Lower Back Pain Pt. 1

Hey everyone,

I've been slacking a bit, but this week I'm going to have a couple of posts for you all concerning the lower back (the lumbar spine). I'll be referencing and quoting Dr. Stuart McGill quite a bit in these posts. For those of you who are not familiar with McGill, he is one of the world's leading researchers of the rehabilitation, injury prevention, and performance of the lumbar spine. He is "the low back guy" in the fitness industry, and is the go-to person for anything and everything back related.

With that being said, I am embarrassed to admit that I got his book Ultimate Back Fitness and Performance about 8 months ago and I still haven't finished it. But my goal for the week is to finish the book, because I am seeing him speak at a Perform Better seminar this weekend in Rhode Island.

So here's part one of the low back series:

Stuart McGill often states to "spare the spine". Much of today's research in lower back health points to keeping the lumbar spine stable, while increasing mobility at the hips and the thoracic spine. However, even with all the research present, the average gym-goer is misinformed and continues to strive to create mobility in the lumbar spine.
This is one of the most common mistakes that I see take place at the gym. Deadlifting/Squatting with a rounded lower back, russian twists, lunging with twists, supermans, scorpions, etc. All of these movements compromise the health of your lower back. Shirley Sahrmann states in her book Diagnosis and Treatment of Movement Impairment Syndromes: :The overall range of lumbar rotation is ...approximately 13 degrees. The rotation between each segment from T10 to L5 is 2 degrees. The greatest rotational range is between L5 and S1, which is 5 degrees (pg. 61-2)." 13 degrees is an extremely limited range of motion (ROM) - why are we trying to mobilize a structure that so obviously craves stability?

The lumbar spine does not act as one fused structure. One way to picture how the rotation occurs is to think about how you would unscrew a nail. Each lumbar vertebrae rotates 2 degrees to its end range, and then the vertebrae directly above it proceeds to rotate 2 degrees, and so on and so forth. So if you factor in the 5 degrees of ROM from S1 - L5, and then the 2 degrees from every segment above that until you reach the L1 vertebrae - you get 13 degrees of total ROM.


That's about 15 degrees of range of motion to either side - now take a look at these next couple of exercises:








All of these exercises show an extreme amount of rotary torque at the lumbar spine with minimal movement at the hips. Here's a quote from Shirley Sahrmann from her book Diagnosis and Treatment of Movement Impairment Syndromes:

"Rotation of the lumbar spine is more dangerous than beneficial and rotation of the pelvis and lower extremities to one side while the trunk remain stable or is rotated to the other side is particularly dangerous." (Sahrmann, pg. 72)

Rotating past the end range of the lumbar spine will stress and twist the ligaments and the facets that support the lower back. We have to evaluate the way we train the "core". Rotation IS a movement that occurs in everyday life, but people get so caught up in "isolating" that they limit the rotation to only the lower back. Herein lies the problem - we must realize that the "core" is not just the abdominal/low back region, but also includes the hips and the torso. Strength coach Mark Verstegen refers to this area as "the pillar", where the transfer of forces between the upper and lower extremities takes place. Here are two quotes from Sahrmann and McGill:

"During most activities, the primary role of the abdominal muscles is to provide isometric support and limit the degree of rotation of the trunk which, as discussed, is limited in the lumbar spine." (Sahrmann, p. 70)

"...elevated risk from very high tissue loading may occur when the spine is fully twisted and there is a need to generate high twisting torque. In other words generating twisting torque, while twisting away from neutral, appears to be problematic." (McGill, p. 103)

Sahrmann refers to the core as an "antirotator". This is not to say that rotation must never occur, but the rotation must occur through the hips and thoracic spine. Furthermore, we must have the muscular control to PREVENT rotation, before even thinking about creating it. Proper progressions from planks, side planks, pallof presses, landmines, etc. must take place before introducting rotary exercises such as cable woodchops, or dynamic lifts (picture below).




Notice how the rotation and power occurs from the turning of the hips and shoulders while maintaining a neutral spine position.

So, to wrap things up for now - we need to think about the true role and function of the "core". We focus too much on strength, and not on stability. Victims of lower back pain often try to "strengthen" their lower back, without realizing that they are exacerbating their current situation. The need for mobility through the hips and thoracic spine, while maintaing stability at the lumbar spine is evident in the research and has to be reflected in our training programs.

Train Hard,

Jason