Are you an athlete tired of annoying injuries holding you back from peak performance? Then this blog is for you. Here, we’ll explore the root causes of low back pain, one of the most common complaints among active individuals. By understanding why it happens and what you can do about it, you can take a significant step toward injury prevention and improved performance. Low back pain doesn’t discriminate—nearly everyone experiences it at some point. While it can stem from many causes, such as disc herniations, spondylolisthesis, osteoarthritis, or autoimmune diseases, this blog will focus on the most common, non-structural causes of low back pain seen in the majority of individuals.
What Determines the Health of the Lumbar Spine?
A healthy spine functions as a team, with every segment contributing to movement. These segments, or vertebrae, must work and move harmoniously, much like a well-oiled machine. Unfortunately, our daily lives often lead to imbalances in the spine. Some areas may move too much, known as hypermobilities, while others become stiff and don’t move enough, known as hypomobilities. These dysfunctions rarely occur in isolation (meaning where there are hypomobilities there are hypermobilities), and are notonly found in the lumbar spine, but throughout the entire body. For example, stiffness in the thoracic spine (hypomobility) may lead to excessive motion and compensation in the low back, neck, or shoulders (hypermobilities); while stiffness in the hips (hypomobility) can overwork the low back or knees (hypermobilities); Over time, this compensation can disrupt normal movement patterns and lead to pain.
To dive deeper, there are three foundational concepts that play a critical role in the health of the lumber spine. They include the DSM, PCR, and RMPPs.
Understanding the DSM
One foundational concept in understanding low back pain is the Directional Susceptibility of Movement (DSM). This principle highlights how the body tends to move along the path of least resistance due to laziness and the body’s goal of efficiency. This is the root cause of compensation. A hypermobile joint will move in the path of least resistance. For example, the hip and shoulder joint commonly compensate anteriorly, and the lumbar spine joints commonly compensate into extension and rotation. The direction of compensation often determines which structure is the pain generator.
Understanding the PICR
The quality of any motion depends on the health of the joint producing that motion. And the health of a joint depends on whether or not the mobile part of the joint can remain in the Path of Instantaneous Center of Rotation (PICR) during the motion. The PICR describes how well each joint has an ideal movement pattern. For example, the shoulder joint has a ball-and-socket mechanism, the PICR describes how well the ball stays centered in the socket as your arm moves. In the spine, disruptions to the PICR (due to hypo and hypermobility’s) often leads to movement (its DSM) into excessive extension or rotation — which can overload tissues and nerves, leading to pain and injury.
The Role of Repeated Movements and Prolonged Postures (RMPPs)
The root cause of disruptions of the joints PICR lie in our repeated movements and prolonged postures we engage in over and over again. These patterns, performed daily and often unconsciously, create hypomobilities (aka imbalances) in the body over time. When it comes to the lower back, prolonged positions may include standing postures, sleeping positions, and sitting postures, while repeated movements are often associated with sport, work, or recreation.
For example:
- Sleeping Position: Ever wake up stiff or achy? I firmly believe that sleeping position can be the number 1 determinant (risk factor) for low back pain. Sleeping in a poor position for hours on end can lead to significant development of both hypo- and hypermobilities, which then cause faulty movement patterns and eventually pain.
- Sitting Position: Whether at work or during a long commute, sitting for hours places immense stress on the ligaments that support spine. Flexible ligaments leads to instability (hypermobility) and hypertonicity of the lumbar muscles supporting the spine.
- Standing Position: When we stand in the infamous “sway-back” position, we rely on our passive system (joints, ligaments, bones) vs our active system (our muscles) to stand up straight. Do this over and over, and those passive structures will eventually lead to pain.
Even athletes aren’t immune. While they may train for multiple hours a day, the remaining 20-22 hours often reflect poor postural habits. Without addressing these root causes, repetitive strain will likely persist, leading to recurrent pain and injuries.
