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The Back is Usually not the Problem (Taken from Miller SWC and Hands On Inc. Suite 304 newsletter, Sept 2011)
Nick Rosencutter, CSCS, NSCA-CPT, CMT

Back Pain is something that is all too common today.  Everybody from their 20’s to their 70’s seems to have it at some time or another.  Many people just try to live with it and assume that its just there.  These people have been to chiropractors, therapists, specialists, trainers and the list goes on.  Regardless of these visits, the pain still remains.  Why is this?  There has to be a cause and a reason, right?
There is a cause and there is a reason.  What many people fail to realize (many health professionals included unfortunately) is the fact that there is a big difference between cause and symptom.  I have seen it time and again.  Client A went to see specialist B, who prescribed some pain killers and some random back exercises.  Pain killers treat the symptom of back pain temporarily.  Random back exercises do nothing but add fuel to the fire of the symptoms.  When it comes down to it, the fact of the matter is the following.  You can treat symptoms all day long, but if you never find and get rid of the cause, the symptoms (back pain in this case) will never go away.  This is the same thing that goes on with a lot of knee issues.  Want to get rid of your back pain? Find the cause and address it.
That being said,  I work with a lot of people who have back pain and have successfully helped a lot of people get rid of it. I have also been around people and have studied work of people who are really good at fixing back issues (like really really really good.)  There are many things that can contribute to back issues in various individuals.  (Note that I said individuals.  Every individual has their own individual weaknesses and needs; therefore, cookie cutter exercise programs that you see in magazines, classes and television will not help every individual and often times can make issues worse.)  Without further ado, lets get to the top causes of back pain that I have come across in both hands on experience and studies. As I just said, different individuals might have certain issues that follow and others might have other ones.  This is why assessment and individualized training is so important; and also why many group classes and exercise videos are not all that wonderful for preventing and/or getting rid of back issues.

Excess Movement in the Lumbar Spine
The lumbar spine (low back area) is not designed for excess movement.  It is meant to be relatively stable.  Many people move incorrectly way too much through their low backs and end up causing lots of excess stress that should not be there.  Be it daily activities or improper exercise choices, too many people are moving where they shouldn’t be.  Some of the following contributors will explain why this tends to happen.

Poor Movement Patterns
This kind of ties in with the first point but will expand into the rest of the body.  Many people (probably about 4 out of 5 people I come across) simply have absolutely no clue how to move properly.  Picking things up, sitting down, standing up, walking, performing exercises, moving in sporting activity and the list goes on.  People in our society have developed movement stupidity.  Ideally, you want to move well through the hips (and have appropriate stability in certain situations), thoracic spine (upper part of back) and ankles while maintaining stability in the lumbar spine, knees and scapulae.  However, instead of moving through the hips with proper low back position locked in to pick things up, people flex their low back with no hip movement to speak of and repetitively damage their spines over and over again throughout the day.  Once people learn how to move properly while using the right muscles at the right time, back pain usually subsides.

Stiff Hips and Thoracic Spine
Either as a cause of the first two points or as a result of them, many people have stiff hips and a stiff thoracic spine.  When you can’t move here, guess where you move? You move through the low back and put excess stress there.  Once someone develops better range of motion in their hips and thoracic spine, their lumbar spine will be spared and pain should subside.  It is a matter of balance among joints and areas of the body. If one area has to take too much stress, something is bound to give at some point.

Poor Exercise Programs
Probably about 95% of the population has absolutely no clue why they do what they do with their workouts and are doing more harm than good for themselves. They go to the gym and do random useless exercises with no rhyme, reason or understanding for any of them.  This is a problem.   We know that we need stability in the lumbar spine yet tons of people continue to train it to move.  Crunches, stretches into extreme ranges of spinal flexion and extension, twisting through the lumbar spine, rounding the back and the list goes on. We need to stop training this area to move and teach it be stable.  This has been proved time and again in the research.  One problem is the fact that media and misinformed health professionals give people the wrong information and they don’t know any better.  Stop stretching and moving excessively through your lower back!!  Now this does not mean that there should never ever be any motion through the low back; obviously its going to move.  The point I am trying to make is that excess, repetitive motion through the area is not desirable.  Enough repetitive bouts of lumbar flexion is actually one of the top causes of disc herniations.  Once you have the motion that is normal in this area, you do not need to overdo it further.  If you do lack a certain range of spinal motion, then you better get it. 
Most exercise machines also contribute to issues as they teach the nervous system inappropriate movement and build upon any imbalances and movement issues people already have. I’m going to elaborate on this point with an example.
  
