There is rarely a quick answer to the question “my lower back hurts how can I fix it?” Or enter any other body part that hurts. In order to help someone the most it’s essential to know their medical background, injury history and all the other details of when you have pain, how long, what helps it feel better, etc. Which is why a doctor, physical therapist or chiropractor has to meet with someone and see them in order to really get a good picture of what’s going on. However (and this however is why I’m writing this) there are situations where you start to see the same patterns over an over again and can assume what’s going on based on what the person is feeling. For example, an athlete who has low back pain after deadlifting. Teach them how to use their hips instead of lower back and their pain may magically go away (as long as there isn’t shooting pain into their leg from a newly ruptured disc). Most of the time there are a few additional areas besides correcting position that need to be targeted (after the person is evaluated and all info is gathered) such as getting rid of muscle spasms, stretching muscles, mobilizing joints and retraining muscles to work properly.
This post is not meant to treat everyone’s low back pain, but I’d like to share my general guidelines (based on research, clinical doctorate training and experience) for what I go through with my patients/athletes who come to me with low back pain/tightness/stiffness:
- Medical/Injury background, as well as current injury information. This is the information that I mentioned earlier that can not be collected in a quick hello at the gym, e-mail or text message. It’s a back and forth question/answer situation where I get to know you and what’s going on. The information obtained helps me see if you need to get diagnostic testing done by a doctor (to rule out things like a disc bulge or fracture or nerve compression), or to make sure the low back pain isn’t coming from a more serious source (such as the kidneys or ovaries).
- Watching you move. This usually includes watching you walk, squat, pick up something from the floor…. along with other movements depending on the conversation above and after learning what bothers you. This helps me to see how you are using your body to help determine the initial cause of the injury. There can be a lot of good treatment that goes on with just educating a person how to move better. Remember that you should be lifting your children and that heavy box of books just as you would a heavy barbell at the gym. And your posture for the start of a deadlift should be similar to the way you stand or sit throughout the day. These are things that can be lost in translation and end up slowing the healing process if someone goes home after their session with me and continues to aggravate their body without knowing it. Posture and movement are key in treating low back pain.
- Specific testing to look at strength, flexibility, joint mobility and other special tests to help me determine my treatment path. There is a lot of research on the common areas to treat with low back pain [see references below] but again it all depends on what is going on in your body. If it’s something more serious it’s very important that you seek medical advice. However, the goal with all of my patients/athletes is to eventually be able to treat little nagging injuries on their own as well as maintain good mobility in their tissues to stay healthy. Here are a few examples of things that I commonly work on with people who have low back pain (click on links for ways to work on relieving these areas on your own, although again not a replacement for medical advice):
- Tight hamstrings/adductors
- Tight glutes (looking at rotation at the hip joint in different positions)
- Tight lower back muscles
- Tight hip flexors (quads, psoas, iliacus, TFL)
- Tight lower back muscles (lacrosse ball on wall or on floor, or foam roll….along with heat/ice)
- Stiff hip joint
- Stiff thoracic spine
- Weak abdominal strength and control during movements (i.e. squat)
- Weak glutes or poor activation
- Poor breathing patterns (not using diaphragm well or not expanding ribcage, along with over using neck muscles)
- Additional problems that I address after the pain has reduced: ankle flexibility, shoulder flexibility, shoulder position (external rotation for active shoulders).
- Check out this video by Theresa Larson DPT.
- Seek medical advice if it doesn’t relieve in a few days with rest
- Also check with your coaches to make sure your form is excellent so this doesn’t happen again
- Also try these pictures:
What does all this mean to you? How can it help you?
If you have lower back pain and feel like you’ve tried all that you can try, make sure you’ve hit all of those spots above. Use this as your checklist to refer back to. Make sure you are lifting things at home just as if you were lifting heavy weight as often as possible! Nothing is perfect every time, but we need to be perfect as often as possible. As K-Starr says, “if you’ve been injured already you’ve lost that privilege to be in a bad position ever.” So this means you have to be extra careful.
If you still have trouble working on the areas above, come to mobility class! Mobility class is not intended to heal injuries but it can give you some pain relief and help teach you how to work on stiff muscles. If you are not a member of CFSB try to seek help from either myself (firstname.lastname@example.org) or another medical professional. Non-CFSB members are welcome to join mobility classes and yoga, which will both help relieve stiff a stiff lower back! And those of you reading who don’t do CrossFit, these things can help you with your pain and get you moving better as well. And again if they don’t……make sure you seek help. The internet can be your worst enemy sometimes so try to meet with someone, have them watch you move and make sure you are receiving the best treatment you possibly can. You only get one body, so treat it nicely.
References for recent articles on low back pain
- Ask the Doc: Lower Back Pain 101
- Meta-analysis of Low Back Pain (2013)
- Are you managing back pain correctly?