Reduce The Risk For Lower Back Pain

America is an injured nation. The total costs of low-back pain in the United States exceed $100 billion per year (1). I have seen this firsthand as a trainer. The majority of my clients have experienced back pain or currently have back pain. Back pain can be broken down into two categories: extension intolerant or flexion intolerant.

Are you extension or flexion intolerant? 

To figure out which one you have you need to complete two tests. If you are extension intolerant then the child pose posture below will feel better than the upward dog posture. Once you know which posture is causing your back pain than you can reduce your back pain by avoiding that position

Upward dog

Upward dog

Child pose 

Child pose 

For today's blog post, we will focus on extension intolerant back pain. This means that you prefer to be in the child's pose position versus the extended upward dog position. 

Form Follows Function  

I believe most back injuries are due to poor body alignment and muscular imbalances. In order for the body to function properly, it must be in the correct alignment. When the body is out of alignment, the muscles of the hip and trunk are affected.  The glutes, abdominals, and hamstrings become weak forcing the lower back to do all the work.

A study done in the Journal of Physical Therapy Science supports this idea. 17 healthy adult males volunteered to take part in the study. The subjects muscle activity and spinal curve were measured during different postural conditions (neutral, sway-back, and lordosis) (2).


As you can see from the chart below, the lumbar erector spinae and lumbar multifidus muscle activity increased three-fold in a lordosis (excessive lower back arch) posture versus a neutral posture. While the gluteus maximus muscle fiber activity reduced two-fold. An inactive core combined with an overactive lower back is the perfect recipe for an anterior pelvic tilt and increased one's risk for injury.

The idea that an anterior pelvic tilt can increase the risk for back pain is supported by CJ Sorensen and colleagues (4). Their goal was to examine the effects lumbar lordosis has on back-healthy participants who do and do not develop low back pain during two hours of standing. Twenty four of the 57 participants who reported back pain also had an increased anterior pelvic tilt.

The authors found an increased lumbar lordosis (anterior pelvic tilt) to be a risk factor for low back pain (4). Put simply, the participants who had an increased lumbar lordosis experienced more pain during standing versus the group with less lumbar lordosis. Therefore, to alleviate back pain we must bring the body back to proper alignment.

To reverse an anterior pelvic tilt, you must strengthen the rectus abdominus, obliques, glutes, and hamstrings. When they become stronger, they are able stabilize the pelvis by tilting the pelvis backwards. Also, inhibiting the latissimus dorsi, quadratus lumborum, and hip flexors through stretching and foam rolling can help too. In essence, you need to strengthen the muscles that tilt the pelvis posteriorly and relax the muscles responsible for tilting the pelvis anteriorly.



Use the ten exercise circuit below to reduce your anterior pelvic tilt. When performing the exercises I want you to pay attention to your breathing and focus on the quality of movement. Perform the circuit 2-4 times in between your lifting days or on your cardio days. After you perform all of rounds, complete the cool down from below.

1. 90/90 Hip Lift W/ 2 Arm Reach 5 exhales

2. All 4s Belly Lift W/ IR Hip 5 exhales

3. Dead Bug 6-10 reps per side

4. Swiss ball Hamstring Curl 12-20reps

5. Side Bridge W/ Clam Shell Iso Hold 20-second hold

6. Hip Flexor Mobilization 8 reps per side

7. Glute Bridge W/ Ball Between Legs 15 reps

8. Active Hip Lift to Lateral Lunge 5 reps per side

9. Quad Pull Back To Lunge W/ Overhead Reach 5 reps per side

10. Hips High Forward & Reverse Bear Crawls 10 reps each

Cool Down

1. ½ Kneeling Hip Flexor Stretch 2-3 minutes per side

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