Classifying Your Low Back Pain For Effective Treatment

This post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

It is estimated that 80% of people will eventually experience lower back pain in their lifetime.

So, unfortunately, if you are someone who trains hard, there is most likely a chance that you have experienced it once in your life. Maybe you are experiencing it right now.

I have had my own issues with extension intolerant back pain to the point where I couldn’t walk for 3 days. 

It was not fun and I’m sure if you are currently dealing with or have dealt with your own lower back pain you would say the same. 

But, there is hope. I know that as a Physical Therapist with a consistent and progressive training program low back pain can be resolved and prevented from ever coming back again. 

The first step in designing this training program is to classify what triggers your lower back pain. 

We can classify low back pain using simple and quick screens to determine if you are sensitive to lumbar flexion, or lumbar extension, or if the load is the cause of your intolerant low back pain.

I have come to learn these quick screens from the work done by Dr. Aaron Horschig from Squat University who has learned them from clinicians before him such as Dr. Stuart McGill. 

Please know that each of these classifications does not mean that you should never perform these movements.

More so it would be a good idea to avoid them in the short term until your nervous system and lower spine can move through the healing process and feel safe moving outside of a neutral position.

As well as until the movement patterns can be retrained and fortified using the best exercises for your specific type of pain in your lumbar spine.

Learn how to classify your lower back pain by reading more below!

The Different Classifications of Lower Back Pain

1) Flexion Intolerant Back Pain

When someone is considered to have a Flexion-Intolerant back, this indicates that spinal flexion or flexing the spine forward such as bending over in a hip hinge to pick something up off the floor will trigger their lower back pain.

You will often see this type of classification with people who have recently suffered a lumbar disc herniation.

Although lumbar disk herniations can happen and be symptom-free, flexion-intolerant pain is a common trigger with this diagnosis. 

A quick screen to see if you have a flexion intolerance involves sitting on a stool or chair, assuming a flexed or “bad” posture, and then using your arms to pull down on the sides of the chair.

A positive test result for this screen would be an increase in your lower back pain and thus reveal it is likely that you are considered Flexion Intolerant. 

2) Extension Intolerant Back Pain

Extension intolerant back pain is the exact opposite of Flexion Intolerance.

This specific category is often seen with people who experience lower back pain laying on their stomachs or with athletes who have repetitive spinal extension in their sport such as throwing objects. 

As well as strength athletes who perform high-volume extension exercises in their training a quick screen for an Extension Intolerance would be a Seated Extension Pull Test or simply lying face down on the floor.

The Seated Extension Pull Test is the same as the Seated Flexion Pull Test but in the opposite direction.

Lower back pain with either of these two tests would suggest an extension intolerance. 

3) Extension With Rotation Intolerance

When trying to classify low back pain we are simply trying to discover spinal movements that trigger pain.

The lower spine will flex and extend but also rotate.

The Prone Hip Extension Test adds rotation to see if this triggers pain. 

The test begins with laying flat on the ground and then lifting one leg off of the floor.

If this causes lower back pain, add a pillow under your hips and repeat the movement.

If your lower back pain changed at all, this would indicate that your lower back hurts as a result of a rotation intolerance when the lumbar spine is in an extension position extension.

This specific category is seen in people who have pain with running or certain Olympic lifts.

4) Load Intolerance

The final classification is as the name implies, for people who experience lower back pain when some sort of load is applied to the spine in a neutral position.

This can be through ground reaction forces or compression of the lumbar spine by the core and back muscles from bracing to lift an object.

The two tests to classify this intolerance are the Heel Drop Test and The Weighted Front Raise Test. 

The Heel Drop Test is performed by simply raising onto your toes and then quickly dropping to your heels.

If this caused lower back pain repeat the test but with your core muscles braced.

If pain is not triggered, improper bracing could be the cause of your lower back pain.

If pain was still triggered, this could indicate dynamic load intolerance and a potentially more serious issue occurring at the spine such as an End Plate fracture. 

The Weighted Front Raise Test is another test to test for load intolerance from the compressive load.

Simply stand in a neutral spine posture with a weight held in front and perform a front raise.

If pain was triggered as a result of your core muscles bracing, a compressive load intolerance would be indicated. 

