It is WAY overdue for us to evolve the way we treat people with low back pain.

When I look at the hottest and most popular posts and exercise protocols for low back pain, I always cringe.

The reasons people are told they have back pain are just NOT true.

And the exercises they are prescribed are so outdated.

I've been rehabilitating people's lower back problems for over two decades and, here is what I can tell you:

Low Back Pain is NOT Caused By

• bulging discs

• herniated discs

• weak abdominals

• tight back muscles

• degenerative discs

All of these things are a result of the problem, they are NOT the problem.

I can also report that these popular exercises for low back pain don’t come close to addressing the cause:

OUTDATED LOW BACK EXERCISES:

• planks

• cobras

• bridges

• crunches

• dead bugs

• back extension exercises

• low back stretches on the floor

All of these exercises may help with symptoms, but NONE of them address the cause. I would even say that many of them are hurtful in the long term.

Bottomline: Your low back problem is NOT a low back problem.

In this article, I'm going to share a COMPLETELY new way of thinking about low back pain and a way to treat it FOR GOOD!

Time to Ask WHY, Not How

The Western Way of addressing most problems is to immediately ask, “How do we fix this?”

How do we fix:

• ADHD?

• CANCER?

• Low Back Pain?

Focusing solely on how to fix a specific issue, whether it's related to ADHD, cancer cells, or back pain, leads to tunnel vision. You will never be able to see the forest through the trees.

It's like fixating on the leaves of a dying tree instead of considering what's affecting the entire tree's health.

Instead of asking "how" to fix the problem,
we need to start asking "why the problem?"

Over my two decades of experience with clients dealing with neuromusculoskeletal issues, this is the question I continuously ask.

When someone comes in with lower back pain, instead of focusing on how to fix this person’s back - I ask WHY is this person’s back in pain.

The answer I always come back to when I ask WHY someone presents with low back pain is actually quite simple.

The lower back is being asked to do something
it was not designed to do.

This leads to the next series of questions that leads us to address the real cause of low back pain and all other neuromusculoskeletal injuries.

1. What is the low back or lumbar spine designed to do?

2. Why would the lower back be asked to do something it isn’t designed to do?

3. If the lower back isn’t designed to do it, what is designed to do it?

Question #1:
What is the Low Back Designed to Do?

The lower back or lumbar spine consists of 6 different structures: Sacrum, L5, L4, L3, L2, and L1.

Your lumbar spine is designed very differently than the rest of your spine. They are the largest segments of the spine and are designed mostly to bear weight. Because of this structure, they have limitations in their ability to move in certain directions.

The lumbar spine moves mostly in what is called the Sagittal Plane, which is the spine flexing forward and extending backward. It can flex forward 65 degrees and extend backward 31 degrees. This equates to a total of 96 degrees of motion front to back.

The lumbar spine can move side to side in the frontal plane. It can laterally flex 30 degrees to the right and 30 degrees to the left for a total of 60 degrees.

The lumbar spine can rotate 15 degrees to the right and 15 degrees to the left equaling a total of only 30 degrees of rotational capacity.

If you summate to total range of motion of your Lumbar Spine (96 flexion-extension + 60 lateral flexion + 30 rotation) it equates to 186 degrees of total motion.

The majority of that motion, 52%, is used to flex forward and extend backward.

32% of that motion is used to side bend left and right.

Only 14% of the motion is designed for rotation!

As you can see from the numbers, the lumbar spine is not designed to do a lot of rotation. This is very significant because many low back injuries occur when rotating right or left.

Question #2:
Why Would the Lumbar Spine Do Something it Wasn’t Designed to do?

The lumbar spine is asked to do things it isn’t designed to do when other segments aren’t doing their job.

Because our bodies are survival machines, it will get motion from regions that require the least amount of energy to access. It will do this even if it causes long-term problems.

The lumbar spine is one of many examples of this.

If areas around the lumbar spine are tight or locked up, the body will ask the spine to pick up the slack. In the short term, it can usually handle it, but over time, it leads to damage.

Bulging Discs, Herniated discs, rotational dysfunctions, compression fractures, and spinal degeneration are often the result of the lumbar spine being asked to go beyond its structural capacity.

Question #3:
If the Low Back isn’t Designed to Do It, Then What is Designed to Do It?

Let’s look at the immediate neighbors of the lumbar spine and break down what these regions are designed to do.

Next-door neighbors of the lumbar spine include:

• The Hips

• The Upper Back / Thoracic Spine

  

Upper Back | Thoracic Spine

The 12 segments right above the lumbar spine make up the thoracic spine. This is the region that your ribcage attaches to.

As you can see from the picture, thoracic segments are smaller than lumbar segments and sit more on top of one another. This design allows for different types of mobility.

The Motions of The Thoracic Spine

The thoracic spine can flex forward 26 degrees and extend backward 22 degrees equaling a total of 48 degrees of total motion front to back.

This is almost half the capacity of the lumbar spine which has 96 degrees of motion, front to back.

The side-to-side motion of the thoracic spine equates to 30 degrees in each direction, equaling a total of 60 degrees of lateral motion.

This is equal to the ability of the lumbar spine to move from side to side.

