In the United States, over 350,000 spinal surgeries are performed every year in an attempt to fix low back pain, and that's not to mentioned disctectomies, and other surgical procedures that attempt to address this frequent condition. But even the American Association of Anesthetists estimates that 20-40% of these surgeries fail, requiring revisions that are even more likely to fail.
Why is that?
Most of times, because the back is not the issue. Now, there are folks out there with skeletal variations that predispose more issues in the spine, but I've found that the back catches the buck from other joints in the body.
Many of my clients with low back pain have significant limitations in hip rotations, hamstring tightness, or core weakness that forces them to over-recruit their spinal extensors, and during their motor patterns, fail to hip hinge.
Want to do a quick test to see if you're one of the later? Try out this PVC deadlift with a pipe or a broom. If you can hinge with the pipe with no difficulty and no rounding of your upper or low back, congratulations, you know how to hip hinge! If not, that might be part of your issue.
And what about limited hip rotation? Our body doesn't just "stop" if it doesn't have the motion. It's going to get the job done, even if that means borrowing range of motion from somewhere else to do it. When the hips are stiff or limited, the spine will accept more load to compensate for this lack of rotation.
Want to know if this is you? Try your deepest low squat, feet normal width apart. Then, I want you to try this internal rotation drill, and try to squat again. If you feel an improvement, it probably means your internal rotators are weak and limiting your functionality.
Even the hamstrings can be a culprit, because they connect to the low back as well! The hamstrings connect at the bottom of our pelvis, on the "sits" bones, but these tendons and fascia run all the way up the sacrum and are continuous with the muscles of the spine. If you bend over, you'll feel the back of your pants get tight. The same thing is happening to your muscles.
Lastly, the spinal extensors can get "tight" or hypertonic to try to stabilize the spine, because the other core stabilizers aren't. That includes the abs, the transverse abdominis, the obliques. If these core muscles are weak, we'll borrow strength and stability from somewhere else. Want to see if your core is strong enough? Try this heel tap drill; if you can do 3x20 on each side without your low back arching, your quads burning, then your lower core does have the strength, but that doesn't necessarily mean it's coordinating well.
So, if you have low back pain, don't necessarily attribute it straight to your back, and look at other culprits. Your back is catching the flack, but someone else is passing it, and the trick to long term recovery is addressing that.
Got questions? Email me at email@example.com and we'll get you started on the path to understanding where your low back pain is coming from, and address it for good.