These classifications are a great way to begin to better understand your lower back pain.

Once you can identify what causes your pain you can then design a training program using simple exercises to start and ten following intelligent exercise progressions that can alleviate your symptoms and prevent low back injuries from returning.

It should be stated though that these tests serve as a quick screen and a more thorough evaluation should occur to evaluate your pain by a health professional. 

Treatment Options Based On Low Back Pain Classification

Once you’ve classified your low back pain triggers, effective treatment often involves corrective exercises tailored to address the source of pain.

These approaches mirror the exact methods employed in my 1:1 Pain-Free Performance Program, where clients achieve pain relief without sacrificing valuable gym time or transforming workouts into lengthy rehab sessions. 

Examining your pain triggers allows for a targeted exercise progression designed to alleviate discomfort and enhance your performance, focusing on addressing specific findings from your assessment.

Fixing Extension Intolerant Back Pain

Addressing extension-intolerant back pain involves targeted strategies to alleviate discomfort and improve movement patterns.

For individuals experiencing pain due to spinal stenosis or extension-based issues, exercises emphasizing motor control and gradual progression play a pivotal role. 

These methods aim to improve stability and flexibility, reducing pain triggers associated with extension movements.

Tailored exercises such as dead bugs, Posterior pelvic tilts, and other exercises for the abdominal muscles that improve anterior core control.

These exercises can assist in enhancing core strength and promoting a neutral spine posture, contributing to improved function and reduced discomfort in extension-intolerant back pain.

Fixing Flexion Intolerant Back Pain

Dealing with flexion-intolerant back pain, particularly concerning intervertebral disc issues like disc herniations, requires a targeted approach.

Opting for exercises and progressions aligned with the McKenzie Method and emphasizing extension-based exercises become crucial.

When managing flexion-intolerant pain, it’s essential to avoid exercises that involve spinal flexion initially. 

Instead, focusing on exercises that promote extension without exacerbating pain is key.

Adopting modified exercises like specific bird dog variations, or incorporating extension-focused routines can aid in strengthening the back muscles while avoiding further stress on the discs, contributing to improved pain management and functional movement over time.

Fixing Extension With Rotation Intolerance Back Pain

Addressing back pain associated with extension and rotation intolerance, especially related to facet joint syndrome, involves targeted rehabilitation approaches.

Facet joint pain due to the specific nature of extension and rotation triggers necessitates exercises promoting spinal stability and mobility throughout the rotation.

Opting for exercises emphasizing core stability while enhancing spine rotation mobility becomes crucial.

Incorporating exercises such as modified planks with rotation, side plank variations, or even gentle yoga poses like the cat-cow or open books can aid in strengthening the core muscles and improving spinal mobility. 

As well as hip flexor and quadratus lumborum flexibility soft tissue work with devices like the Theragun Pro or the Hypervolt Massage Gun and strengthening exercises to decrease any imbalances causing rotations during movements like running.

These targeted exercises help in managing extension and rotation pain to reduce discomfort and improve functionality over time.

Fixing Load Intolerance Back Pain

Addressing back pain associated with load intolerance requires a nuanced approach focusing on proper bracing techniques and controlled movement.

It’s essential to seek medical advice if there’s suspicion of an end plate fracture, particularly with persistent or severe pain.

For managing load intolerance without suspected fractures, prioritizing proper bracing techniques under heavy loads becomes pivotal. 

Engaging the core muscles effectively through bracing, utilizing the “internal belt” created by the deep abdominal muscles, provides stability and support to the spine.

Incorporating motor control-focused exercises that emphasize controlled movements, such as modified deadlifts or squats with guided breathing and gradual weight increments, can aid in improving bracing ability under load. 

Additionally, utilizing the Valsalva maneuver, in the absence of chronic high blood pressure, can assist in creating intra-abdominal pressure, enhancing spinal support during heavy lifting without compromising safety.

Common Causes of Lower Back Pain

Poor Posture and Body Mechanics

If you spend long hours sitting at a desk or engaging in activities that require bending or lifting, you may be unknowingly putting your lower back at risk. 

Sitting for extended periods, especially with poor posture, can put significant strain on your lumbar spine. 