How Detrimental RMPPs Negatively Affect the Lumbar Spine
Here are 3 of the most common examples of how our repeated motions and prolonged postures lead to low back pain:
- Stomach Sleeping – Sleeping on your stomach places your spine in prolonged extension, with the vertebra extending backward for hours. Over time, this posture can lead to pain and stiffness. This position arches the lower back excessively, placing it in constant extension for up to a third of your life (assuming eight hours of sleep). This repetitive strain explains why many people wake up with stiff, painful backs.
- Sitting – They say sitting is the new smoking, right? When it comes to low back pain, long periods of sitting causes to four detrimental things to happen that all lead to lower back pain: (1) it tightens your hips, (2) causes a hypertonic iliopsoas, (3) stretches and stresses your para-spinal ligaments (especially if you slouch), and (4) shuts down your glutes.
- Too much twisting – The lower back facet joints aren’t built to rotate. When you have stiffness in the areas that are supposed to rotate (the thoracic spine and hips), your lower back will compensate.
- Too much extending (bending backwards) – Our lower back likes to arch and lock out in extension to create a more stable environment. The problem, however, is that excessive extension creates shear forces within the facet joints, which will eventually lead to pain.
Breaking the Cycle
Awareness and small changes can significantly impact your lower back health:
- Modify Your Sleep Position: If you’re a stomach sleeper, transition to your side or back. Use pillows to support natural spinal alignment.
- Incorporate Movement Breaks: For every hour of sitting, take five minutes to stand, stretch, or walk around.
- Use a Standing Desk: Alternating between sitting and standing throughout the day can alleviate pressure on the spine.
- Keep your ribs down during exercise: This reduces excessive lumbar extension and shear forces on the facet joints
- Be mindful of your mobility needs: Remember – the body is a well-oiled machine – each joint needs to contribute to movement. If you have a stiff area, other areas (like the low back) will compensate
The Charlotte Athlete Physical Therapy Three-Tiered Treatment Approach
At The Charlotte Athlete, we take a comprehensive approach to treating low back pain, with our primary goal in solving the root cause for long term success. Our treatment sessions include three primary components:
- Education
- Manual Therapy
- Exercise
1. Education: Knowledge is Power
Understanding why your pain occurs is the first step toward recovery (and arguably the most important step). As sports physical therapists, we emphasize teaching our athletes about:
- Root causes of their pain: Most physical therapists believe the root cause of your pain is the imbalances within your body (ex: weak glutes, tight hips, lack of ankle dorsiflexion, etc.), however this approach falls short in a major way. We need to ask ourselves why are our glutes weak? Why are our hips tight? Why do we lack dorsiflexion? Making changes to our repeated movements and prolong postures (essentially what we do all day every day) is key for long term success.
- How to reduce flare-ups: Understanding what movements and/or situations cause your pain not only empowers the athlete but decreases overall recovery time.
- What to do if a flare-up occurs: Understanding the dos and don’ts related to a flare up can significantly affect the length of a flare-up and how long it takes to get past it.
- How to prevent recurrence: Understanding your triggers and adjusting your RMPPs creates self-reliance. When athletes understand the “why” behind their treatment, they’re more likely to stick with the program and achieve lasting results.
2. Manual Therapy: Prepping the Body for Movement
Manual therapy involves hands-on techniques to address joint and muscle dysfunctions. These treatments aim to restore healthy mobility, reduce pain, and prepare the body for active rehabilitation. Some examples of manual therapy techniques for low back pain include:
- Soft Tissue Work: Targets tight or overactive muscles to improve mobility, alleviate tension, and decrease pain, and improve blood flow.
- Joint Mobilizations and Manipulations (Adjustments): To address mechanical faults within the musculoskeletal system, decrease pain by modulating the nervous system, and restore proper alignment and function.
- Muscle Energy Techniques: Specializing manual therapy to address joint dysfunctions, muscle dysfunction, and reduce pain.
- Dry Needling: Targets myofascial trigger points and the nervous system to reduce pain and improve function.
The goal of manual therapy isn’t to fix everything—it’s a primer. It helps normalize the affected areas, allowing you to move more freely and effectively in subsequent exercise sessions.
3. Exercise: Building Strength and Stability
The most critical component of any treatment plan is exercise. Why? Because while manual therapy and education set the stage, exercise ensures your body learns to move better and stays pain-free.
