There is an epidemic of chronic lower back pain.1 It’s one of the leading causes of “Years Lived with Disability” (YLD), is responsible for over 7 million ER room visits each year, and costs us both time (hard to do much of anything when our lower back is hurting) and money (people with lower back pain end up spending thousands of dollars a year on average to treat it). I can’t think of anything that degrades overall quality of life more than persistent lower back pain.
And as is so often the case, our attempts to treat the condition often make it worse. What does the average person do when their back hurts?
They avoid using their back altogether. They tiptoe around and craft a cocoon of comfort for their lumbar spine. Chairs that recline. Slouching. Leaning on their arms. It’s only natural to avoid the pain, but it is also our undoing. In order to reduce low back pain, we must make our backs stronger by training it.
But that’s not how the average person trains.
They’re doing pushups and bench presses. They’re curling (sometimes in the squat rack). They’re doing leg presses and squats. They want strong chest, biceps, quads, and they have them, but they also have the rounded shoulders of the bench press addict, the “folded in hulk” look. Those are the parts that pop in the mirror. They’re the easiest to monitor and see grow before your eyes. They’re what you see when you flex.
And don’t get me wrong. Those exercises and those muscles are incredibly important for health and performance (and aesthetics). But they neglect perhaps the most vital musculoskeletal complex in the human body: the posterior chain.
Think of your posterior chain muscles as the muscles that hold up your back, starting at your waistline. Posterior chain muscles include:
The butt, including the gluteus minimus, gluteus medius, gluteus maximus
The lower back muscles (erector spinae)
Some sources include the calves or latissimus dorsi (aka lats, or side back muscles) in the posterior chain, but the primary ones are lower back, glutes, and hamstrings.
How Can Posterior Chain Training Reduce Lower Back Pain?
In movement, the posterior chain controls hip extension—the hip hinge we perform to lift heavy objects, jump great distances and heights, make explosive movements like throwing punches or fastballs, and run sprints. When you swing a golf club or baseball bat, most of the power comes from the hip extension performed by the posterior chain.
In everyday life, the posterior chain maintains posture. It’s the foundation upon which the torso rests, moves, and stabilizes. It provides safety and security for smaller upper body movements and power for larger lower body movements.
When we neglect the posterior chain, our lower back suffers. It bears the brunt of the work. Its primary role is to resist motion, to provide stability as the rest of the body moves, to be a lever. But when the hips aren’t moving and the posterior chain isn’t engaged, the lower back must move—for which it is ill suited.
Can’t hinge at the hips to pick up that Lego or move that bag of mulch? You’ll hinge with the lower back. Easy way to tweak it.
Can’t engage your glutes to hold up your torso? Your lower back will cover for them. Easy way to develop an overuse injury.
When you’re working at a laptop or scrolling your phone, hunched over, head jutting forward, your lower back bears the brunt of the weight. It’s not a lot of weight. You may not even feel the pain or strain in your lower back muscles. But it’s a low level chronic stress applied to your lower back that reduces its overall work capacity. So when you go from your desk job to the gym and try to deadlift, your lower back can’t tolerate as much resistance. It’s more likely to fail.
When we sit, the posterior chain is “turned off.” The glutes are inactivated, the hamstrings are slack, and the lower back muscles assume the role of posture stabilizer.
When we’re inactive, the posterior chain atrophies. If you’re not throwing balls, lifting barbells, jumping, sprinting, or heck, dancing and playing, you are not using your posterior chain.
Worse still, lower back pain often dissuades people from training the posterior chain. So many of the most effective posterior chain exercises require the lower back to resist forces acting on it that it scares people — and the medical professionals treating them. The last thing the average doctor will tell his or her patient with low back pain to do is swing a kettlebell or do Romanian deadlifts. This is understandable—you can hurt yourself and make the problem worse — but it’s also unfortunate because proper posterior chain training is one of the best allies we have in the fight against low back pain.
Do involve your doctor, though. You’ll want to rule out any small injuries that could become significant or debilitating injuries before you jump into posterior chain exercises.
