Low Back Pain After Lifting?
This week, let’s bring it back to the weight room. Have you noticed your low back gets exceptionally sore after a day of squatting, deadlifting, or overhead pressing? How about thrusters, rowing, and dumbbell snatches? Yes, I’m talking to you CrossFitters after the 24 Open. Have you noticed a low back pump during these exercises, where you feel like your low back is working as hard as your legs? These are signs that something is wrong. The good news is you are not injured. The bad news is a more serious injury is likely coming and your performance is surely taking a hit. Let’s get to the bottom of what’s happening here and the way’s we can go about fixing it!
First, let’s briefly discuss core stability and the idea of the extension compression stabilizing strategy. For the sake of brevity, we will skip discussing the ideas of lower crossed syndrome, DNS theories of the open scissor position, and other ideas describing the same phenomenon. I will stick with Dr. Richard Ulm’s current description of the extension compression stabilizing strategy (ECSS) (check out his work on his website Athlete Enhancement). ECSS is the use of the lumbar paraspinals to lock down the low back into excessive extension to prevent undesired movement, especially flexion, while under load.
To better understand this, let’s discuss real life examples. How about a deadlift. Actually, how about repeated rounds of 300m rows, 10 deadlifts, and 50 double unders for 20 minutes (this was the second workout in the CrossFit 2024 Open of course). Now, when performing a deadlift, it is commonplace in the strength and conditioning world to cue an extended, even hyperextended back. This sounds like “chest up” or “look up”, and even “keep the weight in your heel”. Now these cue are often essential to helping a lifter make changes in their form or motor control that is for the better. Unfortunately, these can all lead to and may rely on the same thing. An ECSS. Forcing the chest up will almost always result in the firing of the lumbar paraspinals and immediate extension of the lumbar spine, often to its maximal degree. The benefit is achieving the position you were trying to get, which may have been getting the bar back over the center of the feet so you can effectively complete the lift. Even more so, the benefit is creating a locked and stable lumbar spine from which to operate from. This means you can squat, deadlift, press, even row on the concept 2 without fear of excessive motion in the lumbar vertebrae. Further, Dr. Ulm even describes how you can get away with this for a long time. Continuing, flexion in the low back due to failure to extend is significantly worse (under load). This is often where the famous disc injury can occur.
That being said, since we have all been encouraged into this stabilizing strategy for a long time, we take the lumbar paraspinal tension with us throughout the rest of the day, week, month and years. therefore, we should take alternative and more appropriate methods of stabilizing the spine seriously. There is in fact a better way to create stability in the core and low back without calling on the lumbar paraspinals to crank you into end range extension. Unfortunately, it takes some serious motor re-patterning and concentration to learn and reproduce this opposing strategy during intense lifts. This stabilizing pattern requires minimal paraspinal tension, but does require control of the diaphragm to descend and take away space in the abdominal cavity. Altogether, the paraspinals create a wall behind the lumbar spine while the abdominals and obliques create a wall in the front and sides. The descending diaphragm pushes fluid, air, and organs into the only space remaining and into the front of the vertebrae, so to speak. This is how intrabdominal pressure is created (IAP).
IAP is the most powerful way to stabilize the spine without the cost of a jacked up low back with high long term injury potential. The cons are that it can be difficult to learn this control over the diaphragm (especially when the lifts are coming amongst a barrage of other exercises, both aerobic and anaerobic in nature), while creating only the required amount of lumbar paraspinal activation. We also must resist the temptation to do the much easier yet effective method of ECSS.
How do you create IAP? First, imagine your entire trunk as a cylinder. We need to be able to breathe in, which is the descent of the diaphragm, so that the cylinder is being pressurized in 360 degrees. This can first be trained with us on our back and hip bent to 90 degrees. This helps us more easily orient the pelvis into neutral as opposed to an anterior pelvic tilt. If we are in an anterior tilt and our ribs are flared upward, the diaphragm will not descend straight down and push abdominal content backwards and in 360 degrees, but instead will descend on an angle, more so towards the abdomen! Instead, we want to orient the ribcage directly over the pelvis. Then, we can take a long breath in through the nose, thinking about pushing the air straight down into the pelvis. We don’t necessarily just want to feel the abdomen moving outward with this, but it is a good place to start. Eventually, we want to feel the side of our abdomen filling with “air” as we breath in, and then last, we want to feel the low back expand as we breath in.
We do not want the chest to be the first thing that moves while we are breathing, though it can come for the ride at the end as we completely fill the lungs with air and have fully descended the diaphragm. Use your hands under your low back to feel this moving as you begin breathing. This does two important things. First, we learn to relax the lumbar paraspinals, as we cannot get expansion there without turning these muscles off first. Second, we learn to descend the diaphragm and use it to create IAP. Third, we learn to eccentrically lengthen the core muscles, allowing this to create the tension or the “wall” that we push air against in the front to begin building pressure into the back. Here is a video of this drill…
We can use this exercise to begin learning what it feels like and what is required to descend the diaphragm and get pressure into the back. This also helps us shut off the paraspinals, a vital role in rehabbing common chronic and acute low back injuries and pain. When we take this practice to standing and use it in our training, we will need to maintain the eccentric abdominal tension and hold the breath (and therefore the diaphragm down occupying space and creating pressure) while creating only as much paraspinal tension as is needed to match the pressure in the abdomen. More on this in the future!
Again, it can be difficult to learn this pattern and even more difficult to begin applying it in intense exercise. To go back to our example, deadlifting in the middle of a WOD is never ideal, and if we don’t want to use ECSS, we will need to use our breath and our diaphragm. This is especially hard after rowing 300m! And even harder after the 8th, 9th, and 10th rep of an unbroken set. And harder STILL after multiple rounds of this! It is indeed difficult to control the diaphragm and recruit it for stabilization when we are already taxed for oxygen in a competition. I won’t lie, after a few rounds of this, I myself turned up my lumbar paraspinals to 10, found my familiar position of lumbar extension and anterior pelvic tilt, and hinged down to pick up the barbell to complete my 10 reps unbroken while my diaphragm and secondary respiratory muscles focused on trying to catch my breath.
And that’s okay!
When it comes to competition, we don’t need to be perfect. The same goes for Olympic lifting, powerlifting, bodybuilding, or even hockey and field sports for that matter, playing is a calculated risk. What is not okay is training 100% of the time with ECSS and then living the rest of your day, again, in a state of hypertonic lumbar paraspinals and ECSS. This is where the chronic low back pain comes into play and even sudden disc injuries from bending over to pick up a pen! But more on that another time. I used the word brevity earlier… so much for that.
To summarize, we have been trained to be experts in ECSS. And thankfully so, considering the alternative may have been rounded and flexed lumbar spines during loaded movements. But there is a better option, especially when we begin thinking long term. The ECSS is there for you when you are about to PR your snatch or want to really push it in a WOD, but we otherwise need to learn to create IAP with the diaphragm, abdominal wall, and appropriate amounts of lumbar paraspinal tension for the majority of our training. Further, we MUST be able to shut off our lumbar paraspinals when operating our normal day. This is a critical component of longevity, whether it be golfers, rock climbers, or CrossFitters.
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-Dr. Nick, D.C.
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