I’ve been seeing quite a few people that are minding what they put into their bodies from a primal perspective, but not moving their bodies or treating their physical attributes with the same regard. This leads to a lot of pain and discomfort, missing out on gym time, and visits to my office.
This article is, of course, not representative of everyone with back pain. This is an explanation of the most common type of low back pain I see in my clinic, which is caused from dysfunctional movement. If you have low back pain due to a structural problem, you will likely know. However, structural injuries are often times resultant of functional injuries. The best way to know why your low back hurts and what type of low back pain you have, resulting from which cause, is to be assessed by a professional. Think PT, chiro, or sports orthopedist. Hint: if you go see one of these disciplines and all they care about is your low back (or site of pain) and don’t assess your whole body and function, don’t waste your time or money. Find someone who looks at the bigger picture of movement and function.
WHY YOUR LOW BACK HURTS
Let’s break your body down to segments in a very simple fashion. Some segments are meant to express a great deal of motion (mobile segments) and some of them are meant to resist, control and transmit that motion (stable segments). These segments alternate back and forth. When looking at the low back (lumbar spine), this should be a stable segment. Everyone loves to talk about how rigid and strong their core is. Core, core, core. We never stop hearing about it. The joints above your low back, your mid back (thoracic spine), should be very mobile. The joints below, your hips, are also meant express a great deal of motion and be very mobile.
When your mid back and/or hips become dysfunctional and stop moving as much as they should, the low back (as well as the other joints surrounding the hips and mid back), which should be stable and transmit and control motion (which is stability), can and likely will start moving too much and doing more work than it is supposed to. This is where we get pain. Again, this is a very simplistic view. Your thoracic spine or hips could be dysfunctional due to other problems going on other parts of your body. There are also more complex mechanisms of pain origination. That’s not the point. The main point here is you have areas of your body doing work they aren’t supposed to be doing.
Let’s make sense of this relationship. Say I have to go to your house to help you move. You have a ton of heavy furniture, most of it awkwardly weighted and shaped. You end up sitting on the floor drinking beers all day while I am painstakingly carrying all your heavy crap down the stairs. At the end of the day, who do you think is going to be hurting more? Me. I go home and rest, kick my feet up and take a nice bath and get some relief. Things are looking up. I head back to your house the next day and you’re passed out on the floor from staying up all night and I have to do the heavy lifting. Same result. I’m overworked and I hurt. Simple. Quit punishing the hard worker here and break the cycle of being overworked.
This is the same as the low back for most people with pain. It is overworked and hurts so people baby it, stretch it out, put heat on it, ice it, throw lacrosse balls into it, foam roll it, adjust it, mobilize it, stabilize it and whatever else, which may feel good at the time but the next day it still has to carry all of that furniture by itself. We never address the problems of the lazy thoracic spine or hip joints.Of course they don’t hurt, they don’t do anything!
HOW TO FIX YOUR LOW BACK PAIN
So what is the paleo fix here? You have to be moving better. Humans are not meant to be rounding their upper backs all day reaching for gadgets and typing away on computers. We are not meant to be maximally flexing our hips for 8-12 hours at a time. We are not meant to be so sedentary we don’t pump blood in and out of our tissues. You have to move, and you have to move well. Movement is king.
For the mid back, generally speaking, people need to be spending a lot more time in extension. Working at a computer, typing on a laptop, texting, tablets, etc. will generally have you looking down and reaching forward. This puts you in a rounded (flexed) position. Your body is smart, so when you are always in a flexed position, it adapts to the stressors to be efficient and keeps you in that flexed position. I work at a computer intermittently throughout the day doing chart notes, otherwise am walking around, being very physical, yet I work on my mid back extension over a dozen times per day. It is that important. For some people, over extension is a problem as well. Not enough extension is generally what I see, however.
The hip is an easy one to take care of. Do you have a seated job? Then the least you can do is get a sit/stand desk and stand up more. Work won’t let you? Get your chiro or family doctor to write a note – I do it all the time. Once you get this desk, go back and forth between sitting and standing. Standing is great, but your body is not meant to do anything for a long period of time, it is meant to move. Do you have a job where you’re moving around constantly? Can you lie on your back and easily bring your knees to your armpits? You probably don’t have a hip mobility problem.
If you are seeing a therapist for manual therapy or doing a lot of soft tissue work yourself and not integrating the movements, you’re losing out on any benefits. Your physical body is like the hardware of a computer and your movements and the way your brain integrates mobility and stability is like the software. You wouldn’t go upgrade your PC and spend thousands of dollars maxing out the hardware to install Windows 98 and run the latest floppy disk, would you? Practice and improve your movements and find someone who can help you through this process.
When you are “exercising” you are already practicing and reinforcing your movements, so do them properly. This means if you are doing CrossFit, if you’re ever in poor form, you’re doing it incorrectly. STOP. You wouldn’t practice free throws by repetitively chucking the basketball at the backboard hoping they go in, have it fly back to hit you in the face and think you’re getting better at free throws. So stop rounding out or excessively extending your low back in movements designed for building strength and metabolic capacity when the mid back and hips should be doing the movement and the low back should be controlling forces acting upon it.
There is a time and place for moving your low back through all of its ranges of motions, but training for strength, power, or metabolic conditioning is not that time. Stay away from repetitively loading end ranges of your low back in these training goals. For my CrossFitters and athletes, this includes, but is not limited to: the pull in a deadlift, the bottom of a squat, jumping up and landing from a burpee, pushing up from a pushup, toes to bar, sit ups, landing on a box in a box jump, pushing weight overhead, rowing, GHD, and KB swings. So yes, pretty much everything.
If you feel like you’re experiencing low back pain due to a compensation or your function not being 100%, then go see a professional about it. Make sure that this person looks at your entire function and doesn’t just pay attention to the area that hurts. Even if you watch a lot of semi-informational YouTube videos or read a great big book about mobility, go see a professional and stop self diagnosing. I feel as though I’m incredibly knowledgeable in this realm and even I work with people to figure out my weaknesses. The doctor who treats himself has a fool for a patient.
Don’t ignore pain. Don’t toss a lacrosse ball into a hot spot. Go get assessed and then when you figure out your movement weaknesses, work on your movement just like your nutrition. One salad is not going to make you lean if you’re overweight. Devote yourself daily to improving your movement and I assure you you’ll feel better.