Let's kick off with some really alarming stats:
- 80% of people experience some form of back pain during their life.1
- That makes it the number one health problem in the world, the number one cause of disease, disability, lost productivity, and lost days of work.2
- That's because 60%-80% of that first 80% will have a relapse in their back pain within two years.3
- And yet, 90% of people don't know what causes their back pain, so what the hell is going on???4
A quick disclaimer before we dive in; I and we here at Core Advantage are not in the business of diagnosing injuries. We are not qualified to diagnose, we are not doctors or physiotherapists and don't play one on the internet. We always refer out to clinicians, physiotherapists, or sports doctors before starting any rehab process.
If you have any form of a back injury or complaint (or any injury for that matter), seek professional advice. This article is for educational and general interest purposes only, hopefully, by understanding what's going on in your body, you can get a better idea of what's going on with your injury and then better manage it in the future.
Please, if you have a persistent injury, seek medical advice.
The first type of injury is disc
These are typically caused by a combination of flexion and compression, which puts a rearward force on the intervertebral disc and stresses the rear disc wall. The best things to avoid for discs are prolonged sitting, sit- ups and crunches (these are wrong on so many levels), poor lifting mechanics, or deadlifts done without a neutral spine. Relatively speaking, they're pretty permanent. Once you've damaged the disc the damage to the annulus is pretty permanent.
But in saying that, if we look at people around the age of 45, 50-60% of people have some form of disc injury. The vast majority of those are asymptomatic; that means they have no pain and no problems. Which means disc injuries can be pretty well managed and often you won't even know if you have had one. With smart training and intelligent rehab, a disc injury can be a non-issue and you can live completely functional and pain-free life.
Extension Driven Injuries
On the flip side of disc injuries, we have extension based injuries, things like lumbar stress fractures, pars defects/fractures, spondylosis, and spondylothesis.
With extension injuries living in chronic extended posture puts stress on the facet joints, which ultimately leads to boney overload. The main driver of extension overload is an anterior pelvic tilt (more on this soon).
Whenever posture, movement patterns or muscles become compromised (due to a change in training volume, an injury, change in shoes, sport, etc) the muscles in the back are susceptible to having to work harder than they are used to, this leads to muscles laying down trigger points and becoming tonic, restricting movement, strength and potentially creating stiffness and pain.
Now that's not all the injuries but it covers a fair chunk of them, now it's time to take a further step back and look at the drivers behind these injuries in
The biggest of those reasons is an anterior pelvic tilt, which is a huge driver of extension and muscular overload type injuries.
The thing with an anterior tilt is it doesn't occur in isolation, it lives in a vicious cycle of doom. Your hip flexors tighten up from sitting, which pulls the pelvis into an anterior tilt, which lengthens the glutes out switching them off.
Then your back gets a little stiff and sore (or you do the wrong type of core training) and your deep spinal stabilisers like TVA and multifidus become inhibited and deactivate, making them weaker, further fueling the anterior tilt and tightening your lower back.
Secondary to anterior pelvic tilt is a thoracic spine locked into kyphosis.
If you can't extend or rotate through your rib cage, your body will compensate and send that motion and kinetic energy into the lumbar spine.
Your lower back and abdominals are supposed to be stable and rigid when we move, working as an anti-motion device. If it has to compensate and increase it's motion compensating for a locked thoracic spine, any one of muscular overload, disc injuries or extension based injury is on the cards.
Poor movement mechanics
If you are a bad mover, the glutes aren't going to be able to do their thing, heel striking when running is a classic example where the glutes are in a position of biomechanical disadvantage sending the ground reaction forces into the lower back.
Running isn't the only place poor movement quality shows up it can also be slouching, carrying around a heavy backpack (with the straps loose is particularly dangerous), wearing high heeled sneakers or shoes or simply sitting for extended periods of time.
As with every body part and area of injury, there is almost always a root cause or a lead domino whether it be an anterior pelvic tilt, excessive thoracic kyphosis, or faulty movement pattern that is creating and driving the symptoms you might be experiencing.
The lower back is very much the alarm bell that tells us something else in your kinetic chain or lifestyle is faulty and needs a systems check.
The last thing to be across when it comes to back pain is the idea of central sensitisation, instead of me trying to explain, you should just go watch this TED Talk by Lorimer Moseley on the topic it's funny, brilliantly explained and such a powerful concept to help understand pain, especially in chronic situations.
For more on Lower back, posture, and anti-desk check out our YouTube playlist
- Sayre C. 2011
- National Institute of Neurological Disorders and Stroke 2014
- Chiodo A.E et al (year unknown)
- American Academy of Family Physicians 2007