When it comes to rotation, this is where the design of the thoracic spine shines. The thoracic spine can rotate 47 degrees to the left and 47 degrees to the right. This equals a total of 94 degrees of rotation!

This is significantly higher than the lumbar spine’s ability to rotate a total of 30 degrees.

The thoracic spine can rotate more than 3X the amount the lumbar spine can rotate.

The Hips

I refer to the hips as the powerhouse of the body. It houses the most powerful muscles, ligaments, and soft tissue in your body. It was designed to take load and produce power.

This is why the hips sit directly below the lumbar spine.

The Hips share the same housing unit as the lumbar spine - the pelvis. The sacrum sits inside the pelvis and the femur bones/legs sit inside the pelvic sockets.

This puts the hip in a very influential position when it comes to the spine.

The Available Motion of The Hips

The hips are a ball and socket joint so the available motion is plentiful.

The hips have 43% more available motion than the thoracic spine and 72% more available motion than the lumbar spine.

This makes the hips a MAJOR factor when it comes to lumbar spine health.

Let’s look at the hip’s specific capacity.

50% of the hip’s motion is available when flexing forward and extending backward. The hips can flex forward 130 degrees and extend backward 30 degrees.

The 130 degrees of flexion available to the hips is 2X as much as the 65 degrees available to the lumbar spine.

The 30 degrees of hip extension is about equal to the lumbar spine’s ability to extend.

23% of the hip’s motion comes from its ability to move from side to side. It can move outward (abduct) 45 degrees and move inward (adduct) 30 degrees.

This 75 degrees of total side-to-side motion is 25% more than both the lumbar and thoracic spine.

The last 27% of hip motion comes from its ability to rotate. It can externally rotate 45 degrees and internally rotate 40 degrees.

This available 85 degrees of rotation is 10% less than available thoracic rotation and 83% more than available lumbar rotation.

Here is a summary of the three areas.

THE DEGREES OF MOTION AVAILABLE FOR EACH REGION

yellow = greatest amount of available motion in that plane
red = least amount of available motion in that plane

PUTTING IT ALL TOGETHER

Now that we've looked at the lumbar spine, thoracic spine, and hips as their own entity, and compared them to one another, let’s look at them as a team.

If you summated the total available rotational, forward, backward, and side-to-side motion it would equate to the:

• 209 degrees of rotational capacity

• 326 degrees of forward flexion and backward extension capacity

• 195 degrees of side-to-side capacity

Now let’s see the roles each member of this three-region team plays in each plane of motion

ROLLS EACH REGION PLAYS IN EACH PLANE OF MOTION

As you can see from the chart above, the lumbar spine plays NO PRIMARY ROLL in any of the three primary planes of motion.

This makes the lumbar spine very dependent on the ability of the adjacent regions, thoracic and hips, to execute their rolls therefore making it the most susceptible to injury.

APPLYING NEW APPROACH TO LOW BACK PAIN

STEPS TO ADDRESSING LOW BACK PAIN

#1: Identify WHEN the low back pain is triggered

This is the key question I ask when someone presents with low back pain. If the client can identify the specific task that triggers the lower back pain, then I can start to break down the mechanics of that task.

#2: Customize the treatment plan based on the task that triggers the pain

This is why the 5-10 generic low back stretches and exercises that you see everywhere are not very effective. They are shotgun approaches to low back pain. This step is what snipers the approach and ensures the root cause is addressed.

Here are some examples of the different tasks that can trigger low back pain:

• walking

• sitting to stand

• bending forward

• standing and rotating to the right

Each one of these tasks can be broken down even further.

Each one of these tasks can be performed from an infinite amount of positions.

I have had individuals who only have low back pain when they bend over with their right foot in front of their left. When they put their left foot in front of their right and bend over, no pain.

I’ve had the same individuals report that when they turn out their right foot, when it is in front of the left and bent over, their pain decreases. And when they do nothing different except turn their right foot IN from that same position and bend over, it increases the pain - relative to when it was pointed straight.

Bottom line, treating low back pain is much more complicated than doing dead bugs, planks, or stretching your back.

#3: Design a Customized Movement Program Based on TASK from Step 2

This is where all that information from the beginning of this article comes in. If someone has right low back pain when rotating to the right while standing with their right foot in front of their left, then those three regions need to be evaluated relative to that task.

Since you now know, that the lumbar spine is NOT designed to rotate very far, there is a good chance it is over-rotating to the right relative to its adjacent structures. If the lumbar spine is rotating too much, it means that either the thoracic spine and hips are not rotating enough to the right.

This would lead to a targeted stretch protocol to improve the hips and thoracic spine’s ability to rotate to the right from that specific position.

DO YOU HAVE BACK PAIN?

Schedule a Consultation with Matt to go through the assessment process:

WHAT LOCKS UP THE THORACIC SPINE & HIPS?

There is one thing you do every day, that will lock up your thoracic spine and hips, and will compromise the health of your lower back . . .

SITTING!

One of the best things you can do to avoid low back problems is to do your best not to sit more than 60-90 minutes at a time. Make sure to get up as frequently if you can and get in at least 10,000 steps a day.

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