There are few musculoskeletal disorders out there that are as common as lower back problems, and every year people spend millions of dollars on pharmaceuticals, chiropractic interventions, and rehabilitative programs in an attempt to regain the great feeling it is to have a well-functioning body. Not surprisingly, many office workers experience some nagging back pain from time to time. However, it’s not just the relatively sedentary population that suffers. Many gym goers, athletes, and fitness enthusiasts also struggle with their lower back and their progression suffers as a result. For some, mild pain only appears occasionally, but for others, lower back pain can become chronic and thereby seriously dampen the quality of life. But why is it so? Are back problems just a normal part of the ageing process – or perhaps just a natural part of being human? No, of course not. As with so many conditions and disorders that the modern man struggles with, the underlying cause of chronic back pain is a mismatch between our ancient physiology and the modern, sedentary lifestyle.
Stone age bodies in the modern world
Prolonged sitting for hours each day (often in a hunched position), imbalanced training, and poor exercise technique are the primary reasons the modern office worker struggle with disorders that were unknown to our physically active prehistoric ancestors. So, it seems obvious that a natural step for reversing this trend is to return, at least partially, to the types of physical activity patterns we are best adapted for. However, while walking more, emphasising an upright sitting posture, and emulating ancestral human activity patterns will certainly help people with lower back pain, it’s usually not enough to see significant results.
This is the same outcome many people experience when they change their way of eating from a processed western diet, high in sugar, refined fats, and processed grains, to a diet that consists of nutritious whole foods. They definitely see results, but simply adopting a traditional, whole foods diet often isn’t enough to get the desired health benefits. In other words, after years of abuse, metabolic and hormonal issues could be the reason you’re not seeing optimal results from changing to a healthy diet. Perhaps you need specific supplements or foods, or perhaps you should be eating a carb-restricted diet as a way to treat your insulin resistance. The message here is that simply returning to basics isn’t always enough.
These same principles also apply to lower back pain. Although emphasising good sitting posture and generally being more active are a good start, a more hands-on approach is necessary to really treat the underlying issues. And this brings us to the main theme of this post. As any experienced coach/trainer will tell you, proper training is important not just to prevent back problems, but it should also be an essential part of the treatment plan. But here’s the problem: A lot of people assume that their lower back pain is caused by a weak back musculature (primarily lumbar erector spinae), and they end up going to the gym doing exercises that specifically target the lower back. But should the treatment of lower back pain really be focused around back training?
Are you exacerbating your condition?
There are many possible causes of lower back pain, but there are also some common ones that characterize a large percentage of cases. While specifically targeting the lower back musculature with “heavy” strength training can be beneficial for some, I’ve found that for the vast majority of people, doing back extensions/hyperextensions (often with a flexed spine), the lying superman, and other exercises that specifically target the back is counterproductive. Why? The answer quickly becomes clear when we take a look at how most cases of back pain actually develop: Years of sitting (in a flexed position), years of imbalanced training (generally, quads and lower back are trained more frequently than glutes and abs), and/or years of poor movement patterns in the gym and daily life.
It makes little sense to treat lower back pain by going into the gym to do a bunch of exercises that are performed with a movement pattern that resembles the one that caused the issues in the first place. Clearly, you can perform back extensions more like a glute exercise, but that is not the way most people perform it. Rather, they go into spinal flexion during most of the lift and finish the contraction with hyperextension.
What you learn when you train people with lower back pain is that the thoraco-lumbar extensors are usually tight/overactive, while it’s the glutes and abdominals that are weak/inhibited. Actually, this is the expected observation, as all of the previous causes I mentioned (with an emphasis on prolonged sitting) promote a muscle imbalance pattern (The Lower Crossed syndrome) that is characterized by tight/facilitated lumbar erector spinae and hip flexors and weak/inhibited glutes and abdominals.
All of the common signs of this muscle imbalance pattern, such as excessive anterior pelvic tilt and a “bulging abdomen”, aren’t always present. However, if there’s one thing pretty much everyone with chronic lower back pain has in common, it’s that they have weak/atrophied glutes. That’s not to say you can’t develop lower back problems when you have strong gluteus maximus, medius, and minimus, it’s just not that common. Why? The gluteus maximus is the largest muscle we have, and the glutes can be thought of as the power center in the body.
People with strong and powerful glutes generally display good movement patterns and exercise technique (at least when instructed) and they have a healthy pelvic alignment (some people display signs of excessive posterior pelvic tilt, but this is much less common than ATP). However, people with weak and atrophied glutes often display poor movement patterns and exercise technique and generally fail to properly engage their glutes and abs during lifting, thereby putting excessive stress on their lower back.
Deadlifts and squats are often inappropriate for this training population (at least at first), as excessive anterior pelvic tilt and/or inhibited glutes typically result in one of the three scenarios:
- Spinal flexion during the entire lift
- Spinal flexion, hyperextension during lockout
- Overarching during the entire lift (exaggerated lumbar curve)
So, what does all of this mean? Clearly, one size fits all approach doesn’t exist, and there are many possible causes of lower back pain and several treatment protocols that can be effective. However, as discussed, lower back pain is more often than not characterized by muscle imbalance patterns, poor movement patterns, and poor posture.
As you know if you’ve been reading my articles, I’m a big fan of exercise when treating mismatch conditions such as upper crossed syndrome, anterior pelvic tilt, and lower back pain.
Naturally, a good first step for someone who experiences chronic lower back pain is to seek out a professional who can help them assess and treat the condition. However, there’s a lot you can do on your own. The following applies to everyone with lower back pain:
- Be more active
- Take small breaks throughout the day if you sit for many hours
- Emphasise good sitting and standing posture
Besides these general recommendations, ask yourself the following questions to determine if the stuff I’ve talked about in this article applies to you (I’m willing to bet that it probably does):
- Do you display signs of excessive anterior pelvic tilt, such as swayback and a “bulging” abdomen?
- Are your glutes weak? (They probably are if you’ve never paid specific attention to glute training)
- Do you have tight hip flexors?
- When doing back squats and deadlifts, do you feel the stress primarily in your lower back and quadriceps, as opposed to your glutes?
If you answered yes to one or more of the questions above, chances are the things I’ve outlined in this post applies to you.
What is the next step? Start the corrective process!
If your problem is lower crossed syndrome/anterior pelvic tilt, check out my 5-step plan for dealing with this condition.
If your problem is primarily weak glutes, check out my guide for building this important muscle group.
It’s important to note that you should do things in a stepwise fashion. Don’t jump in right away with heavy squats. However, to actually make a difference, you have to add appropriate resistance when you start to master the movements. Two safe, effective, and relatively simple exercises that most people with lower back problems are able to perform without issues are the RKC plank and the cable pull through. Squats and deadlifts are also great, but these exercises are clearly not suitable for everyone with lower back pain (especially at first). I can’t emphasise the following enough: Technique is essential. Whether you perform a properly performed squat or a poorly performed squat determines whether you’re aggravating or improving your condition.