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Back Pain: Why You Shouldn’t Fear Lumbar Flexion

Jul 24, 2019

AUTHOR: Dr. Nate Jones, PT

“You should lift with your legs, not your back.”

 “If you round your back, you’ll slip a disc.” 

“My friend’s uncle’s wife’s best friend bent over to pick up her laundry basket 10 years ago and now she has a bad back.”

There’s a good chance at some point in your life you’ve heard a saying similar to these quotes. The ideas that we shouldn’t round our backs and that our backs are fragile structures that need to be protected from heavy loads are incredibly pervasive throughout our culture. However, these concepts are not based on facts, but rather on the fear that our bodies are not strong, adaptable, resilient structures. The widespread belief in these common misconceptions actively contributes to pain and disability.

Our backs should be used to lift, and they should be trained through the entire available range of motion in order to prepare them for daily life. Anatomically, the facet joints in our low backs (joints in between each vertebrae) are angled in a manner that allows for some of the greatest flexion and extension range of motion anywhere in the spine. 

The bony structure of the low back is literally built to round. 

To understand why the widely promoted fear of back rounding (lumbar flexion) can contribute to pain and disability, it is important to understand pain and where it comes from. An in-depth explanation of it is provided here (Pain Blog) but the short version is that pain is an emotional output created by your brain in response to what your brain believes to be a threat to your body. Just like any other emotion, pain is produced by multiple factors. It is possible to have severe tissue damage without any pain, and it is possible to have severe pain without any real damage. It's a protective mechanism. If we only had pain with tissue damage it would be too late to protect anything. 

Research has examined which factors play a role in pain production, and it turns out that fear of movement is one of the biggest predictors of chronic pain.

 In other words, if you are afraid of rounding your low back, you are more likely to experience chronic, lasting low back pain because you are avoiding those movements. 

Avoiding physical load in a range of motion leads to tissue weakness in that range of motion. The tissues in our bodies become weaker when they are not exposed to stress, and they become stronger when the appropriate dosage of stress is applied and they are given the resources to recover from the stress. This is most obviously illustrated by lifting weights in a gym - you apply stress to a muscle with weight, you eat the right foods, you sleep, and you give it a little time, and the muscle becomes stronger. This process isn’t unique to muscle, however; it happens to every tissue type in our bodies, including ligaments, cartilage, tendons, bone, and the intervertebral discs in our backs that we’re so afraid of hurting. This process is also fairly specific to the range of motion the tissues are trained in. 

To put it plainly, if the low back is not trained through the full available range of motion, then it will become weaker in the range of motion that is avoided.

Bending at your back (lumbar flexion) is impossible to avoid in daily life - research demonstrates that a neutral spine cannot be maintained while picking things up, even if visually the spine looks neutral. Eventually, if the tissues are not strengthened through the full range of motion, that weak range of motion becomes the point at which injury happens. Somebody bends over to pick up a basket of laundry, the tissues have been weak and neglected in that range of motion for years, the load through the tissue overwhelms the capacity of the tissue, and they experience an injury with the associated pain and disability.

If lumbar flexion is trained, low back injury can be avoided much more easily. If lumbar flexion is loaded slowly and progressively over time with a movement such as the Jefferson curl, eventually all the tissues will be able to withstand a much higher load, and experiencing an injury picking up something like a laundry basket will become less likely.

If you can perform five Jefferson curls with 100 pounds, rounding your back picking up ten pounds is well within the capacity of the tissues. In addition to strengthening the tissues in that position, strengthening end range lumbar flexion decreases the likelihood that your nervous system will perceive that position as a threat, which means it won’t produce the emotion of pain. 

Our spines are very strong, adaptable structures and we should not be afraid of using them. They should be trained with progressive loading through a full range of motion, including lumbar flexion. This will make your back stronger, make it less likely that you will suffer a debilitating injury, and help you recover from previous injuries. 

Here are some of our favorite exercise videos that we have tested on hundreds of patients who have struggled with low back pain.

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