When back pain strikes it can be scary — debilitating even. Whether you simply slept wrong or you suffered an acute injury, persistent back pain is disruptive to one’s life to say the least.
Dr. Sean Rockett, an orthopedic surgeon, shares causes and considerations when it comes to back pain, and points out some things to be aware of to give yourself the best chance of avoiding chronic back pain throughout life.
The good news — avoiding and treating back pain involves staying active and focusing on strength and stability, all of which can be achieved in a CrossFit gym.
What Are the Different Parts of Your Back?
The back is made up of many moving parts and it helps to have some knowledge of how it functions to understand what can happen if these parts stop working well. The bones or vertebrae stack up like the floors of a tall building. The facet joints are in the back of the vertebrae and they line up like the shingles of a house, one on top of the other. The discs are the cushions between the vertebrae and they act like shock absorbers. There are muscles and ligaments that attach around the bones to provide stability and movement. And most importantly, the nerve roots which come from the spinal cord, exit through little openings or foramina between the bones.
Lumbar musculature
What Can Cause Back Pain?
More than 90% of humans will have an episode of low back pain at some point. Walking upright has given humans certain conditions associated with being vertical. The pain can either be a minor soreness or a sign of something worse to come.
The most common cause of low-back pain (LBP) is muscular in nature. There are a multitude of muscles in the lumbar spine and glutes that can be strained or incur small tears during day-to-day chores like lifting things off the ground or shoveling, or during exercise ot sports. This can set off spasms, pain, tightness, and stiffness.
There are certain conditions that are typical based on a person’s age and activity level. In younger people — ages 15-25 — sprains or strains of the ligaments and muscles are common. These can present as spasms and tightness in the low back. When back pain persists in this age group despite modifying activities, we consider stress fractures.
As we get older, herniated discs can appear, classically from around ages 25-45. This occurs when one of the ligaments fails and the disc pushes on the nerve or chemically causes an inflammatory reaction. This can produce leg pain, numbness, or weakness.
Arthritis can then start to creep in around age 50. As this develops, the spaces between vertebrae can start to narrow and spurs can put pressure on the nerves with a condition called spinal stenosis. This can occur when soft tissues, discs, or bones put pressure on the nerve roots causing weakness, numbness, or pain down the legs.
CrossFit and Back Pain
There are certain exercises specific to CrossFit that can exacerbate back pain if they are not performed with sound mechanics. When performing push-ups or burpees, for example, don’t lose your midline and hyperextend in the low back. Hyperextension occurs when there is a significant or exaggerated bend backward from a neutral spine position with a lack of abdominal engagement. The facets in the back can feel that stress. When this movement fault occurs, I recommend the athlete focuses on a flat back and lifting the hips and back simultaneously to prevent excessive stress in the lumbar spine.
“Athletes who have a hard time correcting hyperextension may benefit from practicing hollow holds on the floor to learn basic mechanics of how to engage the abdominals,” says Eric O’Connor, CF-L4.
When pressing overhead, it’s important not to hyperextend at the finish of the movement. Maintaining a tight abdomen and gluteus squeeze can prevent hyperextension.
While performing deadlifts, focus on setting up with your shoulders over or slightly in front of the barbell while maintaining a neutral spine.
Qualified CrossFit coaches in one of our 13,000 gyms around the world can help you correct these common faults and protect your back.
How to Prevent and Treat Back Pain
All back pain is treatable and some would argue that most is preventable. The muscles around the spine can be strengthened early on in life. This can lead to a strong back for daily activities and athletics. Deadlifts, squats, and other exercises which focus on the muscles of the pelvis, spine, and abdomen can help stabilize the long axis of the lumbar spine. Maintaining lumbar strength is a critical element as we age.
Treatment of back pain is typically a small period of rest followed by movement, stretching, and modification. There are many practitioners who can help with low-back pain by implementing treatments that don’t involve surgery.
Most disc injuries will improve on their own — 90% improve within a month and 95% within two months. Injections and surgery should be a last resort. The medical community’s approach to back pain has evolved to make it more of a brief modification followed by actively moving to allow healing. When bed rest was prescribed, some found the atrophy and deconditioning was actually worse when returning to function. Great news for CrossFit athletes — keep moving under the watchful and experienced eye of your coach to keep a healthy, stable back.
Proper form and training can minimize injuries when it comes to the extremities like the shoulders and knees and the same holds true for the back. Lifting weights in the proper positions and sequences can help you avoid ligament tears and an accompanying disc rupture. Keeping the weights reasonable while lifting helps avoid over stress on the back, especially if the athlete is not ready to increase the load.
“Following CrossFit’s charter of developing proper mechanics and being consistent before significantly focusing on high intensity levels by increasing the speed or load of the movement reduces the risk of injury while promoting long-term results of our program,” O’Connor says. “When mechanics start to deviate from ideal, it is a sign to reduce the load and/or speed of execution.”
Learning not to push through tweaks and spasms in the back will protect the vital structures and prevent worsening of an injury. As in all sports medicine, letting something heal in a week or two is always wiser than pushing through pain for months.
If the pain radiates into the thigh, calves, or toes with weakness or numbness, the nerve may be getting irritated from a disc bulging and chemically irritating the nerve or putting mechanical pressure on it. If this is a chronic situation and there is stiffness in the morning that loosens up as the day progresses, arthritis can be called into question.
Typically, low-back pain will get better on its own and most cases will disappear within one to four weeks. Physical therapists, chiropractors, and massage therapists can help relieve pain while healing.
While some worry that surgery is iminent when back pain occurs, the intervention is actually reserved for severe neurologic compromise or unrelenting pain with a disc herniation. There is usually no need for imaging at the onset of back pain. Initial treatment should be aimed at decreasing pain and preventing stiffness from immobility. As pain subsides, being patient and not overexerting is critical.
Prevention is aimed at keeping the muscles around the lumbar spine and pelvis flexible and strong. Stretching the hamstrings, abductors, and rotators of the hips is important. Abdominal strength is also important to act as a rigid anterior or front structure and take the pressure of the posterior structures in the low back, muscles, joints, and discs.
A healthy back is an essential element to aging and moving well. If you’re concerned about the integrity of your back, don’t shy away from movement — rather focus on moving well with sound mechanics to focus on strength and stability.
Back Pain and CrossFit With Dr. Sean Rockett