Low back pain is one of the most common causes of disability in the US.

8 in 10 people are likely to have an episode of low back pain in their lifetime.

The good news is that the majority of these cases resolve completely.

Unfortunately, however, the recurrence rate is rather high, and a few individuals do go on to have persistent pain.

So what can we do to prevent this?

Low back pain is complex and there are different types of low back pain that may need to be managed differently. By no means do I intend for this post to give you all the answers on this topic.

What I do want to do is share some simple do’s and don’ts of how to manage the most common types of low back pain that do not involve serious injury or pathology. 

I’ve done my best to base these recommendations on current evidence and our evolving understanding of pain and treatment strategies.

So, let’s start with some things you absolutely should NOT do if you experience low back pain...

​...DON'T fear the worst

Again, low back pain is fairly common and most episodes end up resolving completely. So don’t fear the worst. Rather, know that you have good reason to be optimistic, and there are several things you can do to help yourself get better...more on that in a little bit.

….DON’T get on the internet to find answers

That might seem contradictory since you’re reading this post about low back pain on the internet. But the fact is there is a lot of bad and outdated information on the internet. Plus, you're likely to stumble across scary terms like "degeneration" and "disc bulging" which can create unnecessary fear. These terms actually just describe normal findings in most people, even those that don't have any pain.

….DON’T ignore the pain

The opposite of being overly worried about your back would be ignoring the pain and pushing through activities that make it worse. And that's not a good approach either. Pain is your body’s alarm system meant to protect you, and if you ignore these signals and continue to provoke the pain, it may be harder to turn the pain off.

….DON’T rely solely on passive strategies

What do I mean by passive strategies? Massage, electrical stimulation, needling, manipulation, adjustments, etc. None of these things are bad in and of themselves, and they certainly might useful tools to help you improve. But they are most effective when combined with active exercises that help you build self-efficacy rather than creating dependency.

So, here’s what you should DO instead…

….DO stay active

Find some low-intensity exercise that doesn’t increase your pain, and use that to keep moving. That might mean walking, biking, swimming, or something else that doesn’t hurt… the key here is to break a sweat and get the endorphin release from exercise to help reduce the pain. 
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….DO work on improving your lumbar spine mobility

Often when you have low back pain, your movement becomes stiff and guarded. Working on improving your range of motion gradually can help reduce the pain and protective guarding.

Here's a simple exercise that can help you target your lumbar spine mobility...

​If you struggle with shoulder pain or proper positioning during overhead lifts, then THORACIC SPINE MOBILITY something you should take a look at.
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T-spine mobility is often overlooked in its importance to obtain proper overhead positioning. Not enough of it and your scapula (shoulder blades) will not be able to tip back enough to get your arms overhead. Often, that results in excessive strain on the glenohumeral (shoulder) joint and can be a factor with pain during overhead activities and missed lifts due to not being able to get into a good overhead position. 

So how do you know if you have enough thoracic spine mobility? 

Run yourself through this simple test...

Key points: Exhale before each rep to pull your ribs down and prevent arching your lower back. Move to different segments across your upper back and spend more time on areas that feel more stiff or restricted.
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If you don't currently have any shoulder pain, then you can try the advanced version of the last exercise, with a kettlebell or dumbbell to help add some overpressure to the stretch. Be careful not to overdo it with this one, especially if you're new to these drills.

This week we look at how to improve your ankle mobility in order to obtain better deep squat positioning. 

In Part 1 you learned that olympic lifts and front squats require more ankle mobility than a back squat or deadlift. That's because the torso needs to be more vertical in these lifts to keep from dumping the weight forward. And in order to keep the torso vertical, the knees have to travel forward which requires adequate motion at the ankles. We call this motion ankle dorsiflexion and below is the test we learned for it, so hopefully now you know if it's a problem for you or not. 

If you were limited here and couldn't reach the wall, there are two common reasons:

1. You have limited mobility of the ankle joint itself, which is probably the case if you feel like you hit a block in the front of the ankle as your knee travels forward
2. You have limited flexibility of the calf complex, which is probably the case if you feel stretch/tension in the calf/achilles as your knee travels forward

If you are in the first camp and feel a block or pinch in the front of the ankle, here are a couple mobilizations to try:

In addition to helping to improve ankle dorsiflexion, this next exercise can also help you to keep your knees out when you squat.

