Hinge Points and Back Pain

Updated: Mar 13

Back pain of all kinds is something I see a lot of.

Clients hurt for different reasons, but what we all share is that our pain or lack thereof is the result of the way we move and exist on Earth daily. As I teach in our movement assessment courses, chronic pain is typically not the result of one incident (for example, herniating a disc while squatting) but rather a series of cumulative events which sensitizes our back’s pain receptors enough that we start to hurt.

As renowned low back researcher Stuart McGill has documented, a cumulative number of unchecked flexion cycles becomes a potent mechanism for disc herniation. This also explains how low load traumas such as bending over to pick a pencil, tying one’s shoes or even sitting for long periods of time can all contribute to trauma and pain.

The form that poor movement takes over the span of many years is a spine which remains excessively compressed and begins developing degenerative disc disease. This disease—which describes the excessive wearing away of our discs over time—is often the result of prolonged stresses caused by many of the factors above.

A recent example of this—and the way I feel a trainer should address back pain—came in the form of a client I have been working with on and off for years. She has been experiencing back pain and symptoms which she describes as a “stirrup wrapping around her hip” for about a year.

She has done spinal decompression, massage therapy, etc with little last relief. She finally requested an MRI from her doctor and the results were telling.

  • Anterior hernation L3, L4, L5

  • Degenerative disc pathology as related to an MRI from 2014

I could just as well argue that most the population walk around with herniations but what is most interesting about her results came in watching her move.

Observing Mary’s Cat-camel, what we ideally hope for is an equally “wave” of flexion and extension distributed amongst her thoracic and lumbar spine. By contrast, it was easy to observe a “stress riser” or spot where excessive movement is occuring around the herniation sites.

The other significant thing here is the lack of movement in her thoracic spine. This is big deal because any time one area is doing excessive work (the area which herniated) it is more likely to be injured.

So what can I, as a trainer, do to improve this in her program?

1. Re-train the wave!

Our goal in terms of minimizing spinal stress is re-distributing load evenly over Mary’s entire spine. With that said, we are utilizing two blocked cat-camel drills that focus on moving from this area while blocking the lumbar spine.

2. Disassociate affected segments

Mary’s herniation’s likely indicate that three segments are all working together as a group versus moving independently of one another. Another drill we are using for her is “hinge point” training to encourage each segment to articulate on it’s own.

3. Relate to standing/postural positions

After doing both things on the ground, we will first re-test her Cat-camel for more symmetry and then perform a standing variation to relate this more to daily life positions. This move in particular becomes Mary’ “go-to” reset during the day after sitting for long periods of time.

#exercise #mobility #rehab #recovery #back #pain


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