 25 percent of Americans are in pain at any given time. Sooner or later, most people are going to injure their backs. For most individuals it will be the most nagging pain they will ever experience.

Most low back pain can be divided into extension- and flexion-based back pain. Extension-based back pain is typically worse with standing and is seen more in athletes. Flexion-based back pain is typically worse with sitting and very common among office workers. Flexion-based back pain will be the main focus of this article.

Sitting at a desk all day causes musculature in the hips to become very inactive and weak. Poor function in a hip flexor muscle (psoas) leads to a rounding of the lower back instead of using the hips to get up from a chair or picking up a box from the ground for example. This rounding or flexion at the lower back puts stress on the low back that is not natural. A simple, yet effective, way to combat this problem is to take a break every 20 minutes, get up and move around.

Posture is another very common contributor to low back pain. Poor posture often is a result of tight and or inactive musculature around the hips. We can develop exaggerated curves in the spine leading to a hunched over position at the mid or thoracic spine. Over time, this can contribute to a forward head posture. Poor posture radiates toward the extremities such as our arms and legs directly from the hips. In the lower extremities, we can develop rotational deficits often leading to low back, knee, and ankle pain. Poor posture cannot only lead to the feeling of a tight lower back but also shoulder pain, knee pain, neck pain, and ankle pain by putting more stress on these areas.

A common misconception is that stretching the low back is a way to help someone with a “tight” low back. Contradictory to this belief, a small amount of movement at the low back is normal. Encouraging extra movement or rotation is not helpful. Extra rotation and flexion stretches the fibers and ligaments of the low back leading to an unstable spine that could increase the likelihood of injury. In most cases, stop stretching the lower back. This may feel good at the time, but it is not a good idea for long term lower back health.

Diagnostic imaging such as magnetic resonance imaging (MRI) and x-ray are great for looking at someone with lower back pain; they can produce images of the spine that the naked eye can not see. Medical imaging displays how muscles appear, not how they function. Function and anatomy are linked, but function can decline long before anatomic changes will occur. In other words, the problem is not the low back but the inactive and tight musculature that surrounds the structure. While massage, ultra sound, and targeting the injured area helps, increasing strength, improving movement patterns, improving tissue quality using a foam roller, and improving mobility is key for building this musculature and decreasing pain.

A major goal in training is to mobilize or promote movement at the hips, mid, and/or thoracic spine. This will promote stabilization the low or lumbar spine. Visit my site at www.FeldmanPerformance.comand look at the blog titled “Low Back Pain” for effective mobility drills to combat low back pain and incorporate activities into everyday life. We need to start becoming proactive in our efforts to alleviate pain. In most cases, low back pain is not something that needs to control our lives.

Dusty Feldman is a certified personal trainer (CPT) through the NSCA and has his Bachelor’s of Science in Fitness and Human Performance. He currently works at North Dodge Athletic Club in Iowa City and at Advanced Fitness in West Liberty. Any questions can be sent to him at Dusty@FeldmanPerformance.com. You can also check out his website and blog at FeldmanPerformance.com.