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Low back pain with lifting can occur for many reasons. To be clear, we’re addressing how to stop the pattern of experiencing back pain after lifting something. We’re not talking about what to do if you currently have low back pain because you lifted something heavy. If you want to learn more about how to resolve your current back pain, go to this blog post instead.
In treating individuals who have recurring low back pain with lifting heavy or awkward objects, common patterns have emerged. Most of these can be traced back to prolonged sitting. And, we’ve found that they are more prevalent among those who work at a desk the majority of the day. Here’s the five main factors that contribute to recurring low back pain –
- Tight Hamstrings
- Tight Hip Flexors
- Decreased Low Back Strength and/or Endurance
- Decreased Hip Mobility
- Limited Coordination
We’re going to dive into all of these. First, we’ll cover why the factor described can cause low back pain. Then, we’ll talk about how to know if this factor may be at play. Finally, we’ll talk about what you can do to improve the tightness or weakness so that low back pain is no longer a recurring problem for you.
Low Back Pain Due to Tight Hamstrings
Muscles are aligned in layers in the body, and hamstrings feed directly into the back muscles. If your hamstrings are tight, they will pull more on the low back muscles. Muscles can only take so much stress. So, if the combined pull from the hamstrings plus the pull from lifting an object is too much, you’ll experience pain.
To assess whether or not your hamstrings are tight, lay flat on your back with both legs straight on the floor. Lift one leg, keeping your knee straight. Can you raise it up to almost perpendicular from the ground? If not, you may want to focus on improving your hamstring flexibility.
The best way to improve hamstring flexibility is to strengthen a muscle while lengthening that muscle. Our favorite exercise that does this is the single leg deadlift.
Hip Flexor Tightness and Low Back Pain
Another factor that can cause low back pain is tight hip flexors. The hip flexors originate on the spine, come through the pelvis, and insert on the front of the hips. When these muscles get tight, they pull on the back and the hip, putting extra force on the spine.
This extra force causes the spine to move into a suboptimal position, decreasing the space between the joints in the low back. When a joint has less space, there’s less room for movement errors, and it’s easier to tweak something when you’re moving.
The video below runs through how you test to see if your hip flexors are tight. We recommend a partner for an accurate assessment.
If your psoas or iliacus (also known as iliopsoas) is tight, you’ll want to do a psoas march to help improve that tightness. When your rectus femoris is tight, you’ll want to do a rear foot elevated split squat to improve that flexibility. We go through both of those exercises in this video.
Limited Low Back Strength or Endurance Leads to Low Back Pain
This reason for low back pain with lifting is the simplest to explain. Any muscle that doesn’t have sufficient strength or endurance will fail when it’s asked to do more than it is capable of doing. This is the rationale behind rotator cuff injuries, hamstring strains, and so much more.
The tricky part is knowing exactly how to tell if your low back is strong enough or not. We use two assessments in the clinic to help determine this. The first is a reverse hyper test. We ask individuals to perform thirty repetitions of the exercise below and assess their fatigue. Was it easy or hard? Which muscles become fatigued first? What muscles were fatigued at the end? Was it possible to do all thirty repetitions?
The second test focuses on endurance. Next, we ask the individual to hold a reverse hyper position for two minutes. We have them hold this position keeping their entire legs off the supported surface. This means that the bony parts on the front of their hips are the last part that is in contact with the surface they are laying on.
After we determine what is involved – strength (difficulty with thirty reverse hypers) or endurance (difficulty with the two minute hold) – we have the individual simply do whichever test they could not pass as an exercise. They start with a doable, but challenging dosage and gradually progress from there.
Decreased Hip Mobility and Low Back Pain
There is a certain amount of mobility you need to lift objects off the floor. And, if your hips aren’t mobile enough to lift the object, your low back will move to make up for the decreased hip mobility.
It is the movement of the spine under load that leads to discomfort. The role of the spine is to hold the line. Because of this, the best way to prevent low back discomfort with lifting is to keep a nice, neutral spine.
Testing hip mobility is difficult to do on your own. Our best self test is to perform 90/90 hip switches. On each side, attempt to lift the front leg and back foot. If you can easily switch between sides and lift both legs in both positions, your hip mobility isn’t limiting you. For those who find this difficult, working on this exercise for a couple minutes daily is great at improving hip mobility.
Coordination Difficulties and Low Back Pain
This is the cause of low back pain while lifting that is the trickiest to correct. Those who have coordination difficulties often don’t know they have them. It is difficult for those who struggle with coordination to be aware when they are moving with proper technique and when they are not.
When you’re lifting an object, as discussed above, you want to do it with a neutral spine. However, it can be confusing for people to know what a neutral spine looks like and feels like. In the video below, Dr. Sarah is going through a drill with a PVC pipe that gives some helpful feedback. This is usually where we start when people aren’t confident in the concept of a neutral spine.
From there, we take it up a notch. Just as it is important to know when you are exhibiting a neutral spine, it’s just as important to know when you’re not. Injuries are more likely to occur when your spine moves under load. If you’re able to identify when that movement starts and correct it, your chances of getting injured significantly decrease. To help individuals learn what abnormal feels like, we take them through this drill.
Low Back Pain with Lifting
By now, it’s clear that low back pain with lifting can have many different causes. If you’re someone who struggles with recurring back pain after lifting heavy objects, we encourage you to run through the tests described above. From there, we suggest starting with the suggested exercises to help fix any tightness or weakness that you found. If you have any questions as you go through the process, feel free to reach out!