If you are in the second camp and feel more resistance in the calf, here is a great exercise for that:

If you've been stretching your calves for years and feel like you go right back to being tight again minutes after you stretch, this may be just the exercise for you. 

A 2012 systematic review by O'Sullivan et. al. looked at the effects of eccentric training on lower limb flexibility and found "consistent,strong evidence" for increased range of motion and muscle flexibility in all the muscle groups they studied following an eccentric training protocol. The most likely mechanism for this increase in range of motion is that the mild muscle damage caused by eccentric training actually causes muscle adaptations where new structural units of muscle (called sarcomeres) are created in series, thereby increasing the length and flexibility of the muscle.

HOW COOL IS THAT!

But that's not all...eccentric training also improves length-tension and peak torque which can actually help to prevent many common muscle/tendon injuries!

Last point here...it's important to follow these exercises up with loaded movements to help you maintain the range of motion that you gained. Goblet squats are a great option here (Part 2). Really focus on keep your torso upright, pulling your knees forward a bit, and driving your knees out. 

That's all for now folks!

Part 1 of this series covered squat mobility assessment - simple tests you can use to determine what might be limiting your squat. 

In Part 2 will look at some ways to improve your hip mobility if you found a limitation or experienced pain/pinching in your hip during your assessment. 

​Below are four of my go-to exercises to improve hip mobility and comfort in the bottom position. You can view this as a progression from more passive techniques to active/loaded techniques to help maintain gains in mobility long-term.

This is a great one to use if you do experience pinching in the front of your hip. I've found with many athletes that the distraction force from the band helps to reduce or eliminate the pinch. 

This one is a bit of an advanced version of the first exercise. DO NOT work through any pain/pinching in this one. Either limit the range of motion or stick to the first drill until you can better tolerate this one.

This next drill comes from Dr. Andreo Spina of Functional Range Conditioning. It is a great way to actively work on improving strength/control at the end ranges of your hip mobility. I rushed through the demonstration a bit but feel free to take your time in each position to stretch and gradually ramp up and ramp down the intensity of the contraction. After 1 cycle, move further into the stretch and repeat as many times as needed. 

Goblet squats allow for a more upright torso and therefore greater depth in the squat. Loading the squat and spending time in the bottom the most effective way to improve squat mobility long term, in my opinion. 

In the last post, we talked about mobility and tried to shed some light on what we mean by it and why it's so important. In this post, we'll talk about mobility requirements for one of the most basic functional movements and one we see a lot of in CrossFit, the squat. 

So first, let's talk about the biomechanics of the squat. The hip, knee, and ankle simultaneously flex allowing the athlete to descend, while keeping the center of mass over the midfoot. The degree to which your joints will be required to flex depends on where the load is placed. Generally speaking, the more anterior (in front of the body) the load, the less hip motion required, while there is a greater demand for knee and ankle motion. Take a look at these photos and see if you can spot the differences. 

Now that you understand the mobility demands of the squat, let's show you ways to actually assess your mobility. This is important because you don't want to guess and then waste time working on the wrong thing. Here are my favorite assessments:

Quadruped Rockback (from elbows) for hip and knee flexion
​This test virtually takes the squat and flips it 90 degrees. Without having to work against gravity in this position, we can get a good sense of where we bottom out. The key here is to maintain a neutral spine as you sit your hips toward your heels, and to stop at the point at which you begin to feel or see motion at your lower back (this may take some practice and having someone to watch you and give you feedback is helpful). If the spine flexes/rounds, we are no longer getting a true test of hip mobility. The goal is to see the hip crease go past the knees. 

This is also a great position to determine the best stance width for your squat. Play around with bringing your knees closer together and further apart to see where you are able to sit back the furthest and most comfortably. Then adopt that stance the next time you get under a barbell.

Half Kneeling Ankle Dorsiflexion Test
Start with your foot about a hand-width away from the wall (including your thumb). Push your knee forward reaching for the wall without letting your heel come up. You should be able to touch the wall. If you can't, this may limit you in the squat, especially the front squat and olympic lifts where the barbell is more anterior. 

Give these simple assessments a shot and then come back here soon for some exercises I'll be showing to help you improve your mobility in these areas.

Appreciate any feedback, comments, or questions!