Preventing Lower Back Pain

"Prevention is better than cure!"

The following is suitable for individuals with no current, or history of, lower back pain and/or injury who wish to help reduce the risk of future problems. For treatment of existing or recurring pain and/or injury, seek the advice of a suitable professional eg., a physiotherapist.

Lower back pain is a serious problem.

Firstly there is your own personal suffering...

...lower back pain is unpleasant, to say the least, and will usually affect/prevent almost all of your daily activities and overall quality of life, including:

  • time off from exercise

  • time off work

  • not being able to enjoy an active lifestyle - playing sports with your kids for example.

Regarding the bigger picture... lower back pain in the UK, is also responsible for:

  • 11% of the total disability of the UK population (NHS England)

  • 40% of sickness absence in the NHS (and therefore probably the wider workforce where similar statistics are not reliably collected) (The British Pain Society)

  • an annual cost of £10 billion for the UK economy (for context, that's equivalent to approximately 5% of the whole annual budget for the NHS in 2020/21) (The British Pain Society)

  • plus a wide range of hidden costs and personal side-effects associated with reduced activity levels and effects on mood (including negative consequences for individuals' mental health).

A large proportion of lower back pain is preventable...

Common causes include:

  • weak core muscles (the lack of support from surrounding muscles increases the risk of injuries)

  • tight muscles in and around the core/lower back. eg., tight hip flexor muscles can lead to muscle imbalances in the upper leg/glute zone, potentially leading to an unwanted tilt in the pelvis, and ultimately, increased strain on the lower back

  • poor posture (can be both a cause and/or consequence of the above)

  • being overweight - extra weight, around the abdomen for example, increases the work that muscles are required to do to support your posture and shifts your centre of gravity. Both cause your core to be exposed to extra strain.

  • bad habits - poor lifting technique, bad exercise form, sitting positions etc

Reminder: If you are already injured... seek appropriate medical advice.

Preventative Measures

Strengthen Your "Core"

Your "core" refers to more than just your "6-pack" muscles.

The middle third of your body contains a variety of muscle groups, working (ideally) in tandem to support good posture and aid safe movement patterns.

  • abdominals

  • obliques (to the side of your abdominal area)

  • the muscles of the lower back

  • TVA (running underneath your abs)

  • glutes

  • hip flexors

Significant weakness in any of these muscles means that your core may lack the necessary structural support. That may be due to a lack of relevant exercise and/or habits such as spending too much time sitting (remember, even if you are sitting 'correctly', if you are relaxed, your core muscles are 'switched off').

If you are not using your muscles for the purpose that they were 'designed' for, nature dictates that muscle 'tone' will reduce and muscle wastage occurs to spare your body the metabolic cost of maintaining unused muscle mass (and yes, that does mean your overall metabolic rate will decrease too - increasing the risk of unwanted weight gain).

Specific strengthening exercises for the muscles mentioned above, and healthier habits, will help to build (or maintain) core muscle strength and muscle tone (consistent muscle tension) increasing stability in the lower back and reducing the risk of injury.

Improve/Maintain Your Flexibility

Weak muscles disrupt the balance of the core... as does muscle tightness.

Failing to stretch, and poor habits (the same poor habits that cause muscle weakness) can easily result in tight muscles in and and around the core.

Example: Too much time sitting means that your hip flexor muscles at the top of your thighs are consistently flexed (ie. your hips are at a 90 degree angle for a large portion of the day). This gradually causes a tightening of the muscles. Then, when you are standing upright, walking, running etc you have undue tension working to 'pull' your posture forwards.

This is often exacerbated by a corresponding weakness in the glutes, which in this case, should have effectively been working in the opposite direction to your hip flexors (ie. helping to 'straighten' your posture in an upright position. The end result is an anterior tilt in the pelvis (your pelvis is being pulled into a forward rotation).

Potential end results - hip flexor injuries, glute muscle injuries and lower back injuries (still applies even if you are exercising regularly... your exercise 'form' may be negatively affected by the changes in your body's alignment without you realising. It also increases your risk of "freak injuries" eg., when bending over to lift something from the floor).

The risk of this specific scenario occurring can be reduced by:

  1. Maintaining flexibility in your hip flexors

  2. Maintaining strength in your glutes

  3. Avoiding/reducing bad habits (eg., sitting)

Obviously, this can (and should) then be applied to all of the relevant muscles in the body... for example, relatively tight muscles in the front of the chest/shoulders, paired with relatively weak upper back muscles, is often associated with poor upper back/neck posture and pain (common causes - typing and/or using a phones for too many hours per day, with hands/shoulders raised and your head & upper back bowed forward).

Remain Mindful Of Bad Habits

Long periods of sitting (at a desk, driving, watching TV) encourages the core muscles to relax (your chair does the job of supporting you, rather than your own muscles). The less you use these muscles (just like any other muscle), the weaker they get.

Then you need to think about positions...

Flexed hip flexors, hunched posture, leaning etc... can all encourage various muscles to tighten.

Think about scenarios where this might be relevant to you...

  • looking down at your phone?

  • not sitting straight while watching TV?

  • carrying heavy bags on one shoulder?

Either of these outcomes (weakening and/or tightening of muscle) can increase the risk of back pain/injury.

In most cases, 'bad habits' will result in both occurring simultaneously in different muscles.

It's important to be mindful of these habits even if you consider yourself active and relatively fit.

8 or more hours at your desk, followed by an intense workout is obviously better than not training at all...

But if there are imbalances in your core muscles... every exercise, every stride, every rep is an opportunity for injury.

PREVENTION is better than cure!

Don't wait for an injury to occur before taking it seriously...

...reduce your risk in the first place!

  • Break up your sitting with regular breaks - stand, walk, stretch.

  • When you do workout - warm-up properly!

  • Don't neglect your mobility work.

  • Respect the importance of your core strength - even if your workout goals are aesthetic or "core" is not a priority... consider this... a lower back injury is going to significantly reduce your ability to train consistently, and avoiding such a situation is therefore ESSENTIAL to your success!

  • Learn and prioritise proper exercise technique

  • And when you're done... stretch again!