When you slouch or fail to support your lower back properly, the muscles and ligaments around your spine are forced to compensate for this misalignment. 

This can lead to chronic discomfort, stiffness, and even more serious back problems. 

Similarly, improper lifting techniques—such as bending from the waist instead of hinging at the hips—can increase the risk of spraining muscles and damaging discs in your spine.

Muscle Imbalances

Another major factor contributing to lower back pain is muscle imbalances. 

Tight hip flexors, weak glutes, and core instability can all put added stress on your lower back. 

The muscles around your pelvis, hips, and core need to work together to support your spine. 

When one area is too tight or too weak, your body compensates, which can misalign the spine and cause pain. 

For example, if your hip flexors are tight, they can pull on your pelvis, creating an imbalance in the lower back and leading to discomfort. 

Similarly, weak glutes and a lack of core strength can make it harder to stabilize your spine during movement, increasing the risk of injury.

Injuries and Trauma

Injuries are another common cause of lower back pain. 

Disc herniations, sprains, and strains can occur from an accident, sports injury, or overuse.

Disc herniations happen when the soft inner part of a spinal disc pushes out and compresses nearby nerves, which can lead to intense pain, numbness, or weakness in the lower back and legs. 

Sprains and strains, on the other hand, are often caused by improper lifting or sudden, jerky movements. 

These injuries can cause swelling and inflammation, making it difficult to move without discomfort.

Degenerative Conditions

As you age, your body naturally undergoes changes that can lead to lower back pain. 

Conditions like osteoarthritis, spinal stenosis, and spondylolisthesis are common among older adults. 

Osteoarthritis occurs when the cartilage that cushions the joints in your spine breaks down, causing friction and pain. 

Spinal stenosis is a narrowing of the spinal canal that puts pressure on the nerves, leading to pain and sometimes tingling or numbness. 

Spondylolisthesis refers to a condition where a vertebra slips out of place, which can cause pain and discomfort. 

These conditions often develop gradually and can be exacerbated by poor posture, lack of exercise, or repetitive movements.

Lifestyle Factors

Your lifestyle plays a significant role in the health of your lower back. 

A sedentary lifestyle—sitting for long hours, not exercising regularly, and carrying extra weight—can lead to weakened muscles, poor posture, and, ultimately, back pain. 

Lack of physical activity decreases the strength and flexibility of your muscles, leaving them less able to support your spine. 

Excess weight, especially around the abdomen, can put additional strain on your lower back, making it more vulnerable to injury. 

If you find yourself inactive for long periods, it’s essential to make time for movement and exercises that strengthen your core and lower back muscles.

The Importance of Lumbar Mobility & Stability

Your lumbar spine, the lower portion of your back, is crucial for both mobility and stability. 

These two factors work together to protect your spine and prevent injury, especially during physical activity. 

When either one is compromised, you’re at a much higher risk of pain and discomfort. 

Understanding how mobility and stability play their respective roles in the health of your lower back can help you make better decisions when it comes to preventing and managing lower back pain.

Lumbar Mobility

Proper lumbar mobility is essential for maintaining a healthy spine. Your lower back needs to move freely in multiple directions to perform everyday tasks and engage in exercise safely. 

Limited mobility in your lumbar spine can result in compensatory movements, where other parts of your body try to make up for the lack of motion. 

This can put stress on your joints and muscles, leading to pain. 

For example, if your lower back is stiff and doesn’t bend properly your hips or knees may take on more of the load during movements like bending or lifting, increasing the risk of injury in those areas. 

Stretching and mobility exercises that target the lumbar spine can help restore its range of motion, which can reduce the strain on your back and help alleviate pain.

Lumbar Stability

While mobility allows your spine to move freely, stability is what keeps your spine protected during those movements. 

The muscles in your core, including the deep stabilizers like the transverse abdominis, play a critical role in maintaining lumbar stability. 

These muscles help support the spine, keeping it in a neutral position and preventing excessive movement that can cause strain. 

Without proper stability, your lower back is more vulnerable to injury, especially when lifting or performing dynamic movements in CrossFit or other physical activities. 

A lack of stability can cause your spine to move out of alignment, leading to muscle strain, disc injury, or even nerve compression. 

Strengthening your core and spinal stabilizers is key to maintaining good lumbar stability and reducing the risk of back pain.