     Lets take a look at Bob. Bob has a rotated pelvis, lacks hip mobility and lacks it worse on one side.  He can’t stabilize his low back for the life of him.  Bob decides that he wants to work out and get in shape so he joins a gym.  He has no idea what to do so he goes to some random leg machine that he sees at the lovely commercial gym he joins.  He gets on this leg machine and starts to “squat” on it.  Well, with Bob’s rotated pelvis and lack of hip motion, this machine (that has a set path of motion that Bob’s body is not designed to move through) creates excess stress through the areas that are overloaded because of Bob’s postural issues.  Instead of getting in shape, Bob gets hurt and creates a whole new cascade of back pain for himself.  Since his hips don’t move, his pelvis is stuck in rotation and his back is unstable, the set path of motion on the machine reinforces these faults and causes an overload of tissue stress in certain areas.  What Bob likely needs is some very specific exercises, stretches and tissue work to fix the muscular imbalances and movement faults that he has. Random workouts on random machines with no rationale will not take care of these things.
 
    Movement patterns, stability, coordination and balance all need to be addressed within an exercise program.  Performing multi joint, free motion movements including squatting, pushing, pulling and locomotion variations all must be learned and trained in order to develop proper control and movement throughout the body.  Opposing muscle groups must be balanced out appropriately.  There is a biomechanically efficient way that humans are designed to move.  We are not meant to sit down on machines and move weights that are stabilized for us.  There are plenty of machines that have been clinically proven to damage spinal ligaments and discs (such as the torso twist machine.)  Learn how to move and train with a purpose.  EVERYTHING comes down to proper movement.  If you are not training it, you are missing out, big time. This is not to say that every single machine ever created is terrible and should never be used.  It is just that the correct ones need to be implemented at the right time and for the right reasons. 

Weak Gluteal Muscles and Stiff Hip Flexors
The glutes are very important when it comes to back issues.  Many people go through their days with glutes that do not even fire. It is a condition that is known in certain circles as gluteal amnesia.  In our society, sitting is a very common occurrence day in and day out.  When you sit for prolonged periods of time, the muscles in the front of your hips, or hip flexors, gradually stiffen and eventually shorten. It actually only takes about 10-15 minutes for tissues to begin to adapt to a position so imagine what happens when this is done for hours and days on end.  One of the major hip flexors, the psoas, has attachments to the lumbar vertebrae in the lower back.  When this muscle is stiff, it can pull on the lumbar area and cause stress and pain.  When various hip flexor muscles are stiff, they can put the pelvis into anterior tilt, which basically means that they rock it forward.  When the pelvis is in this position, the glutes shut down and are not able to do their job effectively, and an excessive curve develops in the lower back, causing constant stress on the muscles and passive tissues of the low back.  If the glutes aren’t doing their job, the low back has to take up the extra slack.  So, imagine combining this problem with the movement issues mentioned earlier and the other issues that will follow, and you can see where the back pain can come from. 

    To add fuel to this fire, many people who are in anterior tilt are misdiagnosed with stiff hamstrings and are told to stretch them.  With the anterior tilt of the pelvis, the hamstrings are already on stretch; thus, doing this makes the problem worse.  The hip flexors are the muscles that need to be stretched and the glutes then need to be turned on and strengthened.  (If this is the issue for an individual; everybody is different)

Weak and Improperly Trained Abdominal Muscles
Many people have terrible endurance and stability in their abdominals. Having endurance in the abdominal wall helps to provide the necessary support for the lumbar spine and prevent pain and injury.  The abs need to be trained to stabilize a neutral spine and properly control pelvic movement, not to flex the low back and round the shoulders forward as is done with crunches and poorly performed situps so often (ties in with poor movement patterns.)  If you take anything away from this article, please do yourself a favor and stop wasting your time and making yourself worse off with crunches (at least the way most do them; there is an effective way to perform them IF they are for some reason needed).  Learn to train all different sections of your abs with effective exercises that train them to stabilize and work in conjunction with other muscles.  Exercises that train anti rotation, anti extension/flexion and neutral spine leg movement should all be included.  Planks, side bridges, leg lowering, carries, chops and rollouts are just a few effective ones.
 
