How to Prevent Back Pain at the Gym

Poor Lifting Technique 

Poor technique can result in low back pain when it places the spine into flexion (forward bending) or extension (arching backward) beyond a neutral range. Previously it was thought that only forward bending through the lower back was related to back pain, so many people were taught to extend the back while lifting in a strategy to avoid injury. However, its now understood that over-arching can be just as provocative for certain types of lower back pain, especially for those who have a naturally arched posture in the lower back already. Whilst under a heavy load, most commonly with squats or deadlifts, the general consensus for avoiding lower back injury is to maintain the same angle/ curve throughout the movement, however this particular angle or curve is going to look very different for each individual. Although there is one exception to this rule- at the lock out positions of the squat and deadlift a posterior pelvic tilt is recommended which alters the spinal posture.

The best preventative measure to ensure poor technique isn’t result in lower back pain is to determine what a neutral spine looks like for you, and then use feedback to gauge whether your posture is in keeping with this neutral spine. The best way to do this yourself is through filming your lifts from the side in slow motion, or work with an experienced sports physiotherapist for feedback on your form.

Mobility Restrictions

Mobility, or lack thereof, is a large contributing factor for the onset of lower back pain with lifting. However, rarely is it a lack of mobility in the spine which is the issue, most commonly it is stiffness elsewhere that results in greater stress being placed on the back. The joints or muscles which can impact the lower back if they are stiff do vary depending on the exercise you experience pain with, however the most common perpetrators are as follows:

• Limited hip mobility, primarily hip flexion, external rotation and internal rotation, are common causes of back pain. This is especially prominent with squatting and deadlifting type movements. A good test to see if this is affecting you is the 90/90 hip test – YouTube
• Limited ankle dorsiflexion, which can be caused by tight calves, ankle impingement, or previous ankle sprains. Limited mobility here can result in increased trunk flexion, due to the knee not being able to pass in front of the toes in squat and lunge positions. A good test to see if this is affecting you is the Knee to Wall test (aim to be at least >10cm, however >15cm is ideal). The Weight Bearing Lunge Test or Wall Test | Ankle Mobility – YouTube
• Limited thoracic spine (upper back) mobility can also lead to lower back pain, due to the lower back needing to compensate for the lack of movement contributed by the upper back. If you get back pain when pressing overhead or doing rows, this one is likely one of the causes. Thoracic Spine Mobility Assessment – YouTube

It should also be noted that hypermobility, where you have significantly more flexibility than normal, can also relate to back pain if you don’t have the strength to control your movement and posture under load. If you have been referred to as double jointed, or tend to hyperextend at a lot of your joints then you may be hypermobile and at a greater risk of back pain while lifting. Although the best thing you can do is, actually spend more time in the gym getting stronger. However the advice would be to stick to hypertrophy training (i.e. working with high reps and a lot of isolation/ accessory lifts) and not going to your full range, as this is probably beyond the ideal technique.

Poor Motor Control

Motor control is a term which describes the coordination of different muscle groups to complete a particular task. If, for whatever reason, a particular muscle group is relied on more heavily than others while exercising, it may be at risk of an overuse injury or becoming quite stiff and hypertonic. This can be problematic if it starts happening in the lower back muscles, but also if it happens in the muscles elsewhere around the hips and pelvis, as these areas can impact your posture, mobility and technique.

The best way to assess motor control is to perform an isolation exercise which targets a specific muscle group, hold it for between 10-30sec, and confirm that the primary muscle you have an awareness of whilst holding is the one which the isolation exercise is targeting. For example, to assess whether you have adequate motor control of the calf you would go into a calf raise hold, and after 30sec you don’t have any awareness in your calf muscle, then we would conclude that you have poor control of the calf muscles. If we link this back to lower back pain, the key muscle groups for movement and support of this region are the lower core muscles, the glutes and the lumbar extensors. The best isolation exercises to use for the test above would be:

Lower core muscles: Bird-dog How to Do the Bird Dog Exercise | Abs Workout – YouTube

Glutes: single leg glute bridge How to do a Single-Leg Glute Bridge | The Right Way | Well+Good – YouTube

Lumbar extensions: superman Superman Exercise For The Back — (LOW BACK AND CORE EXERCISES) – YouTube

Programming Error

At the end of the day, you could have textbook technique, great mobility and perfect motor control, but if you are hammering yourself at the gym every single session, and not programming your weeks and months appropriately, eventually, something has to give, and a common area for this to occur is the lower back. Programming errors refer to overtraining due to inadequate allowance for recovery, as well as minimal variability in training stimuli. Meaning the body is loaded too often and in the same areas which can result in overuse injuries. This can happen in two ways either acutely (across the training week) or chronically (across a month or year). In terms of the load across your training week it is recommended that the majority of people have at least one full rest day and one low-intensity cross-training day. The most common error I tend to see however is the chronic workload error, whereby someone completes a similar session week after week and aims to lift to failure each time. Which is great in the short term, however in the long term our body doesn’t cope. After a period of time there is a ceiling affect where our body won’t adapt any further to a particular stimulus, and trying to push past that will only result in overtraining and eventually injury. The best advice is to schedule a lower intensity week every 4-6 weeks, whereby you drop the load on all your lifts by about 20% to allow the body to recover and go into the next few weeks much fresher.