Reprogramming Movement Patterns
One of the most common issues we see with athletes experiencing low back pain is poor movement patterns. These habits—often developed unconsciously—can place excessive strain on the lower back during activities like bending, squatting, deadlifting, or sprinting.
Our Process for Movement Retraining:
- Assessment: We observe how you move during key exercises. For example, does your lower back arch excessively during a deadlift? Does your spine reverse its curve when you touch your toes?
- Correction: We use targeted cues and drills to refine your technique. This might include:
- Providing anti-extension and anti-rotation cues during movement.
- Introducing movement strategies to better utilize adjacent boy regions.
- Practicing diaphragmatic breathing to stabilize your core during lifts.
- Progression: As your movement improves, we gradually increase the complexity and intensity of the movement demands, especially while under fatigue.
Strengthening: The Heart of Recovery
A common myth about low back pain is that flexibility programs are the key to relief. This misconception often explains why some Physical Therapy Clinics in Charlotte fall short in addressing low back pain effectively. If we break down the exercise component of a low back pain physical therapy program, 80% should focus on strengthening, while only 20% on mobility—not just traditional stretching. Mobility emphasizes how easily your body can move into the positions you need. But strength alone isn’t enough—it’s about developing functional strength in targeted areas, tailored to each individual’s specific needs.
Core Strength and Stability
The core isn’t just your abs; it’s a dynamic system we call Pillar Strength. It includes your hips, shoulders, and core, and all related stabilizing. Weak or poorly coordinated pillar strength can lead to compensatory patterns, overuse/ overdemand of the lower back, and pain.
Sample Core Exercises for Low Back Pain:
- Pallof Press Variations: Focus’ on maintaining a neutral spine to control against rotational forces.
- Anti-extension drills: Great for improving core coordination and strength against extension.
- Segmental strengthening exercises (ex: Jefferson curl): Builds strength and endurance segment by segment to strengthen the spine without stressing it.
From Rehab to Performance
At The Charlotte Athlete, our ultimate goal is to bridge the gap between rehabilitation and peak performance. Once your pain is under control, we transition as quickly as possible into sport-specific training to ensure you’re stronger, faster, and more resilient than before. With us, you’ll rarely be lying on the ground or little “dink” and “dunk” exercises, as these aren’t functional, nor do they translate well to sports or competition.
Sport-Specific Considerations:
- For runners: ankle mobility, hip mobility, and glute strength.
- For weightlifters: Refining squat and deadlift mechanics to prevent excessive spinal loading.
- For overhead athletes (ex: volleyball, CrossFit): thoracic mobility, scapular stability, anti-extension core control.
- For power sport athletes (ex: football, basketball) : hip mobility and glute strength.
- For rotational athletes (ex: golf, baseball, softball): hip mobility, anti-rotation core stability, and glute strength.
Preventing Recurrence: Long-Term Strategies
Low back pain is notorious for coming back if the root causes aren’t addressed. Here’s how we help our athletes stay pain-free:
1. Build Strength Beyond Rehab: Continue incorporating strength and stability exercises into your routine even after your pain resolves.
2. Maintain Mobility: Regularly mobilize areas that tend to tighten up, like the hips and thoracic spine.
3. Optimize Daily Habits: Use a supportive chair if you sit for long hours (and us ethe back rest!); Take frequent movement breaks during the day; Sleep in a back-friendly position (back or side, not stomach).
4. Optimize Warm-Ups: Utilize a customized warm-up that addresses your specific deficiencies and needs
5. Stay Active
Regular physical activity reduces stiffness, promotes circulation, and keeps your joints and muscles strong and healthy.
Closing Thoughts
Low back pain doesn’t have to control your life. By understanding its root causes, addressing the underlying dysfunctions, and committing to a tailored treatment plan, you can break the cycle of pain and get back to doing what you love—whether it’s lifting, running, or competing in sports at the highest level. If you’re struggling with low back pain, don’t wait for it to get worse. At The Charlotte Athlete, we specialize in personalized, evidence-based treatment that empowers athletes to move better, feel better, and perform better. Your journey to a stronger, pain-free back starts here!