Flexion based back pain is a very common occurrence.
With the nature of our lifestyle now, we sit more than ever and are less active.
So much time gets spent sitting because of work, driving, and technology that this is a real concern.
Flexion based back pain is a result of the spine staying in a flexed position for too long. A toe touch or crunch is trunk flexion because the torso is curling up.
When we sit, bend over, tie our shoes, etc. the spine goes into flexion.
The spine is not designed for a lot of flexion and only gets so many cycles before it wears out.
This is similar to taking a pipe cleaner and bending it back and forth until it becomes weak and snaps in half.
Your spine will not snap in half but it will wear down in the form of back pain, disk bulges or herniations, or other spine conditions like stenosis.
This is an issue because it mostly affects younger people ages 25-40 or so. The younger we are, the more fluid that is in the vertebral disks.
When there is more fluid they are more susceptible to pressure and can become injured much more easily than older people who have lost that fluid.
There are a lot of people who are using up all of their cycles before they even turn 30 and that gives them a lot of time to deal with these symptoms.
Determining if you have Flexion Intolerance
People with flexion based pain are in pain performing a toe touch. The back pain appears or gets worse in this position.
The same condition can also be painful when sitting for long periods of time. People that cannot sit for more than 20 minutes but find relief when standing or walking have a flexion bias.
Symptoms will also disappear when posture is corrected. Maintaining a netural spine with the shoulders in the right alignment will relieve some of the pain.
Training with Flexion Based Pain
Flexion based pain is not a death sentence. I would say that the majority of my adult clients came to me with this very issue.
If a client is physically limited, feels burning pain, or any numbness/tingling is present it is probably time to see a doctor and not train.
A lot of times it does not take a diagnosis, I just find out which movements are painful and avoid them.
Exercises that should be avoided by those in a flexion bias include situps, crunches, back squats/deadlifts (temporarily), bent over rows, and push presses.
Anything that loads the spine heavily or is going to force the back into rounding needs to be avoided.
They are going to make the pain worse and cannot return until the person is training pain free.
There are some exercises that will provide the ability to train without subjecting the back to danger.
This can be pull-ups, pulldowns, etc. but these exercises pull the spine into extension.
Getting out of the bad posture is step one and these exercises are good for maintaining a neutral spine.
Remember not bend at the waste in order to get more reps in.
These exercises also train the lats for strength. The lats attach to the fascia of the low back and play a role in stabilizing the lumbo-pelvic region.
Good lat development will help with stability and extension, both of which are needed to get out of pain.
Glute Bridges/Hip Thrusts
Bridges/ hip thrusts are the best pure glute exercises out there.
Strong glutes have been associated with less back pain.
The reason these exercises are so good is that they take the loading out of the back. With the weight on the hips, the spine does not receive the load to develop strength.
Be sure to drive the movement with the glutes and not the low back/hamstring. Feeling it anywhere but the glutes is a sign of improper technique.
OH Single Leg Anything
Getting overhead is going to put the spine in a more extended position.
Performing single leg work is also going to reduce loading on the spine dramatically.
You cannot do tons of weight which means that stress on the back is reduced, you can activate the core muscles in good alignment, and you can still train the glutes/ other hip stabilizers.
Try overhead lunges or step ups to get your lower body training in while protecting the back.
Lifts can be done with a cable, band, med ball, or kettlbell.
The key is to not move the torso at all. The core needs to stabilize to make the movement effective.
You can start on one or both knees, hold the med ball at one hip, and bring it across your body to above the opposite shoulder.
This will promote extension, core activation, and minimal loading.
Resisting movement in the torso makes this exercise a real challenge.
SA Goblet Squat
Back squats may compress the disks further so they are not recommended for flexion intolerance.
Luckily, goblet squats do not incorporate such compression.
I like going with a single arm, front rack KB position because it activates the lateral core.
Getting the obliques and QL to activate is going to provide stabililty for the spine.
A stable spine is a healthy one and you still get to reinforce the squat pattern with this.
It also takes a degree of extension to avoid dropping the weight on the ground.
Try these exercises out to avoid putting training on hold. Bed rest does not make back pain worse so we need to stay moving.
Walking is a start if the pain is too much to handle. See the right professionals and get back to smart training whenever you can.