There are three guarantees in life: Death, Taxes, and Low Back Pain

Why is back pain so ubiquitous? Some studies reference that over 80% of Americans will experience significant low back pain through the course of their lifetime. In a country with one of the most advanced healthcare systems, why are we still talking about our low backs? We have all experienced it from time to time. For some of us, it amounts to no more than a nagging inconvenience. For others it can be all-consuming, robbing you of the ability to participate in the activities you once loved. The downstream effects begin to metastasize into other areas of your life. Consider that the nuisance of lumbar problems has benched you from running – your favorite pastime, maybe even deeply rooted in your personality. Now, you don’t interact with your buddies at the local running club. Newfound absence of physical activity and positive social interaction start to plague your psychological health. Gradually, this thorn in your side begins affecting your personal relationships. Sleep quality takes a nose dive. Performance at work begins to suffer. You consider that you may never run again. You start to wonder if you will spend the rest of your life dealing with this. The downward spiral continues.

Is this a fatalist perspective on the downstream consequences of low back pain? Potentially. Is this extrapolation an accurate and common story? Absolutely.  It may be easy for us to write off an injury we see as commonplace, even non-life threatening. However, the implications have a wider reach than we may realize.

Let’s talk about the why. The human body is designed for movement – it thrives when challenged. It is remarkably resilient – we can fly pretty close to the sun in terms of tissue stressors before check-engine lights on the dashboard show up.

Injury = Applied Load > Tissue Tolerance

All injury is quantified as when the force applied toward a certain structure exceeds that structure’s inherent ability to manage the load placed upon it. The process is simple. Applied load we can consider as the contractile force of the weightlifter’s quadriceps applied toward the insertion of that muscle upon the knee during a heavy squat. With enough contractile force, the fibrous insertion of that quadricep will begin to separate from the knee, producing painful inflammation at the insertion every time that quad fires. Clinically, this is referred to as tendonitis. Walk into your orthopedist’s office and they’ll have a syringe full of corticosteroids ready to go for that quad tendon. In this scenario, if you are a perfectly healthy weightlifter and this is the first time you’ve ever experienced this particular problem, a steroid injection and some time off from the gym might take care of the issue. But what happens when you get back under the bar again? More importantly, what caused the issue in the first place? Unless you are a 400lb squatter who suddenly decided to try 500lbs on the bar, this is not the consequence of a single loaded event. This is likely a “death by a thousand papercuts” scenario. Matter has limitations.

Now that we understand injury mechanisms as a whole, let’s talk about low back pain. The primary function of the spinal column is to house and protect the spinal cord. It’s an important job to keep this thing safe – that is if you enjoy being able to walk and having control over your bowels. Unlike the thoracic spine which has the buttress support of the ribcage, your lumbar spine relies solely on the integrity of ligaments and musculature to keep it stable. Due to this vulnerability, the locomotor system becomes very adept at compensating when the muscular support of the spine fails. Think of it this way – if the core musculature isn’t doing its job keeping the low back stable, you will compensate by recruiting other muscles to do the job instead. We call this the Compensatory Stabilization Strategy. The body will always find a way to make movement happen. Which muscles join the party is variable, however the outcome is always the same. The body compensates with muscles that are designed to moveyou rather than stabilize you. The muscles that move you aren’t capable of stabilizing for very long – they fatigue quickly. As that compensatory pattern tires out, that’s when pain begins.

Sound complicated? Don’t worry, the fix is much simpler than you’d imagine. Low back pain is often the long, sordid tale of an unstable core. It all starts with breathing – specifically, breathing through your BELLY and not your CHEST. This is called Diaphragmatic Breathing. Why is it important? The diaphragm is the brain’s first-line connection to the muscles of the core. If your brain and diaphragm aren’t on speaking terms, good luck getting that core to fire. Believe it or not, this is how you are hard-wired to breathe. Try laying on your back – now put one hand on your chest and one hand on your stomach. Breathe in through the nose and out through the mouth. Ideally, the hand on your stomach should rise while the hand on your stomach moves very little. If that’s not the case, try envisioning there is a giant basketball inside your stomach that you are trying to fill up with air every time you inhale. Don’t worry, for some of us this will require some serious practice.

Now that makes up one half of the equation – breathing. Now, it’s time to learn how to brace. Bracing is the term we’ll use to describe a total contraction of ALL the core musculature. Think about the type of abdominal contraction you make when you cough, sneeze or bear down on the toilet. Since we already have you on the ground, take a deep breath and fill that belly full of air as deeply as you can. When you reach your max inhalation brace tight and imagine someone is about to punch you in the belly button. Congratulations, now you know how to truly fire your core! This breathing and bracing concept can and should be applied to all movements in the gym. It’s up to you to put it to use.

Content provided by Dr. Tyler Crooks