As much as I make it seem like everyone is hunched over like Quasimodo, not everyone is in flexion based back pain.
The opposite affliction is extension based pain. Extended posture is simply defined as an increased arch in the back and often includes anterior pelvic tilt.
Extension intolerance is usually seen in populations that are on their feet for most of the day. This list includes athletes, teachers, speakers, and personal trainers.
Pay attention to that last one, people who exercise a lot and spend minimal time sitting are also at risk.
The world’s worst or best personal trainers have knowledge of exercise and still fall victim to this.
Athletes and lifters are constantly being told chest up which creates a lordosis in the spine.
Years of doing this with weak abs can cause unfavorable changes.
It is important to recognize because having a huge arch in the back can be just as injurious as flexing the spine over.
Instead of causing damage to the disks, more common extension based injuries occur in the joints of the vertebrae.
Facet joint injuries, spondylolisthesis, and stenosis are some of the injuries that can occur with prolonged extension.
There is not a ton of pressure put on the disks in this case. When we make a exaggerated arch in the back, the bones are still in line but the stress has increased.
It is easy to see why a lot of these populations fall victim to this ailment. A normal neutral spine at rest is considered to be extended. Any increase in the curve of the back is then considered hyperextension.
A lot of these populations:
1. Hang out in that poor posture,
2. Have no anterior core control to speak of
More on this in a minute.
To test for extension intolerance
Start on the floor, face down, and prop yourself up on your elbows/hands. If this position hurts more than at rest we can move on. If it feels better we are probably talking flexion based pain.
Next, roll to the back and make a neutral, normal curved spine. Now flatten it into the ground. If that make things feel better, then we are talking extension.
Working to alleviate it
When I say anterior core control it is a technical way to say that the rectus abdominis (6 pack muscle) does not do a good job to resist extension.
If you put on hand on the bottom of your rib cage and one on your pelvis, your hands should be in line. When you make an arch in the back the hands are no longer in line and the core is no longer engaged.
To reverse that pattern “pull your rib cage down” back in line and hold it while still being able to breathe. This is a properly braced position.
If this position is mastered at rest then there will be a lot less problems with the back. When we lose this braced position we are letting our spine go wherever we want.
Getting in good everyday alignment will reduce the symptoms of extension based pain.
Exercises for an extension bias
The important part here is to make a neutral spine and maintain it through the lift. The curve of the low back should not be changing. Resisting an even more extended pattern is the point of this exercise and it needs to be done slow and controlled. Going through it quickly will defeat the purpose.
Chops can be done in the various standing or kneeling positions. The high to low chop features a pattern that does not increase the arch in the back. Training the core in good alignment is the name of the game here.
3. Lateral Lunges
Lateral lunges have a ton of benefits for different populations. I like them for athletes that spend all of their time going forwards and backwards since this is a side to side exercise. I have had success with hockey goalies and it because it promotes external rotation of hip which they are usually missing dramatically.
From a back pain standpoint it will reduce loading, promote posterior pelvis tilt, and increase hip mobility. The main thing is to hinge at the hips and not crank into a huge extension pattern with this. The chest will come forward a little bit which is ok.
4. Low Row
This version of the row is important because it has a flexion bias. With no control the spine would flex over. This means that we will not reinforce an extension pattern here and still be able to train the back musculature.
5. Stir the Pot
Stirring the pot needs a bit of attention because it is anti-extension in design. This means it is easy to reinforce bad habits. People with extension pain should make sure that their back is flat during the movement to ensure that they are getting their time’s worth.
Start incorporating these exercises into the normal routine and avoid movements that require a huge arching sequence.
Your back will feel better and your performance will benefit from it.