Deadlifts for Lower Pack Pain
Wait a minute, Sisson: are you saying that deadlifts can actually improve lower back pain?
In a 2015 study, 39 men and women with chronic low back pain underwent a 16 week free weight training course.2 They did deadlifts, goblet squats, lunges, planks, and step-ups. This was a progressive program, meaning they started with lower weights and added resistance as they progressed in strength. Loads were between 6 and 10-rep max.
After 16 weeks, they were stronger, their pain had dropped by 72%, their disability score had improved by 76%, and their overall quality of life (every 4 weeks they completed a self-assessment) had skyrocketed.
Another study from the same year had similar results.3 Both the deadlifting group and the group who did more traditional back pain exercises saw major improvements in pain and functionality.
The key with the deadlift is it’s very safe and indeed beneficial for the lower back as long as you maintain proper form. In the two studies I mentioned, researchers didn’t just tell the patients to start deadlifting their 6 rep max. They coached proper technique. If a subject couldn’t maintain a flat (neutral) spine, they raised the barbell until they could.
Neutral spine is everything. You’re not bending your lower back to move the weight. It must stay flat.
Hinge at the hips. Lift with your hips (glutes and hamstrings), not your back.
Barbell deadlifts are the gold standard, but they aren’t required. You can do trap bar deadlifts, kettlebell deadlifts, Romanian deadlifts, or sumo deadlifts. What matters is that you hinge at the hips and maintain a neutral spine using proper technique.
It’s important to not max out. In fact, if you’re deadlifting to address back issues, start light. Going for a PR with back pain is not the ticket. Stick to 6-10 rep sets—enough to provide resistance and build strength gradually.
Planks for Lower Back Pain
The plank is about as simple and accessible as it gets. You don’t need any equipment but the ground. You can modify them to be as easy or as hard as you like.
Do ’em on the knees if you can’t manage the toes. Do them on your hands if the elbows are too much.
Get in the pushup position, only put your forearms on the ground instead of your hands. Your elbows should line up directly underneath your shoulders. Toes on the ground.
Squeeze your glutes and tighten your abdominals.
Keep a neutral neck and spine.
Create a straight, strong line from head to toes – a plank, if you will.
Hold that position.
Tips and cues for best results:
Don’t let your hips sag down to the ground. Sagging hips makes the exercise initially easier, but it takes your posterior chain out of it and defeats the purpose of the exercise.
Look down at the ground. This is a good prompt for maintaining a neutral neck and thus spine position.
When your form begins to suffer, pull the plug. You’re only benefiting from the plank by actually doing the plank.
Does it work? In subjects with chronic lower back pain, 8 weeks of planks improved lower back pain and improved low back strength.4
Planks can be done just about every day. They’re a great way to start the morning or break up sedentary time.
Kettlebell Swings for Lower Back Pain
These are not to be taken lightly. Whereas planks and deadlifts are relatively linear and non-dynamic, KB swings take a lot of precision to get right, especially if you have lower back pain. A lot can go wrong with a poorly-done kettlebell swing.
This is a hip hinge and hip extension exercise. All the power should be coming from your glutes and hamstrings with your lower back a stable lever for transferring the force. If you use your arms to “swing” the kettlebell, you’re doing it wrong. Arms should be passive.
Keep the weight on your midfoot/heel. If the weight gets “in front” of you and you start going onto your toes, your lower back will bear the brunt.
At the height of the swing, maintain upright posture and a straight torso. Do not lean back—this takes the emphasis off the hips and places it on the lower back.
When the weight is coming back down, accept it by sticking your butt back and hinging your hips. Don’t “bend over”; get those hips back.
Stick with a weight you can swing for 20-30 reps at a time. You’re not going for any records here. You just want to get the blood flowing and the hips moving. One effective method is to keep a kettlebell in your office and do a minute of swings every hour.
There are other posterior chain exercises you can do to improve lower back pain, but these give the biggest bang for the buck. They should serve as the foundation for your journey back to pain-free life.
Do you have lower back pain? What worked for you? What didn’t work?
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.