With the rising popularity of Dr. Stuart McGill and his work on the lumbar spine in the health and fitness community, people have started to understand that excessive lumbar motion leads to injuries.  The extent of his research (which he has been leading for years) have given all of us a better understanding of the spine, how it works, how it should move, and what leads to injuries.

This is a MUST read. Period.

Like many other things in the fitness business, it caused an overreaction.  We started avoiding movement at the lumbar spine at any cost.  We started to focus on the hips and the thoracic spine as the places to improve mobility, which I’m not going to say it’s a bad thing because that is exactly what most people need; more mobility in the t-spine and the hips.

This overreaction, though, caused us to ignore that there is a certain degree of movement that is normal to have at the lumbar spine.

As you can see in the chart, although the biggest potential for rotation is at the thoracic spine, the lumbar spine still have a couple of degrees of rotation.  The same thing applies for flexion and extension.

To better understand the reason to why we actually need range of motion at the lumbar spine I’ll refer to the pendulum theory that Charlie Weingroff introduced a little while ago.  To quote Charlie:

“So every joint has a core and it has a neutral that is decided just like a pendulum.  It has to know that the stiffness properties allows it to go all the way to the left, right, front, back, etc., so it can rest with no effort in the middle, the position of optimal force transfer.

The clinical application is that the spine’s neutral is a function of full flexion, full extension, full side bending, and full rotation. Then and only then does the core have it’s premiere chance to do as little work as possible for segmental stabilization, and the phasic lumbar muscles can pick up the bracing slack to handle huge loads and force transfers.

If you don’t have yoga-ish mobility, the middle is always off-center, and the local stabilizers (of any joint system) aren’t triggered ideally via the brain getting “wrong” feedback from the joint receptors (…)”

What this means is simply that if your body doesn’t have a proper “neutral”, everything is going to be affected, compensation takes over, and injuries eventually happen.

Even if the goal should always be to lift weights and reinforce proper movement pattern with a perfectly neutral spine, it doesn’t mean that you’re body shouldn’t “own” that range of motion at the lumbar spine.

My personal story is a pretty interesting one in this regard.  Since reading the work of Dr. McGill years ago I became a strong advocate in limiting motion at the lumbar spine.  When I say I was doing everything with a neutral spine, I mean everything: sitting, brushing my teeth, tying my shoes, and even putting socks on in the morning!  Have you ever tried putting socks on in the morning without allowing any sort of lumbar flexion? Trust me it’s not that easy!  But I was doing it!

Not quite like this, but that far off!

I was also getting pretty strong for my height and my body structure, I was deadlifting a decent amount of weight and I never allowed myself to have anything less than perfect form on every single rep I was doing.

About 2 years ago, I started to get a little less zealous about the whole neutral spine thing in my everyday life.  A couple of months later, I was brushing my teeth in the morning and as I was bending over to spit in the sink I felt a sharp pain go through my right lower back just above my right SI joint.  A couple hours later, I couldn’t bend over at all, and I mean not at all.  Even breaking at the hips slightly to grab a glass from the kitchen table was impossible.  The pain started to go away after 3-4 days, but my back bothered me for a couple of weeks.  And weirdly enough, a similar event happened about 8 months later.

It’s only when I learned about the SFMA, the pendulum theory and other philosophies along the same line that I realized that my lumbar spine wasn’t flexing at all, which was later confirmed to me by a good friend of mine who’s an enlightened physical therapist.

I’ve been working on my lumbar flexion more recently and making sure my toe touch, as per the SFMA, stays intact and turns out my back has been feeling much better.

That doesn’t mean I’m doing silly stuff like stiff-legged deadlift with a rounded back, or crunches and sit-ups, but I’m doing isolated mobility exercises that don’t involve any type of loading to make sure that my pendulum is in the right “neutral” position.

Do you ever assess for lumbar range of motion?  You might be surprised at what you’ll find.

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It has been said that 80% of the American population is going to suffer from lower back pain at some point in their life….That’s A LOT of people!  The sedentary lifestyle of most human beings in 2012 is probably one of the main causes.  If you’re a strength and conditioning professional or a personal trainer chances are you’ll deal with a good number of people suffering from low back pain throughout your career.

The first thing to do is assess the client or athlete and identify where the problem lies.  You should also decide if referring out to a another health professional is appropriate.  Either way, you’ll want to use appropriate corrective strategies, if appropriate, to make the person correct the source of the problem.

What you won’t want though is to turn the training session into a rehab session.  You still want your clients or athletes to feel like they can get a training effect.  They definitely shouldn’t feel like a patient; that’s not your job.  You want to make them feel like athletes and you should focus on what they can do, rather than what they can’t do.

The big problem with most low back pain is that it limits your lower body exercise options quite a bit.  Most of the time any variation of bilateral squat or deadlift will be out.  So where does that leave us?

Although every person is different, there are options that are generally going to be safer than others.  The first thing I would tell you to do is stick to the “do no harm” rule: if it hurts don’t do it.  As simple as that.

That being said here are some options to consider with your low back pain clients and athletes:

Reverse Lunges

Depending on the type of back pain and how severe it is, your athlete might be able to get away with lunge variations using a front squat grip or a back squat grip, but usually DBs are going to be a safer alternative.

Rear Foot Elevated (RFE) Split Squat

In the video above, coach Dan Gabelman demonstrates a bodyweight RFE split squat. If your athletes are pain-free and strong enough, you can load them with 2 DBs or with one DB in the goblet position.

1-Leg Squat

This one might not be an option in some low back clients, but is usually OK with most if you keep a neutral spine throughout the range of motion, even if it means limiting that range of motion.  Someone who’s flexion intolerant and has limited hip mobility might round at the back in the bottom position, which could exacerbate the problem. Usually just bodyweight is plenty hard for most people, so you don’t even have to use any external load to make the exercise challenging.

Sled Drag

What I really like about sled drags for athletes or clients with low back problem is we can use so many variations of them, and also still load them pretty significantly without any negative effect on the low back.

Again, the “do no harm” rule is king.  Make sure you don’t do anything that hurts your athletes.  You should also be smart about what you prescribe them, make sure it’s not making their problem worse, and when in doubt refer out!

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