|By: Alex Carnall|
Probably more common than any injury in my experience has been clients presenting with low-back pain. There are tons of “rules of thumb” expressed as common knowledge or coaching cues that hold no more than face validity and are actually hurting people instead of protecting them. Since this article is going to be published to people who may not be looking purposely for information on the topic, I will try my best to keep it brief and pertinent to strength training. More specifically, with a high focus on injury prevention as opposed to diagnosis and correction – which admittedly are things that I’ve yet to learn lots about.
What I will do is present two general concepts. As always I have AN answer and not necessarily THE answer. So before anyone jumps down my throat on comments or anything, I want to say that these are two of many things to consider.
Concept #1 – Patterned muscle length pathologies.
If you’re familiar with either the late Dr. Vladimir Janda, or the Postural Restoration Institute, you already have a leg up on this idea. Basically these are the most influential thinkers of their time (PRI being the more recent) in terms of this first concept. Janda broke the ice by taking a more holistic look at the human body and the way it moves by conceptualizing the notion that our body operates as a system, and not just a series of segments.
Too commonly do I see people – even AT’s and PT’s – trying to address injuries and problems segmentally (structurally) without stepping back to see what other contributing factors may cause it.In actuality, localized pain is typically a symptom of dysfunction that is really occurring globally. In other words, there is some kind of structural imbalance or problem occurring away from – but is manifesting as pain in – the low-back. Therefore the problem may be acutely mitigated, but not resolved by addressing the area where the pain is experienced.
Janda proposed the idea of upper and lower crossed syndromes, UCS and LCS respectively. The general concept is 
outlined by the image below: For the sake of this article, we need merely give our attention to the bold text. There are common areas where people are uninhibited or overactive (dominant) and areas where people are consequently weakened or inhibited. Without getting into too much detail about specific muscle groups etc. in the diagram, we can begin to understand why it can be problematic.
outlined by the image below: For the sake of this article, we need merely give our attention to the bold text. There are common areas where people are uninhibited or overactive (dominant) and areas where people are consequently weakened or inhibited. Without getting into too much detail about specific muscle groups etc. in the diagram, we can begin to understand why it can be problematic.
Typically an experience of pain may be onset by muscles that are either too short or too long. Or weak, as people say in the biz.
For example, many folks lack the ability to fire their glutes, and as a result become short and tight in the hamstrings which can pull on the lower back. In other instances, people may have overactive rectus abdominus musculature which can shorten the anterior part of the trunk and cause long hamstrings which in turn allow the erectors and spine to shorten. Both scenarios express as pain.
All of our muscles work in anatomical trains. Remember what I said before about looking at the body as a system as opposed to a series of segments. Patterned imbalances can be the result of poor posture, programming, or just laziness.
Posture – Dr. Stuart McGill says “The best posture is the one that is constantly changing.” Staying in the same position for long periods of time prepares us to be patterned in that manner, and our breathing cements these bad patterns.
Programming – If you are consistently using workout routines that do not challenge you to move in all three (saggital, frontal, transverse) planes of motion, or balance your pushing and pulling, you are doing yourself a disservice.
Laziness – If you improperly hip-hinge to pick up heavy things, or use otherwise poor technique and form (strategies as Dr. Janda would call them) when training, you are putting yourself at risk. You have to fire locally (from the core) before you operate globally or distally (with the extremities.)
My major piece of remedial advice on this first concept is two-fold. Along with this food for thought, I encourage you to consider the following.
1) Clean up your act when you’re training: Don’t get lazy when it comes to form. A lot of people who are into crossfit and other types of high volume training (excess for the sake of excess) typically will try to “get it done” vs. get it done properly. Mike Boyle would encourage you that if you must train to failure, train to Technical Failure. This is the point where your form STARTS to deteriorate. Rack the bar, swallow your pride, and reduce the load. Also – consider the ratios of pushing and pulling in your programs, both upper and lower body.
2) Perform a little maintenance work with self-assessment and foam rolling: Take note of how your body feels when you move. Think about the above diagram and consider whether you’re firing in all the right places or not. If you honestly answer no; try some activation drills on inhibited muscles to get a better, more efficient, stronger lift. Also if you’re feeling some tightness, forget about your 10th and 12th Friday sets of cable flies and do some stretching/foam rolling. Make note of trigger points (or knots) and work on areas above and below those as well.
Concept #2: Training within a neutral spine zone.
One of the things that absolutely make me cringe when I’m watching people train is when they let their back sag during prone exercises – if I’m responsible for them, I don’t let it happen. Planks, pushups, back extensions, and eccentric-based core exercises are the worst for this. Flexion based core exercises are also a huge problem as they relate to this concept – and in my opinion should be banned.
The purpose of your core (trunk/superior hip) musculature is to protect the spine as it is meant to be in its natural position. A strong core allows us to maintain better local stabilization to allow for strong controlled distal movement, 
while keeping the spine in a natural position.If we lie on the floor and repeatedly flex and extend our spine, we are doing much more harm than good in the long term. There are only so many cycles of flexion and extension we can endure before something inevitably slips. Think of your intervertebral discs as a sandwich where the vertebrae are the bread. Bite the front of the sandwich and all the goodies discs go squeezing out the back. The same applies to hyperextension. Either way that’s a lame sandwich. Now I understand that flexion and extension are inherent in competition and we will be exposed to them either way, but we canat least avoid/limit them in training.
while keeping the spine in a natural position.If we lie on the floor and repeatedly flex and extend our spine, we are doing much more harm than good in the long term. There are only so many cycles of flexion and extension we can endure before something inevitably slips. Think of your intervertebral discs as a sandwich where the vertebrae are the bread. Bite the front of the sandwich and all the goodies discs go squeezing out the back. The same applies to hyperextension. Either way that’s a lame sandwich. Now I understand that flexion and extension are inherent in competition and we will be exposed to them either way, but we canat least avoid/limit them in training.
Keeping in mind that the spine has 3 segments, we can understand what proper alignment looks like. Cervical, Thoracic, and Lumbar spinal vertebrae are all subject to either rounding (kyphosis) or extending (lordosis.) In addition, we should understand that too much flexion or extension can also occur in each of the three spinal segments. However, in this case we are concerned with the low-back/lumbar spine.
Lumbar lordosis is facilitated by anterior pelvic tilt; and posterior pelvic tilt will promote a kyphotic lumbar spine. Given this information, we can use either the position of the spine or the hips to determine whether the athlete needs correction. I have found good cues to be “tuck your tailbone underneath you” and/or “ribs down.” This helps to correct pelvic tilt and excessive lumbar extension pretty well, even if only until you can do any corrective exercises, or defer your client to another professional. You will actually feel some spinal traction when you correctly lengthen your spine. This means alleviation of compressive forces on the discs and a feeling of more “space” in your back.
With that in mind, once we are able to establish neutral spinal alignment, we can worry about what types of core exercises do fit the new model. I’m generally ok with any types of eccentric-dominant or isometric core exercises. Ab wheels, swiss ball rollouts/”stir the pot”, plank variations, chops/lifts, etc. Anti-extension and Anti-rotation exercises like TRX Fallouts, Body Saws, or Pallof Presses make great choices too.
-Alex
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