These Posture Assessments Can Help Determine What’s Behind Your Back Pain

If you struggle with back pain Dr. Aaron Horschig, DPT, of Squat University, wants to…

These Posture Assessments Can Help Determine What’s Behind Your Back Pain

If you struggle with back pain Dr. Aaron Horschig, DPT, of Squat University, wants to help. He’s already shared three tips to relieve lower back pain. Now, he’s honing in on how posture plays a big role in preventing back pain from plaguing your lifts.

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“Every time you have back pain, there is always a cause. It’s not all in your head, and it doesn’t just appear out of thin air. There’s always a ‘why’ behind pain,” says Dr. Horschig—and by assessing your posture, your ‘why’ can be revealed.

Dr. Horschig has two simple tests to do just that. While we love Horschig’s guidance, we should note that you should not only depend on self-assessments to figure out the problem if you are experiencing back pain. Make sure to check in with your doctor or PT before the pain gets worse.

Assessment 1: The Stool Test

Dr. Horschig has his friend Ed demonstrate the test. The subject sits in a chair, and places his hands on each side. In a neutral position, he grabs onto the sides of the chair and mimics muscle contraction, gauging if he has any pain. From there he goes into an extended posture, pulling up as hard as he can to compress his spine. And finally, he rounds his back, flexing his spine while pulling up as hard as he can.

“What we’re looking for is how does that change his symptoms,” says Dr. Horschig.

Based on where he feels pain, Dr. Horschig will fit his pain into different movement categories:

– Extension with Rotation Intolerance (from the neutral position): This means you need to decrease the amount you’re lifting at that time in order for your back pain to start decreasing over time, says Dr. Horschig.– Extension Intolerance (from extension position): This may indicate a spondy, short for spondylolysis, a fatigue stress fracture of the spine that occurs if the low back is extended repetitively under load. This can lead to spondylolisthesis, an anterior sliding of one spinal vertebrae on another.– Flexion Intolerance (from the flexed position): pain with compression in a flexed position posture. People with this are often dealing with a bulging disk, says Dr. Horschig.

Assessment 2: The Prone Test

Ed gets down on his stomach, where he will lay for a minute or two.

“For some people that have flexion-related back pain, laying on the stomach, which is a slightly extended position, actually feels pretty good. It takes their pain away,” says Dr. Horschig. “If this is you, I recommend laying on your stomach for 2 to 3 minutes a couple times during the day, and intermittently doing some walking. Maybe 10 minutes of walks a couple times a day. This can be very helpful for decreasing your back pain.”

However if you struggle with extension-related back pain, this won’t feel very good.

This test looks at how hip mobility creates (or doesn’t create) back pain in the lower back.

Ed lifts one leg up at a time while still on his stomach.

“If this creates pain, we can say that someone has an extension with rotation intolerance because by lifting the leg up like that, we’re creating an uneven rotational force at the spine in an extended position,” says Dr. Horschig.

By bracing the core while lifting the leg, this can decrease your back pain.

To test this, you need to look at hip extension mobilization.

Using a resistance band placed around your upper thigh as you kneel with one leg forward (the leg without the resistance band), pull forward into hip extension.

“What Ed’s going to do is squeeze his butt, keep his tall posture and brace his core, and just push slightly forward and then back to improve hip extension,” says Dr. Horschig.

Do 15 reps, then reassess how it impacted your back pain. Getting back on your stomach, lift one leg at a time.

“Do you have more hip extension? How does it feel on the spine? If it improved hip extension mobility and took pain away, that shows hip mobility can change your symptoms,” says Dr. Horschig. “A number of people who develop back pain do so not because of a problem at the spine, they do so because of hip mobility asymmetry differences of deficits, and it influences the spine. Over time it creates pain and symptoms at the back.”

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