We live in an age when people think it’s normal to deal with some form of lower back discomfort. We’re all aware of the faulty posture that comes with sitting at a desk for prolonged periods of time. We also know that constantly looking at our computers and phones results in faulty posture. We’re relatively aware that we seem to be living lives where we’re constantly in states of unoptimized posture.
So, what are some reasons why it’s common for us to experience lower back discomfort? What’s driving a society that thinks it’s normal to have a constantly irritated lower back?
With this blog, I’m offering some explanations as to why I think most people’s lower backs might be hurting. But first, I want to clarify a few definitions so that you, the reader, will have a clearer picture of what may be going on.
What is posture? The Postural Restoration Institute defines posture as a reflection of the “position” of many systems that are regulated, determined, and created through limited functional patterns (https://www.posturalrestoration.com/the-science/what-is-posture). I would add that posture and movement should always be analyzed in the context of the environment and the outcome you’re looking to achieve. A 100m sprinter will demonstrate a very different posture when running in the Olympics compared to when he or she is finished eating dinner. However, when the posture and shape the body positions itself in is repeatable and predictable, it becomes a pattern. Our default pattern is what most of us think of as our normal posture.
Pain can be very misunderstood. The most up-to-date 2018 definition of pain, as defined by Cohen et al., is: “Pain is a mutually recognizable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity.” A whole article could be written on the subject of pain, but let’s put that aside for now. It’s important to know that pain definitions have constantly changed over time. It was once thought that there was a direct correlation to physical injury any time someone was in pain; however, now it’s known that sometimes there’s no direct connection. While cognitive processes, emotions, and social context all play an important role in a person experiencing pain, pain doesn’t necessarily mean that an injury has occurred or even that an injury is likely to occur to a given area.
What’s an injury? I would define injury much like Dr. Quinn Henoch does in this podcast and say it’s a result of your tissues’ inability to adapt to its stressor. This can describe a linebacker running into a quarterback’s knee and that quarterback suffering an ACL injury. The quarterback’s knee wasn’t strong enough to overcome the stress imposed by the linebacker. If someone hurts their back deadlifting too heavy, it’s an indication there’s too much stress imposed to the point that the person’s system can’t tolerate the load. I really like this way of defining injury, because it can apply across multiple domains, and I have yet to see a better definition. It’s worth repeating. Pain and injury are not synonymous. You can actually feel pain but not be injured.
So, how does posture relate to the fact that your lower back constantly hurts? We seem to have a general understanding of what “good” and “bad” posture are, but I don’t think many understand how “bad” posture makes the low back hurt.
You might have noticed that I put “good” and “bad” in quotes, because I don’t think there’s necessarily an overarching good or bad posture. There’s “good” and “bad” in relation to whatever outcome you want to achieve. If you want your lower back to not hurt day in and day out, then it’s important to take a look at what patterns and positions you typically hold and which ones you have difficulty getting into. For example, if you’re constantly holding an anteriorly tilted pelvic position, and your rib cage flares but you can’t get into the opposite position, then that should tell you a lot about what’s going on.
Going back to our definition of injury, it’s when your tissues don’t have the ability to adapt to the stressors that are imposed on them. So, if you’re holding an anterior pelvic tilt and your rib cage flares all the time with no way of getting out of that movement pattern, that’s a position where the same tissues are constantly being stressed. It’s not that this posture is inherently bad, but it’s bad, because you can’t find any other movement options where forces are distributed differently, and different tissues are stressed. This results in the same tissues being stressed all the time, which can be the reason why your low back starts to hurt, your hip flexors feel tight, and your neck feels cranky.
So, what do you do to relieve the discomfort? As I touched on earlier in this blog, if this is you, then you need to consider some different movement options. Your brain needs to be taught new, different ways to move. Let’s explore alternative ways we can teach our brains to move.
Overly Extended Posture
Most low-back-related issues I see commonly result from a typically over-extended posture. This posture is where the pelvis is tilted anteriorly and the rib cage flares up and away from the pelvis. This posture typically puts more stress on the low back, hip flexors, and neck.
The above pictures indicate an overly extended posture. You can probably guess as to how that position would put excess stress on places such as the lower back.
If this describes you, what do you need to do to get relief? Probably learn how to breathe to help change the position of the pelvis and rib cage. Below are some examples of simple breathing drills we use at Force Barbell to help people get out of this extended posture and gain some competency related to other positions.
To be the most efficient movers, we need to be competent in all three planes of motion, which means we need to be able to move up and down, laterally, and rotationally. When we fall into an overly extended pattern, it begins to become difficult to be competent in all three planes of motion, especially if we haven’t done anything to counteract this excessive arching. Our diaphragm connects to our rib cage and our lower back and plays a critical role in the breathing process. If our lower back arches and our rib cage flares, this stretches our diaphragm. Now, imagine all the breaths you take in this position every day. That’s your body becoming more and more competent in that movement pattern and less and less competent in other movement patterns. The more time that goes by where we neglect to find more variability and competency in our movements, the more time our bodies might undergo structural changes and the harder it is to get out of this “stuck” pattern of movement.
To gain more tri-planar competency, we need to become more competent in the sagittal plane, which means first we need to learn how to pull our ribs down and get our pelvis into a more neutral position. This can be achieved with the help of the various breathing exercises mentioned above. Once we become more competent in the sagittal plane, this starts to free up our joints to move more easily laterally and rotationally. Below are additional breathing exercises that are a tad more advanced than the ones mentioned above; however, they’ll start to bring more awareness and competency into the other planes of motion.
It’s important to become competent in all three planes of motion, because life is always happening in all three planes. Walking is a tri-planar movement. If we’re not competent when it comes to moving in all three planes, we get “stuck.” This “stuck”position becomes repetitive and results in a poor default pattern of movement.
No single position is bad. No pattern of movement is bad. Patterns of movement only become problematic if we can’t restore a variety of movements and we accumulate stress in one pattern of movement. A common pattern of movement we see is where we have an extended posture, where the pelvis is tipped forward, and the rib cage flares. Most people don’t have the movement competency to get out of this position, so they get “stuck” in it. Our job is to restore competency in the sagittal plane first by pulling the ribs down and setting the pelvis in a neutral position. Once this competency is achieved, we can then start to build competency in the frontal and transverse planes, both which provide more awareness and competency to get in and out of various positions. When we’ve been able to restore these competencies, we have then supplied the person with more movement options where he or she can accumulate stress, as opposed to having him or her merely repeat the same extended pattern.
It’s important to note that we always need to practice improving our posture and patterns of movement. We need to do so for our brains to continually create various patterns of movement that provide options. Once we stop practicing improving our posture and patterns of movement, our default will revert back to the same positioning and patterning that caused us pain. We need to practice a lifestyle of always moving, where we can incorporate variety into how we move.
Cohen, M Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain PAIN Reports. 2018; 3(2):e634-.