    An exercise like the crunch trains the rectus abdominis (the six pack muscle).  Because of too many exercises like this and hunched over, rounded forward postures throughout the day, many people already have a shortened and overbearing rectus with a depressed rib cage and shoulders that are rounded forward.  Why then would you want to make this worse by doing crunches and exercises that promote bad shoulder posture?  Not only that, but the movement of a crunch has absolutely no carry over to any other activity in life.  Finally, the way many people perform rectus exercises involves flexing the lumbar spine excessively.  Dr. Stuart McGill has done probably more research on back health and performance than anyone and he has found repeated lumbar flexion (thousands of cumulative times) to be a major cause of herniated discs. (McGill, Low Back Disorders, P. 45) In many people, it is the external obliques that need to be focused on.  This muscle can be trained with many effective exercises including leg lowering variations and anti rotation variations.  To sum this section up, train the abdominals to stabilize the lumbar spine, not move it.  (Unless you want to create back issues of course).  The abs and pretty much all muscles need to be trained to perform specific tasks, not just trained to be trained. 

Poor Endurance in the Low Back Extensors
Some people have poor endurance in their lumbar (low back) erector spinae muscles in addition to their abdominals.  This sacrifices stability in the area and puts more stress on the passive tissues (discs, vertebrae, ligaments, etc.). 

    It is also important to have a strong back.  Having weak back musculature will only make it easier to sustain injury.  The stronger you are (and this carries over to any area of the body), the less energy you have to use for smaller tasks; thus, decreasing the risk of injury with everyday movements. 

Poor Diaphragm and Inner Core Function
The outer abdominal muscles such as the obliques and rectus abdominis are great; however, it is some of the deeper core muscles that really help to develop proper stabilization around the spine.  The diaphragm is a very important muscle to have functioning properly and in many people that I have worked with, it is not.  From back pain to hip instability to neck and shoulder tension, when the diaphragm slacks, many things and systems throughout the body suffer as a result.  The diaphragm should be the primary breathing muscle. If it is not functioning properly,  other muscles must take up the slack and unbalanced stress and strain occurs.  If yours is working properly, your stomach should expand out nicely when you breathe with limited elevation of your rib cage and chest.  I’m not going to go deeper into this one right now as you are probably tired of reading already anyway, but diaphragm function is a big big deal. 

As you can see, almost all of the problems mentioned don’t even deal with the back itself.  It is usually the areas surrounding the low back that are the problem.  Take care of these surrounding problems and watch the pain run away.  Learn how to move appropriately, fix imbalances that you have and address your individual weaknesses.  This is the way to ultimate back health and performance. 


About the Author
Nick Rosencutter is a Certified Strength and Conditioning Specialist and Certified Personal Trainer through the National Strength and Conditioning Association and is also a nationally Certified Massage Therapist.  He received his Bachelor's degree in Exercise and Sports Science with a Fitness emphasis and Strength and Conditioning Concentration from the University of Wisconsin La Crosse and received his diploma in Massage Therapy from Lakeside School of Massage Therapy in Milwaukee.  He has worked with all varieties of clients ranging from fat loss to various levels of athletes and is also a competitive powerlifter.  He currently trains clients at Southridge Athletic Club in Milwaukee and offers corrective exercise and movement training at Miller Sports and Wellness Chiropractic in West Allis.  You can learn more at his website www.rosencutterultrafitness.com  

Milwaukee Personal Training, Strength & Conditioning, Fitness, Fat Loss, Performance Enhancement, Corrective Exercise