Low back pain is so common that most know how debilitating it can be. There is nothing more frustrating for an athlete, lifter or fitness enthusiast than being injured. Today we look at why low back pain occurs.
Many times clients bring in MRI scans to show me their herniated discs so they can prove how little they can do because of how much pain they are in. I believe them, but also realise the difference between structure and function. More often than not when ask where the pain is they point to a different area of their back than the level of the discs herniation. That’s weird. But consider that the low back is a delicate balance of pressure gradients that modulate the neurological inputs. Clearly pain is more complicated than something we can see with medical imaging.
Analyses of MRI scans have revealed that scans have very little to do with whether or not back pain is present. Structurally normal low backs can have pain and abnormal backs can be pain free. Even when healing has occurred and or no structural damage occurred, neural activation of the back and hips has likely been altered by the injury and pain.
There are several causes of low back pain. Back pain can be classified as either acute or chronic. Think of acute trauma as being hit by someone or something. Acute trauma to the body shuts off neural pathways to the back muscles and results on temporary weakness in the injured area. Chronic pain on the other hand can develop from unresolved acute injury or from long term misuse.
Not all back pain is a cause for concern. Dull achy pain in the muscles of the back after training deadlifts or back extensions indicates that the muscles have been loaded eccentrically. This is means the muscles were made to contract as they lengthened. This is one of the most effective ways of strengthening a muscle. Although it may produce some discomfort at first, in many cases strengthening the back and hip muscles resolves back pain.
Chronic poor positioning of the muscles of the back alters neural activation and can lead to atrophy and weakness. The muscles may not be in a position to work optimally. With chronic pain lasting inhibition of the muscles of the hip and back can cause sciatica, sacroiliac joint pain and other problems in the area. In order for strength to return maximally, the back should be aligned and trained so the muscles pull evenly on the vertebrae. For this aligning to be effective, other areas of imbalance in the hips, shoulders and ankles for example, also need to be resolved.
Deyo, R. A., Rainville, J., & Kent, D. L. (1992). What can the history and physical examination tell us about low back pain?. Jama, 268(6), 760-765.
Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine,331(2), 69-73.