By Stephen Pollock, Senior Physiotherapist
Quite often after a lower back injury some people can develop a fear of lifting or loading their lower back because of concerns they will aggravate or re-injure their backs.
We call this “fear avoidance” – avoiding certain movements or activities due to fear of causing another or further injury.
I often hear certain types of words when dealing with clients who have had past back injuries: including feeling “fragile”, or “weak” or other similar words. These words are usually indicating fear avoidance tendencies.
There is no reason for you not to use your back after a back injury, you just have to use it in the correct way or distribute the load in other ways. Below I’ll outline how back problems can happen and how to manage (and avoid) lower back injuries.
How lower back problems occur
The big lower back muscles are long and cover multiple joints. Problems can arise when a lot of the load when lifting is placed solely through these muscles, or even when these muscles are not used well in conjunction with other supporting musculature then the load is placed directly through the spine.
All muscles, tendons, ligaments and joints in the body have a failure point. They can only handle so much force before they are injured. A big part in the way that we manage lower back injuries is by changing how the load is distributed when lifting. Getting clients to work their glutes (which is the strongest muscle in the body) and hamstrings when lifting or squatting is surprisingly hard, but doing this will distribute the load a lot more effectively, causing less pain and reduced injury chances.
The below photo demonstrates a “fear avoidance” way of lifting. My back is straight and compressing (which it is good at) but this is actually a weak position and not an ideal position for lifting.
The back and/or core muscles are not being activated well, and there is little glute or hamstring use. Most of the work is done by the quads and the knees are well forward past the toes so it places a lot of load on the knees (which could lead to knee issues). Also being on your toes means a more unstable base and less foot surface to put pressure down through. So not a good position to use for developing power and if moved out of this position slightly then you risk further injury as nothing much is switched on to support you. This movement pattern is usually the reason for you describing your back feeling “weak” or “fragile”.
The below picture demonstrates a better squat pattern with a better hip hinge which is key for lifting. It is the same weight but feels much easier to lift with less stress on the back because I have transferred the weight across more muscles and stronger muscles. Note that my knees are not forward past the toes so there is less stress on the knees. There is more angle in the back but now my glutes and hamstrings are switched on which takes load away from my spine. Also now my core, lats and back muscles are engaged which provides me with more stability and less force going through my spine itself. My feet are planted on the ground which gives me a bigger base of support and more surface area to apply force into.
Switching on all of these muscles makes me stronger and less risk of injury. If we can take you away from a fear avoidance way of moving and encourage you to use the right muscles in a safe and correct way then you will have less pain and less potential for injury.