Top 5 Fridays! 5 Common Causes of Extension Based Lower Back Pain (PART 1) | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Common Causes of Extension Based Lower Back Pain (PART 1)

We all know that lifting with a rounded lower back can certainly cause some lower back pain.  What’s also important to wrap your head around is that many people don’t have trouble with lumbar flexion (lumbar rounding) but with the opposite motion called extension.  Lumbar extension is what this gentleman is doing to the left in a upward dog pose.
These individuals don’t have lower back pain when bending forward and with deadlifting movement buts rather with extension based movements.  A lot of times these individuals complain of pain with overhead pressing, especially as the loads get heavy.  They may also complain of pain in the back swing (arch) of a kip and during burpees as the lower back arches.  They also tend to hurt with any sort of lumbar extension testing like an upward dog.
Having lower back pain with extension can originate from a variety of places.  Generally I see this come from people who utilize lumbar spine extension excessively during their lifts.
1) Overhead Press 

Some athletes will press overhead with increased lumbar extension.
Log press – requires more lumbar extension than barbell overhead press
2) Bench Press
I also see this in individuals that utilize a large lumbar arch during bench press:

Check the lumbar arch during my bench press
3) Backswing (Arch) on Kipping
The backswing during a kip creates quite a bit of lumbar extension.  For some, this can be excessive and problematic.
4) Deadlifts, Squats and Olympic lifts
This concept is a bit tougher to grasp than the previous two.  These individuals will generally do 1 of 2 things:
  1. Substitute Hip Extension with Lumbar Extension – This can generally be seen in individuals at the top of a lift.  These folks will finish their lifts but will finish the lifts with excessive lumbar extension and anterior pelvic tilt.  They never truly reach full hip extension.  Check out figure “B” below.pelvic-tilt
  2. Excessively Anteriorly Pelvic Tilt and Lumbar Extend Throughout the Lift – These folks generally start the lift with too much lumbar extension and maintain that throughout the lift.  Imagine figure “B” above throughout a lift. has some great examples shown below:pelvic-tilt-hip-flexion
In all of these individuals we are placing the spine in a position of inefficiency (1).  (Except for the potential of reliance on passive structures as we’ll discuss later).  The spinal musculature is strongest in a neutral position where the lumbar musculature is in an optimal length / tension relationship (Muscles are generally strongest in their mid-range of motion).  In the overhead press and bench press examples we’re potentially loading the spine toward end range extension which is implicated in disorders such as spondylolisthesis.  With the example of someone who doesn’t finish the lift with their hips we’re potentially overutilizing lumbar extensor muscles and not optimally recruiting the powerful glute musculature.  Either way these individuals sometimes end up with extension based low back pain because of their lifting technique.
Now, why does this happen?

1) Overhead Mobility Restrictions:

This one is a very important variable with those over extenders during overhead movements.  If someone is lacking overhead mobility then a common compensation to get your arms fully overhead is lumbar extension.  Check the video below for a visual explanation:

2) Hip Extension Limitations:

The inability to fully extend the hip will also force lumbar spine extension.  This is often seen as increased anterior pelvic tilt at the finish position of a deadlift or squat as described above.  Here’s an easy assessment to check hip mobility.  Make sure the low back doesn’t pop off the table (compensatory lumbar extension) during the assessment.  If this happens then you’ve got someone with a hip extension limitation that could be a culprit for their low back pain.

3) Lack of Neutral Spine and Pelvic Strength, Endurance Motor Control:

Some folks simply have no idea they are over extenders.  Attaining a neutral spine is a skill and some people don’t realize they are not in neutral until they’ve been shown.  I often find that these folks also have lumbar flexionlimitations and increased lumbar extension passive motion.  Given they lack flexion and have excessive extension, a neutral position for them is actually increased lumbar extension.  Others simply lack the strength and endurance to maintain a neutral spine.

4) Too Much Load:

Two things happen when trying to load excessively.
  1. The upper body tries to find a more optimal pressing position – We all know that the world record for the bench press is higher then the military press.  When pressing overhead individuals will lean backwards to get into a more optimal position to press more weight.  Check out this monster’s low back position below.olympic-press
  2. The lumbar spine passive structures begin to get loaded – This is a tougher concept to understand.  As the spine approaches it’s end range of motion, certain structures begin to get loaded.  Imagine bending your finger backwards.  Eventually the motion stops because certain structures on the front side of the finger joint get stretched (and structures on the back get compressed).  The same occurs in the spine.  Now, this increased passive structure reliance can actually increase stability and be a way lifters increase the load on the bar.  Trouble is, we’re loading parts of the spine that don’t enjoy being loaded this way and some spines can get sensitive and or injured as a result.
5) Poor Volume and Load Management:

Applying the right stress in the right amounts while allowing adequate recovery between bouts is a huge player in progression and injury reduction. I’ve written about this extensively in the past and the literature is quite clear (2, 3, 4) in this regard. Proper programming and periodization is enormous.

Stay tuned for next week’s installment where we’ll be talking about some corrections for these issues
Lower Back Pain Party,
Dan Pope DPT, OCS, CSCS, CF-L1

Works cited
  1. McGill, S. (2007). Low Back Disorders. Champaigne, IL: Human Kinetics.
  2. The Development and Application of an Injury Prediction Model for Noncontact, Soft-Tissue Injuries in Elite Collision Sport Athletes. (n.d.). Retrieved August 01, 2016, from
  3. Relationship Between Training Load and Injury in Professional Rugby League
  4. Training and game loads and injury risk in elite Australian footballers. (n.d.). Retrieved from

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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