Common Crossfit Injuries: Lower Back Pain

As a CrossFitter myself I can testify to the high incidence rate of lower back pain and as a physiotherapist it is definitely within the top 3 most common injuries I see. The majority of CrossFitters will be able to recount at least one episode of having their lower back in bits and this is true of the general population as well. To prove this isn’t just anecdotal, evidence shows that between 50–80% of adults will suffer from LBP (lower back pain) at one point or another over the course of their lives (Andersson, 1998) some recovering in 4 weeks (Pengel et al., 2003) while others going on to suffer recurrent episodes (Cassidy et al., 2005).
Clinically when a patient with lower back pain walks in they’ll be triaged into one of 3 categories: non-specific lower back pain (which comprises about 95% of cases); nerve-root involvement around 4% or SSP (serious spinal pathology) <1%. The latter is a straight to A + E deal but the first two can be treated conservatively. In this article we’ll just be looking at non-specific lower back pain and some of potential causative factors in relation to CrossFit. 1. PROBLEM – ‘Poor tekkers’: Unless it’s pathological back pain does not just spontaneously happen, there has to be something causing it and the first place to start is to check whether you’re lifting correctly. Lifting incorrectly whether it’s during a squat, deadlift or clean will predispose you to getting LBP.
SOLUTION: A good trainer or therapist with relevant background will be able to assess this for you and give you cues to correct it.

2. PROBLEM – ‘Weak or inhibited deep abdominal muscles’: There’s a tendency in CrossFit I feel towards movements that bias recruitment of the more superficial, high torque/force producing muscles. There’s absolutely nothing wrong with this, it’s how you get strong! But CrossFit is all about having as equal a balance as possible across the 10 domains of fitness (endurance, stamina, strength, flexibility, power, speed, agility, balance, coordination, accuracy). The inner-unit muscles that contribute to segmental control of your spine (multifidus, transverse abdominus etc) can tend to get switched-off if no one pays any attention to them i.e. if you straight leg deadlift so much that your erector spinae muscles look like tree trunks, you’re inner-unit stabilisers have probably gone on a cruise. This means that it’s more likely during a wod involving high reps under load that your back will burn out because the muscle fibre adaptation has made them able to produce a lot of force but also become quick to fatigue. The erector spinae try to deadlift while keeping your back in a good position (a job they were never intended for) and eventually LBP ensues.
SOLUTION:
Don’t neglect your gymnastics conditioning drills
Ensure that your set-up for lifts incorporates inner-unit muscle activation (pelvic floor, transverse abs, diaphragm)
Core stability/pilates/motor control exercises
3. PROBLEM ‘Hamstrung’: Kelly Starrett has a great article describing how tight hamstrings can lead to early pelvic reversal before reaching parallel during a squat (Starrett, 2007). The lumbar spine sits directly onto of the pelvis so what affects one will affect the other. Early posterior pelvic tilt puts the lower back into a flexed position and means that your hamstrings are at the end of their range. What does this mean? Stress will be placed primarily on your lower back as the hamstrings are at a mechanical disadvantage (end of range = crap length-tension relationship = unable to produce much force).
SOLUTION:
Squat therapy working on maintain the ideal lower back position for as long as possible
Keep performing movements to full range (shorting your squat is only going to make the problem worse although I would advise seeking advice from a physiotherapist if you have persistent back pain before progressing to do these movements under higher loads).
Stretch your hamstrings at the knee end and hip end by performing the stretch with the knee bent and straight.
4. PROBLEM – ‘Over-active hip flexors’: The ilopsoas is made up of two muscles that blend together to form what most trainers and therapists refer to as the hip flexors. While it’s not the only muscle that flexes the hip, it is the only that originates from the lumbar spine and therefore has a direct impact on lower back pain. In a similar fashion to the hamstrings if your ilopsoas runs out of length at the hip end it will make up the deficit (for example as you descend into a squat) by pulling your torso downwards and forwards. To put it another way, it causes you to over-extend your lumbar spine placing stress on the articular surfaces of the facet joints. The other common culprit here is the rectus femoris, a two-joint muscle (as it doubles up as a knee extensor) that is prone to getting tight causing anterior pelvic tilt and once again, lumbar spine over-extension.
SOLUTION:
Stretch your hip flexors religiously! The ‘couch’ stretch is a great one for this as it incorporates both of these muscles and kills two-birds with one stone.
Seek help from a physiotherapist for postural/biomechanical assessment, tailored stretching programme, trigger point release.
Foam roll your rectus femoris! It’s very difficult to access the ilopsoas yourself but the rec fem is the most superficial of all the quads and just waiting for you to foam roll the hell out of it!
This is not an exhaustive list of all the problems that can cause lower back pain as there are many. Diagnosing the source of your back pain and causative factors requires an individualised assessment from a physiotherapist or sports injury professional. But hopefully this article will help as a first line of defence is keeping lower back pain at bay!

J.Glover BSc (Hons) Physiotherapist MCSP
www.jg-physio.webs.com
Jay is an avid Crossfitter, and runs his Physiotherapy practice out of TRAIN Manchester, UK.


You may find Jay’s article about Elbow Dislocation worth a read



References
Andersson, GB (1998) Epidemiology of low back pain, Acta Orthopaedica Scandinavica, 281: 28–31.
Cassidy , JD., Cote P., Carroll LJ., Kristman V (2005) Incidence and course of low back pain episodes in the general population, Spine, 30: 2817–23.
Pengel, LHM., Herbert RD., Maher CG., Refshauge KM (2003) Acute low back
pain: systematic review of its prognosis, British Medical Journal, 327: 323–7.
Starrett, K (2007) Hamstrung, CrossFit Journal, 59: 1-6.