At some point in life, we all suffer from back pain.  For many, it is only a short term problem. But for some, it can be a crippling ongoing issue.

In brief lower back pain is a growing health problem worldwide affecting people of all ages and backgrounds. Back pain is the single leading cause of disability, preventing many people from engaging in work as well as other everyday activities.[1] Experts estimate that up to 80% of the population will experience back pain at some time in their lives. [2] Lower back pain can be categorised as acute, sub-acute, or chronic. Several risk factors have been associated with it such as occupational posture, obesity, depression, sleep, breathing abnormalities and the list continues. This is why the cause for lower back pain remains obscure and diagnosis difficult to make as so many factors can be taken into account. What is important to bear in mind is given these facts it is likely that the spine will be at a greater risk of injury within the training room if it shows movement limitations which is generally the problematic area for the majority.

Therefore for this article, we want to discuss one common finding of lower back pain in relation to training and in particular with squat and hinging movements such as the Olympic lifts, kettlebell swings and deadlifts. Within the training environment, lower back injuries are very common amongst the weightlifters and functional fitness athletes. The great demand for flexibility, mobility and control plays a crucial part in minimising the risk of injury [3,4] and far too often the volume and intensity of work is rewarded over the quality of work (i.e rounds for time or AMRAPs reward volume and not quality, testing maximum loads reward intensity and not quality of movement).

One common finding is hamstring tightness and the lack of mobility that goes with it. Having tight hamstrings will impact squats and hinging movements. The hamstrings can be seen as the fast twitch powerhouse of the posterior chain muscles due to their size and muscle fibre makeup. But in order to recruit them efficiently and effectively, the movements must be performed with perfect technique both under load and with no load.  Movement quality needs to become the number one focus in the gym if the goals of the client are performance, health and longevity. It's not rocket science, the athlete who can train the best movement quality will have fewer injuries and a long career in the sport which means more quality time in training and less time on the sidelines.

For example, the end range of hip flexion dictates the depth of your squat and therefore the degree of the pelvic tilt and of spinal flexion. The problem is when this posterior tilt of the pelvis and flexion of the spine becomes excessive, especially when an external load is added (picture the person that has a rounded back & butt wink during the eccentric phase of a squat) because it will dictate the load being placed on the lower back.  If someone can not squat with correct form when they are unloaded, why would we want to start adding weight and increasing the likelihood of injury? Should we not focus on improving the health of the lower body joints before we start adding load?

If your squat looks like this, it's a good indication that you have hamstring tightness. The hamstring is a big muscle divided into three groups, known as the semimembranosus, semitendinosus and biceps femoris that run down the back of the leg. So there can be a lot of tension in various parts of the hamstrings to address. The following two stretches provided can help you to improve your hamstring mobility and target the best line of tension for yourself. These mobility exercises will help to reduce tension in the lower back while increasing active range of motion in the hamstrings.

As a caution, both are best performed separately from heavy training sessions as they will fatigue to CNS (central nervous system) putting you at greater risk of injury. Having said that they are great for separate mobility work and post-training session.

A1) Hamstring PAILS & RAILS Stretch

2 rounds, Hold the passive stretch for 2 mins, then build up the PAILS contraction to your safest and greatest effort and hold for 15-20sec, immediately followed by 15-20sec MAX effort RAILS contraction, without coming out of the stretch find the new passive stretch, hold for 30sec before repeating for round 2.

B1) Hamstring Eccentrics

2 sets each side, 5 reps of 5-10sec eccentric, 70% - MAX irradiation

References:

[1] The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases,  Hoy D, March L, Brooks P, et al. 2014

[2] Epidemiology and risk factors for spine pain. Neural clin. Rubin DI. 2017

[3] Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit, Montalvo, A et al. 2017

[4] The nature and prevalence of injury during CrossFit training, Hak, PT et al. 2013

Comment