The Balance Between Mobility and Stability

For your lower back to function optimally, both mobility and stability must be in balance. 

If you have great mobility but poor stability, you may be able to move freely, but the lack of support could lead to injury. 

On the flip side, having strong stability but poor mobility can cause stiffness and discomfort, as your spine won’t be able to move as it should. 

Achieving the right balance between the two is essential for preventing back pain and improving your overall function. 

Regularly working on both mobility and stability exercises can help ensure that your lower back is healthy and well-protected.

Practical Tips for Improving Both

Improving lumbar mobility and stability doesn’t have to be difficult. Start by incorporating simple exercises that target these areas into your daily routine. 

To improve mobility, focus on stretches and exercises that open up your hips and lower back, such as hip flexor stretches, cat-cow stretches, and the lumbar rotation stretch. 

These movements will help restore the range of motion in your lumbar spine and reduce stiffness.

To enhance stability, prioritize core activation exercises like planks, bird dogs, and dead bugs. 

These exercises engage the muscles around your spine and help build the support needed to maintain proper alignment. 

Make sure to perform these exercises regularly, as building both mobility and stability takes time and consistency. 

Additionally, when incorporating these exercises into your workouts, be mindful of your body mechanics and posture, ensuring that you move with control and alignment. 

By addressing both mobility and stability, you’ll be able to better protect your lower back and reduce the risk of pain or injury.

FAQ Section

1. Can lower back pain go away on its own without treatment?

In some cases, mild lower back pain may resolve on its own, especially if it’s due to temporary muscle strain or overuse. 

The body has a remarkable ability to heal itself with proper rest and self-care. 

However, it’s important to address the underlying causes of the pain for long-term relief. 

Without identifying and correcting factors like poor posture, muscle imbalances, or movement patterns, the pain can easily return or worsen. 

Even if the pain subsides on its own, working on strengthening and stabilizing your back through targeted exercises can help prevent future flare-ups.

2. How do I know if my lower back pain is serious and requires medical attention?

While most lower back pain is not caused by a serious medical issue, some signs indicate when you should seek medical attention. 

If you experience severe pain that doesn’t improve with rest or over-the-counter pain relief, or if the pain is accompanied by numbness, tingling, or weakness in your legs, it’s important to consult a healthcare professional. 

Additionally, if you have difficulty controlling your bladder or bowels, experience fever, or notice unexplained weight loss along with your back pain, these could be signs of a more serious condition, such as a herniated disc, infection, or nerve compression. 

In these cases, seeking medical advice promptly is crucial.

3. Can I continue exercising with lower back pain?

You don’t necessarily have to stop exercising completely when you have lower back pain, but it’s important to approach physical activity with caution. 

Some exercises may exacerbate the pain, especially those that involve bending, twisting, or lifting heavy loads. 

It’s essential to modify your workouts to avoid movements that exacerbate your lower back pain. 

If you’re unsure about which exercises are safe, consider seeking guidance from a physical therapist or healthcare provider to ensure you’re not doing more harm than good. 

Rest is important, but keeping your body moving is also key to recovery.

My Experience With Fixing My Low Back Pain

​I have had my fair share of lower back pain that has gotten in the way of my training.

After a tough cycle of Olympic Lifting, I walked into the gym and set two new personal records.

A new Snatch and Back Squat PR then the stars just happened to align and when I bent over to pick a weight up I felt something shift in my lower back.

The rest was history. 

The next 3 days I could not even stand on my own two feet let alone get back into the gym to train.

Once I could stand I knew something had to change in how I trained.

Over the next 6 months, I used the same strategies that I mentioned above in this article to assess my movement, identify the source of my pain, design a corrective exercise program based on what I needed specifically, and return to the exercises that were once painful to perform. 

​Today I am back to training hard and setting new PR’s.

This is why I created my 1:1 Pain-Free Performance Program where I help functional fitness athletes eliminate pain while they train without having to miss time in the gym or turn their workouts into rehab sessions. 

If you feel like you just can’t train the way you used to and are fed up with dealing with lower back pain I would love to chat to see how I can help.

Simply click here to schedule a risk-free consultation.

I look forward to chatting with you!

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