Lower Back Pain

Low Back Pain. Over 90% of humans will have it some day. We may eat Paleo but have not gotten away from the curse of walking upright. The pain can either be a minor soreness or the sign of something worse to come. Crossfitters often have some kind of tweak or soreness and the back is a very common site for a lot of things to go wrong if we are not careful.

What can cause Low Back Pain. DT. Kidding but it can be an issue. The workout DT has dead lifts, hang power cleans, and push jerks. For anyone with LBP, DT can place a severe strain on the lumbar spine if you are not careful. The start of the deadlift position for people with LBP will provide flashbacks to tweaks or aches in their past. As with any injury and as with DT, you don’t want to push through pain and listen to your body. As I tell people there is the pain of wind being sucked from your body which is OK and part of this whole phenomenon that we love so much. But then there is the pain of muscle, bone or nerve which we have to respect.

The most common cause of Low Back Pain (LBP) is muscular in nature. There are a multitude of muscles in the lumbar spine and glutes that can be strained or have small tears in them after pulling or pushing. This can set off spasms, pain, tightness and stiffness. If it stays directly in the low back then the nerves are probably not involved.

If you start having radiation of the pain in to the thigh, calves or toes, with weakness or numbness then the nerve may be getting irritated from a disc bulging out and chemically irritating the nerve or putting mechanical pressure on it. If this is a chronic situation and there is stiffness in the morning that loosens up as the day progresses, then arthritis can be called into question. Other reasons for LBP include stress fracture, infection, tumor all rare.

Typically LBP acutely will get better on its own and most cases will disappear within 1 week to 4 weeks.  Professionals are there to help including physical therapists, chiropractors, and massage therapists. Initially there is usually no need to image things. If things don’t get better the there are xrays, MRIs to look for nerve or disc involvement, but often times that can be picked up with a good physical exam. Initial treatment is aimed at decreasing pain and preventing stiffness from immobility. As pain subsides being patient and not doing Fran on the third day of treatment is a good idea. Surgery is reserved for severe neurologic compromise or unrelenting pain with a disc herniation.

Prevention is aimed at keeping muscles around lumbar spine and pelvis flexible and strong. Stretching of the hamstrings, abductors and rotators of the hips are very important. Abdominal strength is also very important to act as a rigid anterior or front structure and take the pressure of the posterior structures in the low back, muscles, joints, and discs.

16 Comments

    • Thank you I hope it helps you. Sean

  1. I appreciate the article and especially the diagram, but you didn’t seem to address what, for my wife and I, is the most common problem. We’re 60+ Crossfitters and often have lower back pain that is diffuse and does not seem to come from disk problems. We get bouts of it periodically and it can start anywhere. I’ll often just wake up with it. Traveling is the worst because you sleep in strange beds and hotel rooms almost never have a comfortable chair with lumbar support. It seems to be a muscle problem in the lower back. The best relief seems to come from just getting it relax by laying on the floor with knees up, like sitting in a chair, but flat on your back.

    I’d love to know where this comes from and what muscles are to blame.

  2. Bob, Your pain sounds like wear and tear type arthritic symptoms. Arthritis pain and muscle pain can be very similar. Best thing for this is keeping your paraspinal muscles strong and your abdominals solid as well. The way to diagnose it would be to get an xray of your low back and see somebody. Good luck , Sean

    • Thanks. I notice Crossfit does NOT seem to aggravate it, which is perhaps counter-intuituve.

  3. Hi Dr. Rockett,

    I am a fellow crossfitter at CFNE (been going there for about two years and have yet to meet you) but I have a (muscular?) pain in my right lower back that has been there for months. I took time off and returned to CFNE and the pain did not cease. It was probably when I thought it was a good idea to deadlift 300 pounds but who knows! I have tried acupuncture (which helped for about one hour), spoke briefly to a chiropractor, and was offered some other insights from some other fellow crossfitters, but at this point I would just like a diagnosis! I am wondering if I should go ask my former PT or keep my appointment that I made with you for the 31 of this month. I am convinced it is some sort of muscular tear/strain and I am not sure how that can be diagnosed via an X-ray. Any words of wisdom would be much appreciated! Thank you.

    Best,

    Mary C. Abraham

  4. An exam can usually tell what is going on. We will get xrays to confirm.

  5. In the past 6 weeks i have started having gruelling pain in my lower back, it gets worse as the day progresses, at
    times the pain spreads to my groins, outer legs and feet,
    my feet then gets terribly cold, also while i am moving
    around its not so bad, but once i just stand like when i am making dinner the pain becomes debilitating, the only way i get relieve then is if i sit down or lie down, if i
    go to bed with the pain its gone in the morning but as soon as i become active it starts, i currently use Voltaren
    gel but it has very little effect.
    Please advise what the problem could be ia am a 50 year old female.

    Thanks
    Helen Bisset.

    • Helen, you may have something called spinal stenosis or a disc herniation. You should see someone for this starting with your PCP. Good luck, Sean

  6. Good article, I have had lower back pain with occasional pains through my glute, hamstring and calve for about 6 weeks now, I have seen a physio and it did get a bit better, some days it feels better than others. It does seem to loosen up as the day or my training session goes on, but is painful/ uncomfortable in the bottom of a squat or and kind of lifting from the floor! It’s becoming very frustrating now as it doesn’t seem to be getting any better.

  7. Dear Dr. Rockett,

    I just want to thank you. Many in both of our professions do not support and some will not even treat a patient if they are a crossfitter. As a crossfitter for over a year I have seen the major benefits of crossfit physically and mentally as I am sure you have as well as members at your box. When you are confronted by naysayer colleagues , what do you reply?

    I just found your site and will be directing my trainer’s to it to turn people to for quality, accurate and easy to understand advice. Thanks

    • Thank you for your kind words. When colleagues usually talk to me about it they don’t understand that it is usually the coaches who are trying to slow people down and that the people themselves are pushing heavier. I have been giving a lecture to different boxes about injury prevention and most people say the same thing.

  8. Hi Dr. Rocket! Do you know of other docs like yourself in the LA area that understand CFitters? I’m having pretty moderate to severe back pain and am going on week 4 without any improvement. Would love to see a Doc that understands CF because it would be so much easier to speak the same language so to speak.

    • Hi Alexis, sorry I don’t

  9. This is interesting to me. I’ve been having low back pain in a localized area on the left side of my lower back for almost 2 1/2 months now. I’ve gone to PT, chiropractor, and it’s slowly getting better….very slowly, but I still feel it (squatting is what triggers it most, the compression is painful). Would an issue this long warrant an MRI?

  10. Hi dan if the pain is getting better that is usually the best sign, because an MRI is usually to see if surgery is indicated and to help a surgeon plan their approach, but if it is better then you usually don’t need to operate. Does that make sense.

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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